7 Tips To Speed Up ACL Recovery
Michal Dabrowski CAT(C) RMT
One of the most common and most debilitating injuries in sports is the ACL tear. The typical recovery time for an ACL injury that requires surgery is about 6-12 months but you constantly see professional athletes back playing their sports in less time than that.
Why is that? What are they doing that the average person isn’t? That’s what we will explore in this blog post. We take a look at what you can do to speed up your own healing and get back to playing the sports you love.
ACL Anatomy and Function
The first step to a speedy recovery is understanding the structure that we are trying to heal and why the injury happened in the first place.
The ACL connects the femur (upper leg bone) to the tibia (lower leg bone) and prevents the lower leg bone from moving too far forwards relative to the femur. It acts as the main stabilizing ligament in the knee and prevents your knee from giving out when walking, running, jumping and playing sports.
How Do ACL Injuries Happen?
Ligaments connect one bone to another and any movements that go beyond what the ligament can handle will cause a tearing of that ligament. Tears can be minor, or partial tears, or they can be major where the ligament tears completely.
A fully torn ligament will likely need surgery to repair the damage whereas a partially torn ligament (depending on which ligament) will most likely respond really well to therapeutic intervention like manual therapy and exercise.
In the case of the ACL, tearing occurs when the tibia moves too far forwards or the femur moves too far backwards.
The most common mechanism for an ACL tear is when a person plants their foot in one direction and moves their body in another (think of a football player cutting). Any athlete who does a lot of sudden changes in direction, quick starts and stops and pivots is at higher risk for this type of injury.
When someone tears their ACL they may feel a painful pop, the knee may give out and the injury results in swelling to build up quickly in and around the knee. Walking becomes painful and difficult as well.
If the forces that cause the ACL to tear are significant enough, other structures like the MCL or meniscus may also be affected potentially prolonging recovery time.
Signs and Symptoms
Some general signs and symptoms of ACL injuries are:
- Generalized knee swelling
- Knee gives out when walking
- Limited range of motion
Speeding Up ACL Recovery
There are many ways to prevent an ACL injury. But if you have been unlucky enough to injure your ACL here are a few things to help you speed up your recovery.
1. Start Rehab NOW!
DO NOT delay your rehab! My clients who tear their ACLs start rehab the very next day. Some even start the same day. The longer you wait to begin rehabilitation the longer your recovery will be. Starting rehab as early as possible (even before surgery) will ensure quicker recovery after the surgery.
Many people often have to wait a few months before they can even get surgery and many of my clients who start rehab early regain the ability to run prior to theirs scheduled surgery date.
This type of strategy is called “Pre-hab” (Pre surgery rehabilitation) and helps prevent muscle wasting and losses in strength. We’ve all heard the expression “If you don’t use it you loose it” when talking about muscle function. This also applies in cases of ACL injuries.
Think about it this way, if you don’t start rehabilitation until after your surgery you may have already spent a few months protecting that injured knee before you start to work on strengthening the muscles needed to walk, run and jump normally. By this time, you will have probably lost a lot of muscle mass and already developed compensations which will take longer to correct after surgery.
Starting Pre-hab soon after injury will allow the rehab process post surgery to go smoother and quicker.
2. Movement = Medicine
It is important to keep the ankle, knee and hip as mobile as possible and as soon as possible. You want to ensure you keep as much range of motion in these joints to avoid any compensations and tissue tension from developing. Movement will also redistribute fluids and help decrease swelling.
There will be some limitations to how much stress you can place on the ACL, especially after the surgery, but moving within pain free ranges of motion will ensure you obtain full mobility quicker than if you were to protect the knee for too long.
3. Maintain Strength
The first muscle that atrophies or “shrinks” is the quad muscle - particularly the VMO (vastus medialis) which is the quad muscle on the inner part of your upper leg.
Expect this muscle to show visible signs of shrinking within 24 hours after injury. It is very important to keep the brain-to-muscle connection strong in order to speed up recovery. Imagine being so weak that you have trouble even contracting or activating the muscles surrounding your knee.
This is what the quad feels like after an ACL tear. It’s not so much the building of the muscle that’s tough, it’s getting your brain to quickly send signals to the muscle when you want your knee to move. The earlier you begin light, pain-free contractions the better your stability will be and the better control you’ll have throughout knee range of motion.
4. Don’t Break Routine
If you’re an athlete, unless you have a doctors appointment or are with your therapist doing rehab, you need to be with your team. If there’s a team meeting - you’re there. If your team is watching and reviewing video - you’re there. Be there even during practices to support your teammates and keep up with plays and strategies your team is working on.
Take this opportunity to develop and show leadership. You now have an opportunity to watch your team from a different point of view. You can address key weaknesses you see in your teammates and work with the coaching staff to help address those weaknesses.
Being an active team member and keeping up with your regular routine will also help with the associated mental health challenges that come with injuries like anxiety and depression by giving you a sense of purpose even though you can’t fully be with the team just yet.
If you’re not an athlete, develop a strong support system to help you with your rehab. Recruit friends or family members to help you with your exercises. Join a group to talk through some of the challenges and struggles you’re facing with your recovery.
Talk with your therapist about some of your fears and worries. We are trained to look after your mental health too, not just the physical. Injuries don’t have to be so isolating and they won’t be if you have a strong support system.
5. Proper Nutrition
A very important factor in recovery is nutrition. Poor diets not only bring you further from peak physical condition but also impact your healing negatively.
Make sure to eat foods high in vitamins, minerals and nutrients and avoid processed foods and foods with high sugar contents. Incorporate more fruits, vegetables and berries into your diet and make sure to stay hydrated.
6. Get More Sleep
One of the most important but not talked about and monitored enough factors to speed up ACL injury healing is sleep. The best recovery is done when we're sleeping. But, not just any kind of sleep, we’re looking for that restful REM sleep, or deep sleep.
Many people’s sleep is impaired due to the psychological impacts of injury. Anxieties, fear, frustrations and uncertainty about the future can impact a person’s sleep and severely affect healing. If you’re sitting up at night unable to go to sleep for more than 3 nights in a row it’s time to focus on getting good quality sleep.
7. Train Both Sides
Remember the end goal of rehab is getting back to normal - often times even stronger than before the injury. I’ve seen many people start a rehab program that focuses only on the injured side but completely avoids the uninjured or "good" side.
If you’ve spent the last 6-12 months working on the affected side, the one with the ACL tear, but neglect the “good side” then you have just potentially created a lot of muscle imbalances. The knee you injured now becomes your “good leg” and the one that never had any injury now becomes your “weaker” leg.
In this situation, you then have to prolong your rehab to work the “good side” to get it up to speed with the side you have been rehabilitating for the past year. During your rehab, always work both sides and don’t just focus on the injured side so you can prevent these muscle imbalances.
Injuring your ACL can be a scary injury at first but with the right approach to rehabilitation and proper guidance and plan you will get back to doing what you love in no time!