How To Keep Balanced With Pilates After ACL Surgery

Therapydia Pilates ACL Tear Treament

If you’ve had surgery or suffered a major injury to your ACL, you’ve likely felt immobile as you worked through the recovery process. Your ACL works as a rotational stabilizer for the knee. When you make quick turns or sharp movements, it keeps your knee as stable as possible. Objectives during ACL rehabilitation are to make sure you can fully move your knee through every range of motion. Pilates comes into play as a solution that furthers your ACL recovery. One major component of ACL treatment is to rebuild strength in the muscles that surround your hips and thighs such as your quadriceps, hamstrings, and glutes. Pilates doesn’t put too much stress directly on your injured knee but gives you all the tools to increase strength and flexibility.

Reforming The Knee

Therapydia ACL Injury Treatment

Pilates has different exercise options available depending on how much weight you can put on you knee. Working on a reformer, as opposed to a mat or chair, can help you begin doing Pilates moves much earlier. A reformer is a piece of equipment used in Pilates which looks like a bed with springs, a sliding carriage, and resistance bands. If you’ve had ACL surgery, it allows you to stay horizontal and have lighter resistance on your injured knee as equipment guides you to strengthen the muscles around your knee joint. Common movements on the reformer involve footwork and side-lying movements for your injured knee. You’ll begin correcting any muscles that aren’t aligned in your lower body, which will help your knee recover by keeping it stable as you start walking.

Stabilize Your Knee Joint

Once you start being able to bear more weight on your knee, you have the option of doing some Pilates mat work. Since you’re able to move around a bit easier, you’ll work on continuing to increase the range of motion of your knee that may have started on the reformer. Better alignment throughout your spine and pelvis is key. Instead of just focusing on strengthening your injured knee, you’ll be increasing flexibility around your back, core, and hips as well. Without alignment in those areas, you’ll be putting too much force on your injured knee. All pilates exercises are designed to have built-in postural awareness to improve spinal alignment. You might be able to do an exercise like The Saw to not only stretch the hamstrings but also your abdominals and the muscles of your back. These all work together to promote a more stable knee joint.

Therapydia ACL Injury Treatment

• Sit up straight on your bottom
• Extend your legs in front of you, keeping your feet shoulder-width apart
• Stretch your arms out to the side, palms facing forward
• Inhale and twist to the right, keeping your abdominals and hips steady
• Reach the pinky finger of your front hand across the outside of the opposite foot
• Touch your little toe if you can, but move in that general direction if you can’t
• Once you’ve gone as far as you can, inhale and untwist back to sitting position
• Repeat the same movement on your other side

Retraining your injured knee to have the balance you need after an ACL injury is tricky. That’s why another point of focus is on your hips. A move like Swimming builds a lot of much needed strength in your core, glutes, and hamstrings. That way, you’ll be more balanced and put less pressure on your healing ACL.

• Lay on your stomach with your legs together in parallel
• Keep your arms stretched straight overhead and the tip of the nose to the mat
• Pull in your abdominals so you lift your belly away from the floor
• At the same time, keep your tailbone moving down towards the mat
• Reach out and extend your arms and legs in opposite directions
• Focus on getting length in your spine so your head moves up off the mat
• Continue to reach your arms and legs out as you alternate sides
• Pump them up and down in small pulses

Staying Balanced

After ACL surgery, what you need from your body is better strength and balance. Using Pilates to develop strength in your back, core, and hips will give your body the alignment it needs. That way, you’ll develop your body’s sense of balance which was thrown off after your ACL injury. You’ll be able to use Pilates to focus on specific weaknesses and retrain imbalanced muscles that may have contributed to your injury. Having musculoskeletal issues in your body will delay recovery and continue to strain your knee. Pilates allows you to maintain control, balance, and coordination in your healing knee. Talk to your physical therapist to see if Pilates is an activity you can do to complement your ACL rehabilitation.

ACL Recovery Timeline: Treatment Breakdown

A common athletic injury that you’ve probably heard about might have to do with tearing the ACL. The ACL, or anterior cruciate ligament, joins the upper leg bone (femur) with the lower leg bone (tibia) and functions as the primary rotational stabilizer for the knee. When you’re moving forward, such as when you’re running, the ACL isn’t really involved. It only comes into play when you’re cutting around or changing directions to stabilize the knee joint area. An ACL injury commonly happens when you rotate too quickly or with too much force in that joint area, which causes your ACL to overstretch and tear. Depending on how badly torn the ligament is, you may be a candidate for surgery to repair the damage. Post-surgery, you will likely feel immobile. You may wonder how you’ll ever get back on your feet again. Although the timeline for ACL recovery varies depending on your specific injury, you should expect 4-6 months of one-on-one treatment with your physical therapist.

