ACL Injury Part 2: Surgery & Post-Op Rehabilitation
If you missed part one, click here to read about Joel’s ACL injury, confirming the ACL tear, and early prehab before surgery.
In Part 2 of our Knee ACL Injury and Rehab series, we follow Joel through surgery and his first week of rehabilitation post-op. Take it away Joel…
Before going in for my hamstring graft ACL reconstruction I followed the prehab exercises, reduced the swelling down as much as I could, and got my range of motion (ROM) as close to full as was possible. I was ready to roll for surgery!
I’ll fast forward through all the paper work and formalities and cut straight to being in the operating theatre. I slid onto the bed, closed my eyes for what felt like a nanosecond and voila! It was all done. I slowly started to come to, but would drift in and out of consciousness due to the anaesthetic.
In my drug induced state, I remember being asked about my knee pain, which at that point was actually quite sore. No sharp pain but a deep throbbing sensation. “Six out of ten” I mumbled to the nurses, then drifted back off to sleep. Once I was awake the surgeon made a visit. He looked at the knee, admired his handy work, checked the X-ray, and boasted “Ah yes, another perfect reconstruction”. Let’s hope so I thought to myself!
With the tick of approval from the surgeon, it was time to get some fluids in me and wait for the physio to arrive to check on me and assess my walking with crutches. It was time to move. With the physio by my side I started making my way to the chair for discharge using the crutches. Surprisingly my leg actually felt alright. Pfft this is gonna be a piece of cake I thought!
Oh how naïve I was…
I went to the bathroom to empty the tank and as I bent down to lift up the toilet lid, BAM! A sharp pain shot up the back of my leg and I thought I was about to pass out. It was my hamstring. It felt extremely tight with sharp pain on certain movements, weight bearing or even just sitting. Since the graft for my new ACL was sourced from the hamstring (specifically semitendinosis and gracilis), the pain made sense. Bring on the Endone!
But painkillers were just the start. To give you a complete overview, my postop meds and instructions were as follows:
- Paracetamol for pain relief (as needed)
- Endone for stronger pain relief to be taken initially and then only if needed (It was definitely needed)
- Anti-inflammatories to help reduce swelling in the knee post op (10 day’s worth)
- Anti-nausea to combat any symptoms from the anaesthetic (as needed)
My acute plan for the first week:
- Weight bare as tolerated
- RICE: Rest, ice, compression, elevation
- Heel slides – Improve knee flexion range
- Heel digs – Activate hamstrings
- Co-contractions – Activate quads (specifically VMO – that’s the medial part of your quad if you had forgotten)
- Ankle pumps – Fluid circulation
Perform 10-15 reps of each, every 1-2 hours, followed by 20mins of ice for swelling and pain relief.
So here we go… let the yearlong rehab journey begin!
POST OP REHABILITATION:
My first week
With all the anaesthetic still in my system the first couple of days I actually had very limited pain. So I decided to see how much weight I could put on it. I’d take a step, and then another, and another after that.
Walking! On day one!
Here’s me thinking that I’m absolutely killing it, already on my feet, and only fresh out of surgery. If only I knew how the next day would go, I wouldn’t be so ecstatic.
Day 4 was my rude awakening. Talk about one step forward two steps back. It was just as my physio Andrew had said it would go. “Day 4 post ACL surgery is always a tough day for 90% of patients,” he had warned me. Why? The stronger drugs are wearing off so you’re in more pain; more stiffness due to being in bed and sitting down for most of the day; and swelling increasing because you are starting to weight bear more and more. All of that is in addition to the fact that your knee has just undergone a major operation! Did you forget? I sure didn’t.
Thankfully the remainder of that first week got easier with each day. The most significant thing I noticed over that time was the muscular atrophy which occurred due to swelling. No matter how many contractions I did each day, my quad was noticeably shrinking and weakening in front of my very eyes. However, this is absolutely normal and to be expected.
The key goals in this early stage of recovery is to get the swelling down and achieve full knee ROM. The real strength gains will come later; approximately 6 months later in most cases. I have to keep reminding myself of this daily: rehab takes time; stay patient, stay active, and you’ll be rewarded in the long-run.
Joel has 7 years combined study and has gained experience and developed skills across a broad range of areas including sports, orthopedic rehabilitation, neurological rehabilitation, geriatrics, pediatrics and cardiopulmonary. Joel uses a combination of exercise therapy, manual techniques and evidence-based practice to help his clients return to optimal health and to prevent further injuries.
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