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Is physio after ACL surgery painful (anterior cruciate ligament)? Learn about rehabilitation and exercise following ACL reconstruction

Published: 06 November 2024

What is ACL (anterior cruciate ligament) reconstruction surgery?

Undergoing ACL (Anterior Cruciate Ligament) surgery can be a daunting experience, but the real work really begins with post knee surgery physiotherapy. This leads to the question most are asking “Is physio after ACL surgery painful? At The Physio Clinic Glasgow, we appreciate that you may be worried about this and wanted to take some time to help build your knowledge on the subject. Yes, discomfort is part of the journey — but you need to know what’s normal post-surgery pain and when it could potentially be a problem. We'll explain the rehabilitation process, unpack what this means for pain and how our bespoke approach can make your recovery as effective & effortless as it should be.

Understanding ACL Surgery and Physiotherapy

Following ACL surgery, the majority of patients are required to complete a physiotherapy program that is designed not only to help your knee heal but also focuses on early walking with a crutch, improving muscle strength in the quadriceps and regaining knee extension. This usually involves gentle, moderated exercises that are gradually progressed in intensity to encourage healing, reduce swelling and normalise range of motion. That said, how much pain you experience is partially up to your body and what shape it is already in due to a combination of the level of injury as well as these exercises.

What is an ACL Injury?

ACL injuries happen when the ligament that helps stabilise your knee joint is either pulled, torn or completely ruptured. One of the examples is a torn ACL, which often requires surgery to reconstruct this ligament, followed by extensive physiotherapy to help you get back all function in your knee after surgical treatment.

Is Physiotherapy After ACL Surgery Painful?

The short answer: Yes, physiotherapy after ACL surgery can be painful but should not be excruciating. And in many cases, your pain is experienced as the body is healing and there is an active inflammatory process from the surgery. At The Physio Clinic Glasgow, we stress that a certain amount of soreness (around 4/10) is normal however extreme pain is never acceptable.

Types of Pain You Might Experience:

Post-Surgical Pain: The initial pain you will feel after surgery will be relieved within a couple of weeks.
Muscle Soreness: You may experience muscle soreness due to the nature of the physiotherapy. It will feel similar to the soreness you feel after a good workout.
Stiffness and Tightness: As you try and increase the range of movement you may feel that your knee, calf or thigh is stiff but this will improve as you continue to exercise and move.

What Pain Level is Normal?

There is "good pain" and there is also definitely some "bad pain". There may be mild to moderate pain during or after physiotherapy exercises, but it should settle within one or two days. If the pain is sharp and stabbing or suddenly severe, it could be indicative of overload — possibly leading to a more inflammation or another injury that should probably warrant an immediate conversation with your physio.

The Phases of ACL Rehabilitation and What to Expect

The following will help you understand the stages of ACL rehab post-knee surgery at Physio Clinic Glasgow. Knowing these stages and the post-ACL reconstruction exercises can allow you to anticipate what kind of pain you may have, as well as manage it.

1. Initial Recovery Phase (Weeks 1-4)

Goal: to decrease pain and swelling in the knee and to increase the range-of-motion exercises.
Discomfort: Mild to moderate pain as the swelling in the knee reduces and it gets used to increased movement.
Tips: A rehabilitation programme that helps you regain full range of motion, along with exercises to work your thigh muscle are particularly import. Swelling and pain should be managed, and your physiotherapist may encourage ice and elevation at times.

2. Strengthening Phase (Weeks 4-12)

Goal: Get the muscles around the knee to grow stronger (mainly quads and hamstrings)
Expected Discomfort: Muscle soreness as the exercises become more advanced and intense.
Tips: Strengthening exercises should become more challenging at this time, we should have full knee extension and near or full knee flexion at this stage. Remember to vigorously strengthen both legs, not just the injured leg.

3. Intro to Advanced Strengthening, Plyometric and Running (Months 3-6)

Goal: Regain full knee function with more dynamic movements and exercises in the lower limbs.
Expected Discomfort: At times your knee might be sorer as a result of increased activity and intensity in the exercises.
Tips: The ACL graft is still vulnerable at this stage, so slowly introduce running or more explosive exercise. Don't shy away from open chain exercises such as leg extension machines.

4. Return to Sport or Full Activity (After 6 Months)

Goal: To get back full knee stability and normal range of motion, with a return to your normal sports or daily activities and exercises.
Expected Discomfort: Mild aches and pains will be normal as your body re-adjusts to the higher level of exercise and activity.
Tips: Delay your return to sport until your physiotherapist performs tests such as hop testing and a battery of strength tests in line with rehabilitation guidelines.

How The Physio Clinic Glasgow Helps Ease Your Recovery

Here at The Physio Clinic Glasgow, we understand that individual care can be the game changer in your journey to complete ACL recovery. Here, our team of physiotherapists provide individualised approach into creating a rehabilitation plan that will ease your transition from one stage to the next.

Key Benefits of Our Approach:

Individualised Treatment Plans: Each individual and injury is unique so every programme will match your needs and goals.
Patient Education: We teach you how to manage your pain effectively and recognise when it’s time to ease up or push harder.
State-of-the-Art Techniques: Our clinic uses the latest methods to enhance your recovery and reduce discomfort during your sessions.

Tips to Minimise Pain During ACL Physio and Rehabilitation Exercises

Here are some practical strategies to help you manage and reduce pain during your physiotherapy sessions:

Stay Consistent: Regular physiotherapy is crucial for a faster recovery, even if it feels challenging. It's important that you follow the guidance provided by your physiotherapist.
Motion is Lotion: Gentle movement and walking will help keep the knee mobile and help control swelling.
Communicate Openly: Keep an open line with your physiotherapist about what you’re feeling both physically and mentally.
Follow Your Rehab Programme: This is just as important as your in-clinic sessions. The more consistent you are, the quicker you’ll notice progress.

FAQs

Q1: How long does physiotherapy last after ACL surgery? The duration varies depending on the individual, but most people need physiotherapy for about 9 to 12 months to fully recover.

Q2: Can I take painkillers before my physiotherapy session? It’s best to discuss this with your physiotherapist at The Physio Clinic Glasgow. Often, pain control can help you rehab more vigorously but won't mask more severe pain.

Q3: What if I miss a physiotherapy session? Try not to miss rehab sessions, as consistency is key to your recovery. Don't dwell on missed sessions, simply start again as soon as possible.

Return to Sport with The Physio Clinic Glasgow

Physio for ACL surgery is no picnic, but it does not have to be a nightmare either. Here at The Physio Clinic Glasgow we endeavour to make your rehab experience as painless as possible, leading you back towards full recovery. A little discomfort is good, it's where we make the most progress BUT if you feel that searing pain STOP and take advice! In some cases, with proper treatment, and a support system of family, friends and dedicated professionals on your side you will recover in no time.

To improve upon these ACL phases and get tailored physiotherapy that is true to the ACL rehabilitation guidelines from an expert, contact The Physio Clinic Glasgow today.