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0 Weeks, Treatment Before You Even Have Surgery

Pre-rehabilitation physical therapy, or “prehab”, is a form of physical therapy that begins before you have scheduled surgery. Prehab focuses on increasing strength and flexibility of the muscles in your surgery area. Although the surgery will fix the tear, it will also cause the muscles in the knee area to become weak and stiff. You’ll want to strengthen all the muscles that will aid in keeping you balanced post-surgery. Undergoing prehab before surgery has been proven to improve knee function faster after surgery. One study in 2013 found that patients participating in prehab returned to sports almost 2 months faster. Prehab treatment might involve building up quadricep and core strength pre-surgery so you’ll see greater knee stability and faster recovery post-surgery. It could also involve teaching you how to use assistive devices (i.e. crutches) and tackling tricky movement barriers, such as stairs, so you know how to move around after surgery.

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0-4 Weeks, Baby Steps

Many of the same goals you would want to achieve in prehab also apply here in the initial phases of physical therapy treatment. Some of these processes may vary depending on your doctor’s protocols. Main priorities will be to reduce inflammation, regain range of motion of the knee (i.e. bending and straightening the knee), and begin to slowly withstand bearing weight on your injured knee so you can start to walk. Making sure you have the proper flexibility includes immediate manual therapy, or hands-on techniques, that your physical therapist will perform on the surface of the knee joint and the muscles surrounding it. A common complication post-surgery is stiffness and loss of range of motion because of excess scar tissue formation. Your physical therapist will manually breakdown any scar tissue restrictions that may be developing in your knee. Manual therapy can also help decrease swelling around your knee. You’ll slowly wean off of your dependence on crutches as your knee tolerates. Important exercises in this phase of rehab (i.e. straight leg raises, half squats, partial lunges, etc.) will be targeted toward quadricep strength. By strengthening the muscles at the front of your thigh, walking will become that much easier and the knee will feel more stable.

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4-10 Weeks, Getting Back To Walking

At this point, the goal is to start getting your natural walking pattern back. You want to be able to control your walking movements again, which means you may have to begin some balance training. Both the fact that your knee is injured and that you haven’t been using your injured knee very much will have thrown your body’s sense of balance off. Guiding you back into proper walking form involves a combination of continued manual therapy and personal exercise-based treatment. It’s key to start building up balance on your weaker leg by doing some one-legged activities. There will also be a focus on building up strength and full flexibility in the muscles around your hips as well as the muscles around your knee. With improved strength in your hips and quads, you’ll be putting less pressure on your healing ACL. You’ll be working your way from exercises such as single-leg squats to step-up and step-down techniques (using a step) as well as resistance training with a band.

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12-16 Weeks, Starting Some Light Running

By about 3 months, any swelling you had will likely be gone. You also should have full range of motion in your knee, which means being able to extend and bend without restriction (135-145 degrees for bend, 0 degrees for extend). If you still have muscle stiffness, your physical therapist will apply more manual therapy to any specific muscles that are restricting your ability to extend or bend your knee. Depending on your unique recovery progress, your knee joint may still need to be manually mobilized in a certain way. Any basic aspects of leg movement should be back under control, such as naturally walking or being able to move around casually. Your personal ACL treatment program will continue building strength in your core and lower body muscles. You might be doing some endurance training on a stationary bike, elliptical, or treadmill. At this point, you will want to do some more advanced balance training on balance boards or bosu balls to ensure that your healing leg is stabilizing well. Your physical therapist will want to customize your treatment to make sure that you’re treating any balance issues that were caused by your ACL injury. At some point in this phase, you might begin lightly running, jumping, or getting back into any physical activities you used to do.

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4 Months+, Getting Back In The Game

There’s a range of what patients with a healing ACL injury might begin to do around 4 months. Everyone has different preferred physical activities and you’ll begin to get back into your favorite activities at this point. If you played basketball, you might begin some shooting drills. If you’re a runner, you might begin getting back into some longer jogging. It all depends on what your activity takes to get back into. You don’t want to halt any progress you made by overly exerting your knee, but certain sports-based drills will be okay to practice. Your treatment program post-injury should focus on not only reducing pain, but building up your body’s strength and flexibility in a way that prevents a future ACL tear. Beyond that, you’ll be given the tools you need to have better endurance, balance, and coordination with your healing knee. You may feel totally thrown off balance and mobility-wise after your ACL injury, but one-on-one treatment is meant to steadily get you back to 100%.