Knee
> ACL
Tear > Treatments
Physical Therapy
Home Recovery
If you and your doctor decide
on a non-surgical treatment to repair your torn ACL
(anterior cruciate ligament), you will most likely need
to do exercises to strengthen the muscles around the
knee. You will need strong hamstring muscles in the
back of your thigh and quadriceps muscles in the front
of your thigh to stabilize your knee so it can support
your weight. Doctors often prescribe physical therapy
instead of surgery for less active people or if an ACL
tear is not complete. You will probably be given a regimen
of exercises that begin at home and continue for up
to six months after the injury. You will likely feel
pain and discomfort for the first few days after the
injury, and your doctor may prescribe medications depending
on the severity of the pain. These will likely be mild,
over-the-counter painkillers such as ibuprofen or acetaminophen.
Elevate your knee when you are not moving around, and
ice it for between 20 and 30 minutes two to three times
a day to reduce pain and swelling. Physicians occasionally
prescribe a CPM (continuous passive motion) machine
for the non-operative treatment of an ACL tear. A CPM,
which attaches to your bed and will move your leg in
a continuous range of motion when turned on, will help
flex and extend the knee and prevent the joint from
becoming stiff due to inactivity. Within a week after
the injury, many people are able to lift their leg without
assistance while lying on their back. You will probably
be encouraged to begin walking and putting some weight
on your knee immediately with the aid of crutches and
possibly a brace; your doctor will let you know what
is best. You may need to use crutches for between two
days and three weeks. Within two weeks, the majority
of patients should be able to walk carefully without
crutches. It is important to avoid activities that put
your knee at risk. Anything in which you might twist
your knee can lead to further injury. With proper physical
therapy, people who lead more sedentary lives can often
return to work within a week, and after four or six
weeks most can resume driving.
Your physician may prescribe visits
to a physical therapist to begin supervised strengthening
exercises as soon as possible after your orthopedic
evaluation. Non-operative recovery from a torn ACL takes
an average of between four and six months with 45-minute
exercise sessions three days a week. Though everyone's
rehab program is slightly different, physical therapy
for a torn ACL follows a general pattern. The first
three weeks are usually spent restoring a full range
of motion to your knee and recovering to the point of
being able to walk without crutches. Movement may initially
be painful, but it is important to not allow your knee
to stiffen. Rehab progresses to resistive exercises
to strengthen muscles around the knee. During this time,
you should be able to resume functional activities like
stair climbing, single leg support, swimming, and driving.
After about three months, the emphasis will change from
strengthening to functional training, as you begin exercises
specifically geared for your activities and lifestyle
to regain balance and control over your body.
These may include more vigorous warmups on a stationary
bike, elliptical trainer, or treadmill. You should be
able to return to normal activities after about four
months. Physicians usually suggest that you continue
strength training even after your knee has been rehabilitated.
After your physician measures knee strength, you may
be able to exercise at full strength and compete in
your favorite activities. However, your ability to exercise
may remain limited to walking and light activity even
after rehabilitation. If your knee continues to buckle
and remains unstable after rehab, non-operative treatment
of your ACL tear may not have been effective. Instability
may put your knee at risk for progressive arthritis.
You should consult your physician about undergoing a
more aggressive approach.
Knee
strengthening exercises: Ligament injuries
Strengthening the hamstrings and quadriceps
muscles is the only proven way to prevent further ACL
injury. Strengthening may help prevent instability,
which can lead to injuries to knee structures, such
as cartilage, meniscus, and ligaments. The more aggressive
and dedicated you are during rehabilitation, the greater
the chance that you will maintain a stable knee. Many
of the exercises and activities that are popular for
fitness put stress on your knees. To prevent further
instability injuries it is important to be diligent
in doing the exercises you learned from your physical
therapist during rehabilitation. A small amount of pain
is normal during physical activity, but if you feel
so much pain in your knee to warrant taking a painkiller
before an activity, you should consider cutting back
or stopping. Do not play through the pain after an ACL
injury - it may be a sign that your activity is putting
too much stress on your knee. Here are additional ways
to spare your knee of unnecessary stress:
Daily
living - the average person takes between 12,000 and
15,000 steps a day, exerting a force between two and
five times your body weight on your knees. After a knee
injury, take it easy on your knees during the day whenever
possible to save them for activities and exercise. Avoid
stairs when there is an elevator, take the shortest
path when walking, and consider wearing athletic shoes
designed to absorb shock.
Muscle
strengthening/conditioning - activities themselves are
not a substitute for conditioning. It is essential to
adhere to the muscle-strengthening program you learned
in rehab throughout the remainder of your life. The
best strengthening programs are low-impact and non-weight-bearing,
like stationary bikes and certain weightlifting programs,
so that the knees do not have to absorb shock.
Recreation
- your sport or activity of choice helps maintain mental
and physical well-being, but it is not a conditioning
program. Sports that require twisting and quick direction
changes put great strain on your knee.
BRACES
Some people feel safe wearing a knee brace after an
ACL injury, but if the brace is too tight, it can cause
added pain afterward an activity. If you do wear a brace,
wear one that has a kneecap hole or padding. There is
no evidence that braces prevent injuries, meaning they
are not a substitute for increasing your muscle strength.
Always consult your physician before buying a knee brace.
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