“Help!” Continues . . . So you’ve had ACL Reconstruction, Now What??

Hi! We are continuing our discussion on ACL tears and last post we talked about what to do if you think you have torn your ACL. Today we will discuss Rehabilitation and all the questions you should ask your Physical Therapist and Orthopaedic Surgeon and the answers they may give you . . .

If you missed the first part you can read it here Help! My daughter tore her ACL . . . We think??

So you’ve had surgery . . . 20150625__701135-s500-phHopefully you are feeling like you made a great choice ~ I don’t suspect you are necessarily happy with needing surgery and the coming rehabilitation but now that your joint is stable again proper healing can begin ~ its uphill from here baby!

I suspect you have the lots of questions tho . . .

  • How long do I have toimages-8
    • take meds
    • use the crutches
    • wear a brace
    • keep icing
  • When will it stop
    • hurting
    • being so swollen 
  • When can I get back to
    • sports
    • school/work
    • walking normally
  • Is this normal???

First lets talk about some common things you may be surprised by or concerned about that your  surgeon may not have mentioned . . .

  1. You may have a LOT of pain and swellingtherapeutic-drugs-monitoring-19-638
    1. STAY ON YOUR MEDS AS LONG AS YOU NEED TO!
      The pain and anti-inflammatory medication is needed to manage the pain and swelling along with frequent icing for the first days after surgery. If you do not take your medications regularly they will not build up in your system enough to control the pain and swelling.
    2. It is okay to use the ice machine that was sent home with you as much as you need. It doesn’t really freeze your knee just keeps it cool and comfortable.
    3. elevate your leg as much as you can during the day.
  2. You may bruise ~ tearing your ACL and Surgery are both internal injuries that can cause bruising.
  3. You may have trouble sleeping ~ Because of the pain and swelling, you may not be able to find a comfortable position.
  4. You may feel nauseous
    1. This should only last a day or two 
    2. if it lasts longer the pain medication may not be sitting well in your stomach. Speak to your physician about a different medication.
  5. You may feel more tired ~ everything you do may require more effort.
    1. Getting in/out of the car
    2. Walking with brace and crutches
    3. You may have trouble lifting your leg
      1. It will be heavy and your muscles may not be working well.

Lastly, you will (sometime in the rehabilitation process)images-6

be frustrated at the speed of recovery,

be concerned about your progress,

be anxious to get back playing your sport,

be sad that this is taking sooooo long,

be angry that this happened!

Allow yourself to have these feelings, sit with them, embrace them, accept them and move through them ~ it’s a part of the healing process.

A typical rehabilitation protocol looks like this:

Phase 1

  • Control pain and swelling with ice, medications and exercise to create optimal healing conditions.
  • Keep muscles working with exercise to avoid atrophy.
  • Introduce joint range of motion with exercise to prevent stiffening of tissues.
  • Continue wearing brace until you have adequate quad muscle control to protect ACL ~ usually 2-6 weeks depending on surgeon.
  • Use of crutches as needed when walking ~ usually only 1-2 weeks.

Phase 2 ~ continue with above and . . .

  • Introduce coordination exercises if haven’t already.
  • 6 weeks is a key healing time requiring protection of graft ~ at this point many people are feeling better and assume they can doing things that could put the graft at risk for tearing.
  • Toward the middle and end of this phase introduce balance, agility and coordination.

Phase 3 ~ continue with the above and . . .

  • Increasing speed with balance, agility and coordination
  • Remediate movement pattern dysfunction to prevent future injury.

Phase 4 ~ Return to Sport

  • Typically return to practice with a specialized knee brace at 8-9 months and playing in games at 9-12 months.
  • All making sure that you are using normal movement patterns and are cross training the opposite movements as well to reduce your risk of future injury

So there you have it  . . . The Nutshell Version of ALC rehabilitation!

Have I answered your questions? Created more? Post below and let me know . . .

Speak with you soon! Roxi

Help! My daughter tore her ACL . . . We think??

So I get a text from a friend of mine . . . and my heart sinks . . . she tells me her daughter may have torn her ACL during a soccer game his weekend! She writes “If you have time can you call me about Marie’s ACL and what questions we should ask the surgeon?”

Being a Physical Therapist, I get phone calls, texts and emails like this frequently. I also have personal experience with kids sports injuries. You see the moment they go down and pray its nothing serious, you cringe or gasp, your heart pounds as you calmly reassure yourself that everything is going to be fine. Most of the time they get up and keep playing, other times they walk off and rest, but the worst is when they are carried off or god forbid an ambulance is called!

Deep breath . . .     imgres-2

Once the adrenalin rush has subsided, your child is comfortable, and you’ve had a chance to process the injury then you reach out to people you know, who have experience, for advice . . . What’s next?

