ACL REHAB PART 3: REDUCING SWELL AND IMPROVING RANGE OF MOTION

If you missed Part 1 and Part 2, click the links to catch up.

With my first week was behind me, I was up and moving about. Remember when I said the first key goals are to:

   1. Reduce swelling and

   2. Improve knee range of motion (ROM)?

Welcome to my first major road block.

SWELLING

No matter how many times I used the AirRelax compression device or iced my knee, it was constantly hot, and the swelling would not budge. I also had pitting oedema all the way down my shin. That’s a type of swelling where your skin basically becomes mouldable putty due (see photo below) to poor ability of the body to remove excess fluid.

It didn’t help that less than two weeks post ACL reconstruction I was back at placement for my Masters, on my feet all day walking around Canterbury Hospital 5 days a week. If you didn’t already know more swelling leads to more muscle wasting.

But it’s not all bad news, there were some positive outcomes as well.

Range Of Motion (ROM)

Despite the swelling my ROM was doing okay. I was lucky, and had full knee extension day one post op. Most ACL reconstruction patients are very limited here and can’t get their leg completely straight. To get your correct walking pattern back you NEED that extension, so push it hard until you get it. Achieving full extension back to 0 degrees is basically your goal number one post ACL surgery (along with getting swelling down to a mild manageable level of course).

My flexion on the other hand was very limited. Every time I tried to bend my knee as much as possible it felt like it would explode from the pressure. I struggled to even get a full revolution on the exercise bike!

What was to blame? Mainly swelling, scar tissue, and all that jazz. But don’t be afraid, your knee will not explode! You just have to break down the scar tissue by keeping the leg moving and the range will come. How long will it take? I wish I had a crystal ball to tell you, but it varies. It may take a few weeks; it may take over a month. No two ACL reconstructions will behave the same. So, don’t stress!… If only I knew that at the time…

MY WEEK 2 SCARE:

By two weeks I had enough ROM gains in flexion to get on the stationary bike and do a full revolution. However, it was still very tight, and I tried to push it as much as I could (being impatient as always). On one of my revolutions I felt a sudden very sharp pain in the front of my knee, and I hopped off the bike immediately, too afraid to get back on.

Over that time, I was starting to get random quad spasms making it feel like my knee cap was moving out of place. While sleeping I would get these involuntary strong hamstring contractions which hurt like hell and woke me from my sleep. But the scariest part was that I started getting feelings of instability where my knee would occasionally give way if I stepped a certain way. I was starting to panic. Had I re-torn the graft? Did the pin dislodge when I got that sharp pain on the bike? I thought to myself “dammit Joel what have you done?!”

So, I got an X-ray and went to see the surgeon fearing the worst. The result? All clear! There was no pin dislodgement or loose bodies in the knee and the ACL was very much intact. The x-ray did show some inflammation below my knee cap. Add to this the general swelling around the knee and muscle wasting, which all created decreased support around my knee joint and ultimately led to instability I was feeling.

As someone who is stubborn and sometimes impatient, I had to keep reminding myself that rehab is a long journey. This is something I tell my patients as well, but always focus on the positives. It’s important to stay patient but stay active. Recovery isn’t linear, there will be ups and downs. Remember, every ACL will respond differently. ACLs are just straight up weird, and many milestones will come when they decide to come. Just roll with it!