Welcome to Part 3 of the Pathway to Recovery: ACL Injury and Surgery series.
As we mentioned in Part 2, there are certain things you need to consider and prepare after returning home from ACL surgery. As a recap, the first two discussed in part 2 were:
Proper care of the surgery site
Becoming comfortable with your immediate limits
Finally, we will touch generally on surgery and injury nutrition2 and how it can optimize recovery3 as well as some recommended exercises that are generally advised for ACL surgery.
Let’s start with nutrition as it is critical for a strong and optimized ACL surgery recovery. For more details, see our full blog post Surgery and Injury Recovery: Nutrition for a Strong Recovery. In that post, we highlighted the high levels of hospital re-admittance after surgery (image below) and how a robust pre and post surgery nutrition can lead to a stronger recovery to combat these occurrences.
To avoid being one of these statistics, make sure you optimize your nutrition.
But what is the best way to optimize surgery recovery nutrition?
There are over 25 key nutrients that the human body needs to ensure a strong surgery or injury recovery. Because these nutrients tend to become depleted once the body is injured (including surgery damage), supplementation is often required to maintain optimal amounts.
Important ingredients such as Vitamin C, Vitamin A, Zinc, Magnesium, Arginine, Glutamine, Copper, Selenium, Vitamin B complex, and Probiotics should make up the foundation of your focus. In addition, you should try to include anti-inflammatories such as Quercetin and Bromelain to reduce excess inflammation and aid in pain control after surgery.
Even in the best of times, acquiring all of these nutrients on a daily basis from natural food sources as part of a healthy diet is quite challenging. Per the CDC and NHANES nearly “80% of the population are deficient while nearly 10% are malnourished in key nutrients”. Further, the USDA had stated that “nearly 50% of Americans are deficient in Vitamins A, C, and Magnesium” which are critical for wound healing.
While these ingredients can be obtained from natural food sources, it is important to note that your consumption must be much higher and “more regular” than normal to get the effects without supplementation. Therefore, whatever you decide, it is highly advised to add some supplementation to your post surgery diet (avoiding Vitamin E for a duration after surgery if possible).
While there are a few supplements out there, including whole recovery programs; few are like the HealFast Surgery and Injury Recovery Program, that contain both the key ingredients in optimized dosages for recovery and are safe for surgery.
After surgery recovery nutrition, comes post-surgery exercise
The last step in avoiding post-surgery complications and obtaining a strong recovery requires you to take special care when following your physicians’ or physical therapists’ post-surgery exercise instructions.
The common ACL exercise program “covers several phases related to weight bearing, developing leg/knee strength, and range of motion.1” Each phase will be initiated by your physician and should not be rushed. Take pain medication during these exercises to help ease swelling and inflammation and work to control initial pain. Usually your brace will be off for most exercises, but again speak with your physician or physical therapist before trying any of these on your own.
Exercise 1: Quad Sets: (roughly 5 mins each session)
Lie on your back with your good leg bent with foot on the floor for support. Under the operated leg place a rolled towel.
Push the back of your operated knee down into the towel roll by tightening the quad muscles without letting the heel come up as you tighten your quad, i.e. do not straighten the knee.
If you experience pain when pushing down, try to make the towel roll a tad bigger.
Hold each contraction for 10 seconds then rest for 10 seconds between reps. Repeat this 15 times, 3-5 times each day.
Exercise 2: Passive Extensions: (roughly 15 mins each session)
Lie on your back with the good leg bent and its foot flat on the floor for support.
Place a towel roll under the heel of the operated leg and let your leg straighten as much as possible (not into pain).
If your ACL knee is not straight, use your hands to gently push down on your thigh.
Hold this stretch for 10 seconds and repeat 4 times a day. After the stretch allow for your knee to remain straight for 15 mins.
Exercise 3: Leg Raises: (roughly 3-5 mins each session)
**Your brace should be on and locked at Zero Degrees (straight)
Lie on your back with the good leg bent to 90 degrees so that its foot flat on the floor for support.
Slowly lift the operated leg to the height of the opposite knee, ensuring it is kept straight the whole time.
Perform 3 sets of 10 reps, done 3 times a day.
Exercise 4: Active Bending: (roughly 3-5 mins each session)
Sit on the edge of a sturdy table or chair and support your operated leg from behind its ankle with the good leg, and follow these 3 steps in order.
Keep the operated leg relaxed and slowly allow it to bend with the other leg assisting it by supporting it from behind as mentioned.
Let the operated leg dangle slightly and gently bend it back by itself as far as you can tolerate
Next, if possible, cross your good leg in front of your operated leg, and use it to gently bend your operated leg a slightly back further. Hold for ten seconds and release slowly.
Continue into passive straightening exercise.
Exercise 4, Part 2: Passive Straightening:
Finally, support the operated leg from behind using the good leg as you did in step 1. Once supported, use the good leg to help straighten the operated leg.
**DO NOT ACTIVELY straighten your operated leg on its own. Let the GOOD leg do the work/lifting.
Hold each procedure for 10 seconds and repeat 20 times for 3 times a day.
Again, for your own safety and recovery, we ask that you speak to your physical therapist and primary healthcare physician before trying any of these activities. We have merely listed some common exercises that may or may not be assigned to you depending on your individual and highly personalized surgery.
To end the ACL Injury and Surgery Series we have also compiled some frequently asked questions that we thought might be of use and interest.
When can I return to driving?
If the surgery is on the right knee then it might take about 6 weeks and as soon thereafter as you are comfortable.
If the surgery is on the left knee and you drive an automatic, you may begin driving as soon as you are comfortable driving and not taking pain medications.
If the car is standard and the surgery is on the left knee, like before it may take up to 6 weeks.
When will I be able to run again? What about sports?
Running is generally dictated by your lower extremity strength but in general a person may be comfortable and allowed by their doctor around the 12-16 week period.
As for sports, this can take up to and over 6 months depending on the sport, the recovery trajectory, and the person’s recovery nutrition plan.
When should I stop icing/cryotherapy?
In general, you should do this for as long as possible even once the swelling, pain and inflammation is gone. But in general when those three symptoms subside it can be stopped.
When can I return to school/work?
Consult your doctor and determine what level of activity is required, but with brace usually 1 week.
When should I start physical therapy?
You should attempt it as soon as possible and prescribed by your physician. This includes the home program that may/may not contain some of the exercises listed above.
What if I think I re-injured my ACL after operation?
Do not wait for it to heal on its own. If you feel that you have re-injured the operated leg, make an appointment with the doctor as early as possible for a professional consultation before “undesirable healing occurs.” Usually the ACL itself may not be re-damaged but surrounding tissues and structures can become irritated.
We hope you enjoyed this ACL Injury overview. It is a common injury, but one you the patient can aid the outcome over. Make sure to prep properly, ensure you are getting great pre- and post surgery nutrition, and exercises and icing as instructed and you will have a stronger recovery.
Hospital for Special Surgery medical recovery
General Disclaimer: All information here is for educational purposes only and is not meant to cure, heal, diagnose nor treat. This information must not be used as a replacement for medical advice, nor can the writer take any responsibility for anyone using the information instead of consulting a healthcare professional. All serious disease needs a physician.