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Author Topic: acl tear knee surgery  (Read 1306 times)
jcguy20
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« on: December 13, 2008, 11:51:04 PM »

i know your suposed to listen to doctors.............but i kind of take more of people who have been through it

i tore my acl back in april had surgery in june and rehabbed for a couple months (im 19 and play college football) my doctor didnt clear me until now december but i played 2 games one in october and november

i know that was way to early but somehow my coaches convinced me to play and i did...it didnt hurt then i had a huge protective brace on


but now its the sixth month and people say after surgery they have no pain or little pain...

i have alot it usually hurts to run now i stretch alot and do leg lifts with ankle weights but just wondering why its hurting so damn badd now after six months


i went to the doctor and he said the acl and everything seems fine and that it might be because ive only brunning and not lifting...and that maybe my leg cant support my frame right nowbecause of all the lost muscle mass (im about 5'8 200) do you guys agree


i just wanted another athletes take on this who has been through this i know the doctor knows but if eel some athletes who have been through it have a little better advice...


(i have not lifted since my surgery in june my trainers at school for some reason wanted me just running and not lifting even though i was supposed to?)


thanks for opinions
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The Coach
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« Reply #1 on: December 14, 2008, 11:13:53 AM »

i know your suposed to listen to doctors.............but i kind of take more of people who have been through it

i tore my acl back in april had surgery in june and rehabbed for a couple months (im 19 and play college football) my doctor didnt clear me until now december but i played 2 games one in october and november

i know that was way to early but somehow my coaches convinced me to play and i did...it didnt hurt then i had a huge protective brace on


but now its the sixth month and people say after surgery they have no pain or little pain...

i have alot it usually hurts to run now i stretch alot and do leg lifts with ankle weights but just wondering why its hurting so damn badd now after six months


i went to the doctor and he said the acl and everything seems fine and that it might be because ive only brunning and not lifting...and that maybe my leg cant support my frame right nowbecause of all the lost muscle mass (im about 5'8 200) do you guys agree


i just wanted another athletes take on this who has been through this i know the doctor knows but if eel some athletes who have been through it have a little better advice...


(i have not lifted since my surgery in june my trainers at school for some reason wanted me just running and not lifting even though i was supposed to?)


thanks for opinions

1. Did your Dr. clear you for practices or games. Chances are it was for practice only until your stable enough for games.

2. From surgery to full sport play should be between 5-8 months provided you did the rehab correctly without being impatient........sounds like you were impatient.

Again, as I have said, full rehab should take between 5-8 months. After the athlete is released from passive PT, we take over with a 5 phase plan for complete rehab to competitive play.

The following protocol is from the Dr who I send all of athletes to and works with me as an advisor in my business........


PHASE I (0-4 wks)

Goals:

1- Gain full knee extension so patient can ambulate with a Normal gait.  Teach patient a home exercise to achieve this immediately.  The rehab cannot move forward until this goal is achieved.
2- Control swelling: Swelling inhibits quad firing and limits ROM; as long as there is a flexed knee gait, the more the patient ambulates, the swelling will increase; therefore, limit activities and ambulation early in rehab. Dr. Mora will encourage patients to strictly rest the first 3 days following surgery to avoid the formation of a hemarthrosis.  For the same reason.  Encourage ACE wrap, icing and elevation the first 2 weeks. Slow patient activity down.
4- Normal gait: patients will ambulate with flexed knee gait secondary to no quad control; have patient focus on quad contraction and full knee extension during heel strike and stance phase of gait.  The patient should ambulate using crutches usually for 3 weeks.  If gait progression is slow, allow a single crutch.

Exercises:
Quad sets (10 X 10sec) at least 100/day, SLR, Heel slides,  Do not perform SAQ or LAQ to full extension.
Patella Mobs-  Do once incisions are healed and minimally tender to touch.  Teach patient to do frequently.
I do not use a immobilizer in most cases.

ROM: 
As tolerated.  Goal is -5-100, Emphasize Manual patella mobs especially superior/inferior, Seated heel slides using towel, Prone hangs if needed to gain full extension

Pedlar/stationary Bike:  Not the first 2 weeks (to avoid swelling).  Can only be done when the knee flexes equal or more than 110 .

