Rehabilitation Strategies for ACL Tears and Chronic Pain After Injury

Anterior cruciate ligament tear

Hello doctor, I had a car accident in December 2018 that resulted in a fracture of my lower leg.
After having a bone screw inserted, I underwent rehabilitation for over a year, but my entire lower leg remains stiff and painful, even light touch causes pain.
The doctor mentioned it might be a nerve injury issue.
In June 2020, I decided to undergo another surgery to remove the bone screw, but all my symptoms persisted, and I also suffered a torn anterior cruciate ligament (ACL) due to the procedure.
Currently, my entire lower leg is still stiff and painful, light touch is also painful, and my knee ligaments are very sore.
There are still bruises on my lower leg that haven't faded, and although the bone has healed, the fracture site still hurts.
I have continued with general physical therapy, but there hasn't been much improvement.
The doctor suspects it might be complex regional pain syndrome (CRPS).
If that is the case, will my condition improve? The area around my knee ligaments is really uncomfortable, and the doctor said that ongoing electrical stimulation therapy would help, but since it has been such a long time, are there better rehabilitation methods to aid in the recovery of the ACL? Thank you, doctor!

J, 40~49 year old female. Ask Date: 2021/03/14

Dr. Wang Zhaomin reply Rehabilitation

Sympathetic nerve dystrophy and fracture joint pain can persistently cause distress.
Treatment with rehabilitation physical therapy modalities and manual exercises can improve the condition, but not all patients can achieve complete recovery.
The actual situation needs to be assessed through an in-person examination, as online consultations cannot replace a physical visit.
Please consult a neurosurgeon, orthopedic surgeon, or rehabilitation specialist for an accurate diagnosis and appropriate treatment.

Reply Date: 2021/03/14

More Info

Rehabilitation strategies for ACL (anterior cruciate ligament) tears and chronic pain following an injury can be complex, especially in cases where there are additional complications such as nerve damage or reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome (CRPS). Your situation, which involves a history of significant trauma, multiple surgeries, and persistent pain, requires a multifaceted approach to rehabilitation.

Understanding Your Condition
From your description, it seems that you have been dealing with chronic pain and stiffness in your leg following a series of injuries and surgeries. The fact that you experience pain even with light touch suggests that there may be a neuropathic component to your pain, possibly related to nerve injury or RSD. RSD can occur after an injury or surgery and is characterized by severe pain, swelling, and changes in skin color and temperature.

Rehabilitation Strategies
1. Physical Therapy: Engaging in a structured physical therapy program is crucial. A physical therapist can design a rehabilitation program tailored to your specific needs. This may include:
- Range of Motion Exercises: Gentle stretching and mobility exercises can help improve flexibility and reduce stiffness in the knee and ankle.

- Strengthening Exercises: Focus on strengthening the muscles around the knee, including the quadriceps and hamstrings, to support the joint and improve function.

- Proprioceptive Training: Balance exercises can help improve coordination and stability, which is particularly important after ACL injuries.

2. Pain Management: Since you are experiencing significant pain, a comprehensive pain management approach is essential. This may include:
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain. If neuropathic pain is present, medications like gabapentin or pregabalin (Lyrica) may be beneficial.

- Nerve Blocks: In some cases, nerve blocks or injections may be considered to help manage pain.

3. Electrical Stimulation: As your physician mentioned, electrical stimulation therapy can be effective in promoting healing and reducing pain. This includes modalities such as TENS (transcutaneous electrical nerve stimulation) or interferential current therapy, which can help modulate pain signals.

4. Heat and Cold Therapy: Alternating between heat and cold applications can help manage pain and swelling. Heat can promote blood flow and relax muscles, while cold can reduce inflammation and numb sharp pain.

5. Hydrotherapy: Water-based exercises can be particularly beneficial for individuals with joint pain, as the buoyancy of water reduces stress on the joints while allowing for movement.

6. Psychological Support: Chronic pain can take a toll on mental health. Cognitive-behavioral therapy (CBT) or other forms of psychological support can help you cope with the emotional aspects of chronic pain.

7. Alternative Therapies: Some patients find relief through acupuncture, massage therapy, or chiropractic care. These modalities can help alleviate pain and improve function.

8. Surgical Options: If conservative measures fail, discussing further surgical options with your orthopedic surgeon may be necessary. This could include procedures to address any structural issues in the knee or to relieve nerve compression.

Prognosis and Expectations
The prognosis for recovery from ACL injuries and associated chronic pain varies widely among individuals. Factors such as the extent of the injury, the presence of nerve damage, and the effectiveness of rehabilitation efforts all play a role. While some patients experience significant improvement with appropriate rehabilitation, others may continue to have chronic pain and functional limitations.

It is important to maintain open communication with your healthcare team, including your orthopedic surgeon and physical therapist, to monitor your progress and adjust your treatment plan as needed. Regular follow-ups can help ensure that you are on the right track and that any emerging issues are addressed promptly.

In conclusion, while the road to recovery may be challenging, a comprehensive and multidisciplinary approach to rehabilitation can help you manage pain, improve function, and enhance your quality of life.

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