Pain: Why you should see a physical therapist after ACL surgery.

I decided to write another post in light of the situation that I am currently in. This is all I have to say... If you ever experience and ACL tear (especially if you plan to have surgery) run to a physical therapist. Preferably, both before and after surgery. I was in a tricky spot because I was in the middle of moving when I should have been doing pre-op work. However, after surgery, it is my opinion that Physical Therapy is NOT an option. It is a necessity. Unfortunately, your surgeon may not know this or believe this. I feel that in my case, I made a huge mistake of listening to my doctor. He doesn't like to send people to therapy right away because there is the risk of hurting the graft. When talking to him, I didn't think that I was doing too badly. I'm just a little slower than average, I was told.

Sure, if you don't receive therapy right away, you can still make a full recovery. However, the amount of pain you will go through is going to be much, much worse. What happens is after 4 weeks scar tissue starts to lay down more quickly. Once that happens, all you can do is push through it. I have noticed a big difference coming into my fifth week. My leg is harder to bend, like thick taffy. Today, I asked Dale to bend it for me because I have been having difficulty getting it very far on my own. I'm telling you, it hurt. I cried a bit, chewed through a towel and gripped the table so tightly that my shoulder and chest muscles wouldn't stop quivering. I'd like to think that I have a decent pain tolerance. You don't do marathons and Ironmans without one. But this type of pain is different. It feels much like it did when I first injured it. Also, because it is hard to relax, your hamstrings will start to guard making the motion harder to get. Still, I guess I am not the worst of the worst cases. Dale says that the barrier is still soft so it is easier to get through. Sometimes, it is hard and that is when he has had to put all his weight into it (to the point where he is black-and blue from pushing). But getting the motion in the knee is only part of the solution. Keeping it is the other. Every day that you will work at it, you will gain a certain amount of motion. However, overnight, things will stiffen up and you'll be back to square one. So going through the process of having someone bend your knee is not a one-time deal. It is a daily process. Since, mine has gotten so bad, I'm working against the clock to get the motion back and get through the scar tissue before it hardens even worse. THis means more days on the table having my knee forcibly pushed into a new range. Unfortunately, this is a scene that is too commonly seen among PTs. I've been told that over my 16 weeks at the clinic I will probably see other cases similar to mine. Although it can't be totally prevented, some things can help:
1. Pre-operative strengthing and work to get full knee flexion and extension back
2. Post-operative physical therapy. The clinic that I'm at sees their patients the day after surgery.
3. Following the guidelines set by both your surgeon and PT. (Weight-bearing restrictions, completion of home exercises)

There are certain cases where getting range back after surgery isn't possible. I'm thinking of one person who isn't allowed to bend her knee much for th first four weeks. Still, she has good leg strength and started physical therapy immediately afterward.

This has been my first experience with an ACL injury both as a person and as a student physical therapist. I wish I had known more going into this process because maybe I wouldn't be in the position I'm in now. I wish I would have demanded to be seen by a PT starting the day after surgery. In Michigan, by law, you can't go and see a physical therapist without a doctor's prescription. This is different from most other states where there is some form of direct-access to physical therapy. It's kind of funny how all these issues that we have talked about in school are currently hitting right in the face.

I'll recover. It is just going to be a very tough couple weeks ahead. As Dale has said to a collegue, "She'll let me bend her knee because she wants to be able to run again."