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ACL Surgery - 3 Month Update!


I have said this before, but the mental challenge of recovery is almost more difficult than the physical. By mid-month two, I started feeling more like a normal human being and less sad about, well, everything. At month three, I ditched my brace completely and am now walking without a limp most of the time. My knee is still quite stiff in the morning, and I have to do my daily PT to warm it up for movement. Getting back on the elliptical machine has been a godsend. I'm close to reaching full knee flexion, and I've been fitted for a functional brace, which I hope to pick up later this week. This new brace is typically used if you're returning to sports (which I'm not), but I will use it for workouts and (hopefully) some hiking with my dogs soon.


MOST IMPORTANTLY, I did my first Pilates Reformer class since March! 👊


Challenges between months two and three:

  • Swelling during month 2 continued to inhibit my ability to reach full extension while walking. My Physical therapist implemented something called the Graston Technique, where he used a metal tool to break up the swelling and scar tissue under my patella. It was a game changer, but I wish he'd done it sooner 🤔

  • The "catching" I was experiencing in the later part of month one into month two was actually my lax quadriceps tendon getting caught between the tibia head and femur head. This is normal, and I don't know why no one mentioned this from the beginning, but my surgeon confirmed this during my three-month post-op visit. This is extremely important to note because though it is prevalent, it can be scary if you don't know that. For a while, I was convinced that it was my meniscus and that I was f*cked. NOPE. As my quad gets stronger, the less it happens, and it should completely resolve in the coming months.

  • What the f*ck is the Popliteus, and why is it important? The Popliteus is a small, thin, flat, triangular-shaped musculotendinous complex of the lower leg with the popliteus muscle and the popliteofibular ligament. It constitutes a part of the posterolateral corner of the knee. It is a deep knee joint muscle forming the popliteus fossa's floor. In Lamen's terms, it's a deep muscle behind the knee. Why is it important? If it's super tight (and yours probably is), you will have difficulty reaching full extension. It wasn't until I got some manual therapy (massage) in the back of the knee and upper calf and started stretching my calf/soleus that I reached full extension while walking. Additionally, when watching TV at night with my legs on my ottoman, I put a 5 lbs weight on my quad to help ease my leg into full extension.

Lessons learned:

  • Using a compression sleeve. I have no idea why this wasn't recommended by my doctor or my PT to control swelling. I took it upon myself to purchase one and start wearing it regularly. It was another game-changer. It contained the swelling beneath my patella and lifted my quad, so there was less "catching." If you don't have one, buy one!

  • Trying other PTs. Some people are of the mind that it's important to see the same person over and over again. Respectfully, I disagree. Good physical therapists come from various backgrounds and training and employ different techniques. While physical exercise and strengthening are important, manual therapy is just as necessary. Some PTs are better at running you through mobility and stability exercises, while others have a real intuition and perception of the connective tissue and muscle that needs to be released with touch/massage. This, more often than not, is not the same person.

  • Advocating. It never ends! It's important to be and continue to be self-educated and involved in your recovery. Google has everything you need to know about the knee structure and then some. This understanding, along with trusting your intuition and listening to your body, keeps you safe and asking critical questions about your recovery instead of constantly assuming everyone else knows better. Trust me. That's not always true. You know your body best. This is NOT me telling you to disregard your PT's instructions, but this IS me giving you permission to challenge them. They just might agree with you!

  • Ice, Ice, Baby! I'm still icing. Yup. If you're still swelling, you're still icing. I'm on my feet a lot and finally getting back into doing my normal commute into the city, which = a lot of walking. I keep the compression sleeve on and ice every night before bed.

Three - four-month milestones and what to expect:


OBJECTIVES

  • Confidence in knee stability

  • Maintain motivation

  • Running

  • Improve aerobic fitness.

METHOD

  • Progress proprioception

  • Agility skills, advanced plyometrics, cutting, hopping figure 8s

  • Increase speed/height of step/height of jump gradually as confidence improves.

GOAL:

  • Safe to introduce open kinetic chain exercises if indicated

  • You should have good hip and knee control and proprioception, and be free of effusion to initiate running.

MILESTONES

  • To be able to hop in a figure of 8 around chairs 3m apart

  • Full knee flexion (130º+) or equivalent to non-affected (not vital – ROM equal to functional needs)

  • Able to perform power-based activities – 3 sets of 10 repetitions squat with weight and correct alignment

  • Perform independent sport-specific exercises.

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