So after sympathizing greatly with her, I asked my friend:

  1. What happened? Was it a contact or non contact injury?
  2. Did Marie hear or feel a pop? Is her knee swollen? Can she put weight on it? Does she have full range of motion? How much does it hurt? Does it buckle?
  3. Has she had any imaging ~ X-ray, MRI?
  4. How is she feeling emotionally? How are mom and dad doing?
  5. How can I help? What do you need or want from me?

And I listen . . . Any healthcare provider you choose should ask similar questions and then listen.

Then she asked me:

  1. What could be wrong in the knee? Is it the ACL?
  2. Does she need surgery? Could she get away without it?
  3. What should I ask the orthopedic surgeon?
  4. How soon could she play? Is this going to affect her permanently/forever? Will it limit her ability to play soccer going forward? And as an adult?

As you can imagine this conversation is a little different for everyone . . .

The Nutshell Version: What You Need to Know About ACL Injury.

The Mechanism by which an ACL tearhqdefault

  1. Cutting and planting moves (with rotation) or quick change in direction ~ non contact injury.
  2. Getting hit in a manner that pushes your femur backward or your tibia forward past the point at which the ligament can hold ~ contact injury.

You may hear or feel a pop, and the knee joint will probably swell up, it may or may not hurt much past the initial injury.  In order to confirm it is actually a tear in your ACL and not injury to muscle, knee cap or meniscus instead, you need a clinical evaluation by a Physical Therapist or an Orthopaedic Surgeon and an MRI.

The ACL or Anterior Cruciate Ligament is a ligament which connect the femur to the tibia. If it tears completely it makes the knee joint unstable to correct this there are two options:

  1. Surgery to reconstruct the ligament and restore joint stability.
  2. Physical Therapy to train the muscles to maintain joint stability in any and all activities in which a person wants to engage ~ from standing and walking to sports performance.

The general recommendation is surgery IF . . .

  1. You have a complete tear and it impacts other structures like other ligaments or the meniscus.
  2. You want to return to a high level of athletic play.

Surgical options include:

  1. Allograft ~ a cadaver tendon is used to reconstruct the ACL
    • PROS:  Only one location in the knee to heal, better motion, less time in operating room
    • CONS: chance of rejection of graft since it is not your own tissue. Higher failure rates, slower to adapt to person body.
    • Recommended for: older patients
  2. Autograft ~ your own patellar or hamstring tendon is used to reconstruct the ACL
    • PROS: no chance of issue rejection, its your own tissue so it doesn’t have to adapt, its stronger and lower failure rates
    • CONS: have two sites to heal the ACL and patellar or hamstring tendon. This may slow the recovery time as it can create tissue irritation at the graft harvest tendon location.
    • Recommended for: younger patients, athletes

When you see the Orthopedic Surgeon you should ask the same questions my friend asked me . . . once you know the diagnosis ask these questions:

  1. Is surgery needed? What are the options?20150625__701135-s500-ph
  2. What kind of surgery do you recommend or what kind of graft will you use?
  3. Can I have Physical Therapy before surgery?
  4. What happens after surgery? How long do I have to wear the brace? Use crutches? When can I start physical therapy? Sleep or walk without the brace? Return to sports?

For answer to those last questions see my next post coming this weekend . . .

. . . The Nutshell Version: What You Need to Know About ACL Rehabilitation!

Until next time . . . CiA13cRXEAQaiLr

Roxi

Annual Exams

How many of us have annual exams by our physicians, ophthalmologist, dentists? Most of us are so busy that these appointments rarely top the priority list but does that mean they are not important? Absolutely not! I am embarrassed to admit that altho I work in the healthcare profession I see my dentist for a cleaning yearly (although it should be every six months), my internist every year to year and a half for a wellness exam and I can’t recall the last time I saw an ophthalmologist – but it is on the top of my list currently!!

The other person we should be seeing for regular exams is our Physical Therapist. Physical Therapists are your movement specialists. We are the experts in normal and abnormal body mechanics, re-education of normal movement and functional movement training. The Vision of our professional association states PT’s are  “Transforming society by optimizing movement to improve the human experience.” http://www.apta.org/Vision/

Reasons to see a physical therapist include:

  • Injury including muscle or tendon strain, ligament sprain, fractured bones, pain, and many more.

  • Post surgery including ligament reconstruction, tendon repair, joint replacement and many more.

  • Chronic or recurring injury or disease that limits your ability to function or move the way you want.

But have you ever thought about seeing a PT for:

  • A fitness consultation

    • Improving flexibility, strength, endurance

    • Improving balance, coordination

  • Enhancing sports performance

  • Injury prevention

  • A postural consultation

“Physical therapists have the education, experience, and expertise necessary to provide a broad health screening to allow tracking the patient’s health status over time.” www.apta.org/AnnualCheckup/

 The goal of ZPT is to be your PT for life! You have a medical doctor, a dentist and an eye doctor. Why not have a doctor of physical therapy?

Click here to inquire about annual exams!

Be Well! Roxi