Restoring full range of motion, regaining quadriceps contraction and decreasing swelling should be the primary goals after ACL surgery to properly set the foundation for the rest of rehab. As a physical therapist that specializes in ACL rehabilitation, I see patients from all different phases of recovery after ACL surgery. Every therapist has different biases when it comes to treatment, at the end of the day, there is no one singular correct way of rehabbing. However, there is definitely a wrong way of doing ACL rehab.
When I meet a patient for the first time to perform an evaluation, I always make sure to ask questions about their previous physical therapy experience as well as perform some tests and measurements. One of the key things I look for is symmetry in range of motion. If I find differences after measuring their range of motion, which majority of time is knee extension (straightening), I’ll often ask why they stopped working on range of motion. More often than not, the answer is, “my physical therapist told me it was good enough.”
I’m always extremely frustrated because they were given poor medical advice. While there are certainly rare exceptions, one of my primary goals and non-negotiables in the early phases of ACL rehab is full range of motion. Knee extension is often mismanaged and patients are told they have full extension when their knee reaches 0 degrees.However, many people do have slight hyperextension which is normal and should be symmetrical on both sides.
Failing to restore full knee extension can alter the mechanics of the knee. As ACL rehab progresses, the patient will begin performing higher level tasks such as running and jumping which can lead to knee irritation due to having a poor foundation. Additionally, the quadriceps will have a significantly harder time regaining full strength if full knee extension is never achieved.
While I certainly understand that there are potential complications such as scar tissue that may impede range of motion, being told that range of motion is “good enough” is unacceptable. Full range of motion is a must and should be addressed early and often. The patient needs to understand why it’s important so they regularly work on it at home.
If you have interest in learning more about ACL rehab with me, please visit my website by clicking here
If you are interested in online ACL training with me, please click here