Recovering from ACL Rehab: Overcoming Setbacks and Pain Management

"Slipped while rehabilitating the anterior cruciate ligament."

Hello, doctor.
A few days ago, I asked about "slipping during ACL rehabilitation," and I appreciate your response.
Initially, my original doctor mentioned that the MRI showed a white area near the upper side of the knee bone, suggesting possible muscle contusion or near rupture.
I was then referred to a specialist in knee injuries, who said we needed to discuss it further.
Ultimately, the conclusion was that it was just a knee sprain, and the ligament below the knee (which I found online might be the patellar ligament) was loose.
The doctor said I wasn't taking rehabilitation seriously, which would prolong my recovery period (during the two weeks of waiting for the MRI results, when the situation was unclear and swollen, I was afraid and unable to rehabilitate).
He mentioned that my injuries were also due to not being diligent in rehabilitation (resulting in muscle stiffness and weakness).
It has been three weeks since I slipped, and now the swelling in my knee has decreased somewhat, but I can only bend it a little.
Now, nearly four months later, the rehabilitation therapist says my bending angle is 55 degrees (it was about 110 degrees three months ago).
My muscles are very stiff, painful when pressed, and atrophied even more, especially in the thigh.
Strangely, the muscles above the knee have become loose and more mobile.
The doctor said I could stop using two crutches once I can lift my leg while lying down, and I can remove the knee brace once I can straighten my leg while sitting.
The brace has been adjusted from 20 to 40 degrees.
The rehabilitation therapist has only instructed me to perform active knee bending and muscle contraction exercises.
Previously, I could only actively bend my knee to about 90 degrees, and then I was forced to bend it to about 110 degrees using a resistance band (but afterward, it quickly returned to 90 degrees).
Now I can't use the resistance band; I'm unsure what exercises can effectively improve my bending angle.
What should I do if there is no progress? Is surgery under anesthesia the only option, or is there a possibility of adhesions surgery, or am I left with no options? Is there a way to salvage the atrophied muscles? What exercises should I do? Also, will the looseness of the patellar ligament affect my rehabilitation? It has been three weeks since I slipped, and I still experience pain in the area below the knee (possibly due to the looseness of the patellar ligament?) and behind the knee.
Is this normal? The MRI showed a white area near the upper side of the knee bone; why did the original doctor suggest possible muscle contusion or near rupture, while the knee specialist concluded it was just a knee sprain? (He lightly pressed on the muscles above my kneecap and repeatedly asked, "Does it hurt?" I didn't respond with pain because the atrophied thigh muscles hurt wherever pressed, making it hard to differentiate.) In two months, it will be six months since the surgery, with weekly visits to the rehabilitation therapist and monthly visits to the doctor.
I'm very worried that time will pass like this, and my leg will be beyond help...
I've heard that the longer it drags on, the more sequelae there will be.
What kind of sequelae can arise?

kimochi, 40~49 year old female. Ask Date: 2012/03/27

Dr. Shi Guozheng reply Orthopedics

After anterior cruciate ligament (ACL) surgery, the typical rehabilitation period is about six to nine months.
Although you have sustained another injury, the good news is that there is no further significant damage.
Therefore, continuing with rehabilitation therapy to strengthen your muscle strength is the best course of action.
Keep it up! It is possible that you may gradually experience lingering effects such as muscle weakness and persistent pain.

Reply Date: 2012/03/27

More Info

Recovering from an ACL (anterior cruciate ligament) injury can be a challenging journey, especially when setbacks occur, such as slipping and potentially exacerbating the injury. It’s understandable to feel frustrated and concerned about your progress, particularly with the pain, swelling, and limited range of motion you are experiencing. Here’s a comprehensive overview of how to manage pain, improve rehabilitation outcomes, and address your concerns regarding muscle atrophy and ligament stability.

Understanding Your Current Condition
From your description, it appears that you have experienced a significant setback in your recovery process. The initial assessment indicated potential muscle damage, but subsequent evaluations suggested a less severe knee sprain. This discrepancy can be confusing, but it’s important to focus on the current symptoms and work with your healthcare providers to develop a tailored rehabilitation plan.

Pain Management Strategies
1. Medication: Continue using prescribed pain relievers as needed. Over-the-counter options like acetaminophen or NSAIDs (non-steroidal anti-inflammatory drugs) can help manage pain and reduce inflammation. Always consult your physician before making any changes to your medication regimen.

2. Ice Therapy: Applying ice to the knee can help reduce swelling and numb the pain. Aim for 15-20 minutes of icing several times a day, especially after rehabilitation exercises.

3. Elevation and Compression: Keeping your knee elevated can help reduce swelling. Using a compression bandage can also provide support and minimize swelling.

Rehabilitation Exercises
Given your current limitations, it’s crucial to focus on gentle, progressive exercises that promote mobility without exacerbating pain. Here are some suggestions:
1. Range of Motion Exercises:
- Heel Slides: While lying down, slide your heel towards your buttocks and then back to the starting position. This can help improve knee flexion.

- Quadriceps Sets: While sitting or lying down, tighten your thigh muscles and hold for a few seconds. This helps strengthen the quadriceps without moving the knee.

2. Strengthening Exercises:
- Straight Leg Raises: While lying down, keep one leg straight and lift it to the height of the opposite knee. This strengthens the quadriceps without putting stress on the knee joint.

- Wall Sits: Stand with your back against a wall and slide down into a sitting position, holding for a few seconds. This can help strengthen the muscles around the knee.

3. Gentle Stretching:
- Hamstring Stretch: While sitting, extend one leg straight and reach towards your toes to stretch the hamstring without straining the knee.

Addressing Muscle Atrophy
Muscle atrophy can be a significant concern following an injury. To combat this, focus on:
- Progressive Resistance Training: As your pain decreases and range of motion improves, gradually introduce resistance exercises using bands or light weights.

- Functional Activities: Incorporate activities that mimic daily movements, such as standing up from a chair or walking, to promote muscle engagement.

Concerns About Ligament Stability
If there is a concern regarding the patellar ligament's stability, it’s essential to communicate this with your healthcare provider. They may recommend specific strengthening exercises for the muscles surrounding the knee to enhance stability and support.

When to Seek Further Help
If you continue to experience significant pain, swelling, or limited range of motion despite following your rehabilitation plan, it may be necessary to consult with your orthopedic specialist. They may consider imaging studies to assess the current state of your knee and determine if further interventions, such as surgical options, are warranted.

Potential Long-Term Effects
Delaying rehabilitation can lead to chronic pain, instability, and further muscle atrophy. It’s crucial to stay proactive in your recovery. Regular follow-ups with your physical therapist and orthopedic surgeon will help monitor your progress and adjust your rehabilitation plan as needed.

Conclusion
Recovering from an ACL injury requires patience, persistence, and a well-structured rehabilitation plan. Focus on gradual improvements, communicate openly with your healthcare team, and stay committed to your recovery exercises. With time and effort, you can overcome these setbacks and regain strength and function in your knee.

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