Weeks 2-6: ACLR Rehabilitation
During this period of my recovery, I was amazed at the small, yet consistent gains I achieved. On day 9 following my ACLR surgery, I appeared at SMI-LA for my first session of PT. The first session was defined by assisted flexion, quad sets, terminal knee extensions, and various manual techniques. I felt a major sense of accomplishment upon finishing my first 4 strait leg raises. The execution seems easy, (contract your quad, and lift the whole leg off the table without a lag, and hold for 10 seconds). But when you have had 33% of your patella and bone plugs extracted, the early strait leg raise is daunting. Nonetheless, battling to maintain strait leg raises, without a lag in the lower leg, becomes the cornerstone of the first 4 weeks.
Weeks 2-6 of the ACL-R is characterized by meeting and exceeding your knee flexion goals. My week 4 goal was set for 130. Additional focus is placed on restoration of quad strength, restoring knee extension angle based on the contralateral leg, and beginning a progressive resistance exercise (PRE) program that targets all of the lower body and core musculature. These include supine heal digs on stability ball, heal raises, leg press, clams, standing knee extension holds, among others. I am fortunate to have an excellent PT, Chris Graham, who not only pushes me in my program, but performs the manual work of friction massage, joint mobilizations, and increasing my joint ROM. The final milestone that I needed to achieve in the initial four weeks was progressing from 2 crutches, to 1, and then finally walking unassisted. The emphasis on restoration of correct gait mechanics cannot be over stressed. If your gait is impaired, there is an increased risk of having problems down your kinetic chain. Components of proper gait includes striking the right heal with terminal knee extension and quad contraction, shifting to the planted right side using glute strength, maintaining level hips, and establishing equal timing on each side.
My home program continues every day, and includes consistent quad sets, assisted fexion, Continuous Passive Motion machine, and weight bearing walks. The usage of the CPM starts to diminish, and by the CPM end day (day 21), I was achieving 120 flexion. Icing is a huge part of the recovery. A unnerving scenario arises if you do not stay ahead of the swelling. The knee joint will become so filled with hydrostatic pressure that it prevents full knee extension and basically shuts off any effective quad contraction. So, in addition to 2-3 hours of rehabilitation program per day, icing is always vital.