Modalities:
MS may be needed to facilitate quad if contraction cannot be voluntarily evoked
Ice should be used following exercise and initially the first 2 weeks every hour for 20 minutes.
Do not become dependent on Estim/TENS modalities
 

 

PHASE II (Weeks 4-8 wks)

Goals:  Full quad control and tone, perform activities of daily living without difficulty.  Quad atrophy improvements.  Be sure that hyperextension and patella mobility has not deteriorated. 
ROM goal by the end of this phase critical:  Full ROM is not always 0-125.  Full motion is actually "equal to opposite side, including full hyperextension".  Make side-to-side comparisons and improve accordingly. If motion is proceeding slowly evaluate patella glide and increase patella mobs as needed.

Exercises:  Closed chain exercises will be advanced.  Squats usually around wk 5; Lunges wk 5-6; forward and reverse, Hamstring curls, Single leg squats, Single leg wall squats

The 4 cone Box drill:  Set apart about 6 ft and have the patient start on one corner, walk to next cone, side step to next, backward walk to next and finally side step opposite direction to end up at starting cone.  As ambulation improves, slowly spread the cones farther apart while encouraging quality and speed.  This exercise is done daily at home.

Pedlar/stationary Bike:
May start after 2 weeks and if flexion is equal or more than 110 .  Pedlar should be used at home for 10-20 min daily with No resistance.  The Pedlar bike is obtained at Dr. Mora's office.

Balance/Gait:
Always encourage to walk with normal gait and to have full extension at heel strike.
 

 

PHASE III ( 8wks-16 wks)

Goals:  Maximize strength in a safe manner that does not over-stress a susceptible graft. Not ready for pivoting or jumping maneuvers yet.  Straight line running by 4 months with minimal pain and swelling.  Proper running techniques.

Exercises:  Begin Stairmaster/Nordic Trac/Elliptical Trainer at 12 weeks.  Once able to master these, progress to backwards running.  Backwards running should be done with the patient properly positioned like a football Safety.  They should stay low, knees bent, and well balanced.  Once backwards running is mastered progress to straight-line running.  Running is based on quad tone, no swelling, no limp, and permission from Dr. Mora.  The patient can begin to jog at a slow to normal pace focusing on achieving normal stride length and frequency.  Jogging is done in small incremental steps.  Start with a few yards daily and then increase the length and duration
 

 

PHASE IV (4-6 months)

Goals:  Proper plyometric, closed chain strengthening and agility activities.  Should be able to accomplish an ACL injury prevention program at the 6 month point. 

Exercises:  Initiate the ACL injury prevention program (PEP or POISE) at 5 months for autografts and 6 months for allografts.  Ask Dr. Mora for information and video.  Teach proper landing techniques, especially in female athletes.  Landing from jumps is critical knees should flex to 30 (stay low) and landing should be as soft as possible.  Controlling valgus (keep knees under feet) will initially be a challenge and unilateral hops should not be performed until this is achieved. 

Sports Specific drills.  Progression: Straight line, figure 8, circles, 45 turns, 90 cuts.  Initiate sprints and cutting drills at 6 months.

Dr. Mora's 3 L's of ACL Injury Prevention on the field: 
  1)  Soft Landing following jumps at all times. 
  2)  Stay Low while running at all times.
  3)  Keep your knees in Line with your feet at all times.
 

 

PHASE V (6 months and beyond)

Goals:  Gradual return to Sports at the highest level.

Continue sports specific drills, Single leg hop test to check for deficiencies in neuromuscular control.                 



Most patients are back to full sports by 5-7 months. 
 

www.joelocalpt.com
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jcguy20
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« Reply #2 on: December 14, 2008, 01:09:58 PM »

my doctor is in texas my university is in minnesota (i live in texaS)


soo my doctor at school says put a brace on it should be fine at about the 5th month mark


i did most of the rehab that you had for about 6-8 weeks when i get to my university we did more of agility and running and being on the bike...

to this day i still stretch and started back doing leg lifts and quad exercises....

i had all my flexibilty back pretty fast and extension came alot quicker and faster than flexibilty did


its still swollen and swells up sometimes but ive been icing it alot more


i wasnt on crutches for 3 weeks either i was on there for about a week and my doctor said try and put more pressure on it soo i threw the crutches out and wore that huge brace and walked....


ive been to him and he keeps saying the acl is fine and that maybe i need to build more muscle do you agree with him?
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