I was in the middle of a workout this week when I got a text from a co-worker.

"Hey, what graft type do you think is best for ACL reconstruction?"

I thought about the research that I’ve read over the years comparing the benefits of each graft type, remembering that quad and patellar tendon grafts seem to be slightly stronger than hamstring and allografts, but tend to deal with more anterior knee pain. I said:

“If I had to go through it again, I would probably choose a quad tendon graft.”

As a two time member of the ACL club myself, I can’t help but use my personal experiences to influence my professional guidance.

My mind wandered through the memories of grueling physical therapy sessions, the small victories that felt monumental at the time, and the moments of doubt that tested my resolve. Then I thought back to all of the patients that I had guided through their own rehab, just like my physical therapist had helped me. Using my personal experiences to help them avoid my pitfalls was so valuable in giving them the tools to return to their sport safely.

In this blog post, I'll delve into the insights gained from my dual perspective as both a patient and a physical therapist. I'll share the key lessons learned during my ACL rehabilitations – lessons that have not only influenced my professional practice but have also fueled my passion for helping others navigate their own recovery paths. Whether you're a fellow healthcare professional, a patient currently undergoing ACL rehab, or someone interested in the intricacies of sports medicine, I hope my story and insights will provide valuable perspective and inspiration for your own journey or practice.

Personal Lessons from Each Stage

Early ACL Rehab (0-4 weeks post-op)

Do more of everything.

I had my first ACL surgery when I was a sophomore in high school, and let’s just say that I am a little more proactive now than I was back then. I was a dutiful patient, but I looked at my exercises as homework that I just needed to check off the list.

Because of that, my therapist had to do a lot of the heavy lifting of getting my range of motion back…and it hurt. A lot.

She didn’t do anything wrong, she just had to be the bad guy because I wasn’t helping her out in between sessions by working on my range of motion and hammering quad sets (an early stage quad activation exercise).

The second time around, I learned my lesson. I knew that if I did as much as I could outside of my PT sessions, my PT wouldn’t have to crank on my knee.

That included resting, icing, and swelling management!

A man assists a woman with a leg stretch on a therapy table in a clinic. Boston Marathon flag, anatomical poster, and shelves in the background.

In the early stages of rehab, it can feel like the only thing you can do is sit on the couch and watch Netflix. While you do need to rest, you can be proactive in that rest.

I was icing and elevating while watching Game of Thrones. I was working on my knee range of motion almost constantly, but within my tolerance so that my knee didn’t get cranky afterwards. I was doing 100’s of quad sets per day. I was doing more of everything even though it didn’t feel like I could do much of anything. I didn’t think about “finishing my exercises for the day,” I just made them part of my routine.

The second time around, I had almost my full knee range of motion by 3 weeks post-op.

Middle ACL Rehab (2-4 months post-op)

Don’t get cocky.

In my experience both personally and professionally, this is a common place for mistakes to happen. Most of the time, you aren’t wearing a brace after 6 weeks if everything is going as planned, but you are not even close to having normal function of your injured knee. This phase can get messy for a couple of reasons:

The previous phase goals haven’t been met (full ROM, good quad control, knee swelling) but you’re worried about falling behind so you start progressing before you’re ready
You feel closer to your normal self so you start wondering if you could get back to some social activities that might be pushing your limits (which for me was paintball– I know, the cockiest of cocky)
Your doctor tells you that you’re 3 months post-op so you can start running. This one has gotten SO MANY patients into trouble. One of the most unproductive and meaningless time based milestones.

The way to get through this phase successfully is having a really strong relationship with your PT where you can rely on their judgement to give you guard rails, and evaluate when you’re ready to do more without getting distracted by the timeline.

This is a concept called criteria based progression, where to progress to the next stage of rehab you have to prove competency with skills built in your current stage. For example, no running until you can perform 30 seconds of single leg hopping with good symmetry and no pain with no soreness or swelling the next day. Doesn’t matter how long it takes. It’s like a video game where you can’t go onto the next level until you beat the current one.

Late ACL Rehab (6-12+ months)

Hold on tight to your motivation.

For people who weren’t previously doing hard lower body workouts 2-3x/week, making that adjustment and being consistent for a year is incredibly difficult. As you get closer and closer to returning to your normal activity level, the workouts get more fun, but they also get harder. It’s mentally and physically exhausting.

My motivation stayed very high during my first ACL rehab journey because I was trying to get back to playing high school soccer, and I had to make it back to sports by the time the next season’s try outs were starting. I also had my parents advocating for me, which went a long way.

My second ACL rehab journey happened in college. I wasn’t on a timeline to get back to sports, I wasn’t even playing competitive soccer anymore, and I didn’t have my parents reminding me to get back into PT.

Over 10 years later I’m still working to make my strength more symmetrical.

I often wonder how things would be different if I had been able to stay motivated for longer to finish out my physical therapy properly. Even if you’re not returning to the activity that you were doing when you injured your knee, you need to find something challenging that will motivate you to get to 100%.

Final Thoughts

The last thing that I always mention to people when they are about to go through ACL rehab is to find a PT that they both like and trust.

If you just met your PT and they aren’t giving you good vibes, or they don’t work with athletic people, or they haven’t had many ACL cases, it’s worth finding someone who does. You’re going to be seeing a lot of them.

The relationship that I made with my physical therapist was so special to me that I became one myself. Don’t settle!

At Alterra, we are shaking up the traditional PT experience to make it better using our personal and professional experiences. If you're local to Boston's Back Bay and are trying to figure out where to do your ACL rehab, we'd love to help! Book a free discovery call to chat with a therapist today.

Book Free Discovery Call

Next on your reading list: