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ACL Series: What Seems Wrong but Is Normal.

In the last post I discussed what could go wrong, this time I’ll discuss all the things that may seem weird but are normal. Each client has asked these questions so maybe you will get a preview of what’s to come.

My leg is hot, swollen, and red, is this normal?

Yes, it really is. You just had surgery and this is the side effect. What isn’t normal is if you start having a fever, that means that there’s likely an infection. This is the time you need to see your doctor. As long as it’s around the operated knee then it’s normal.

If I start moving my leg a few days after surgery will the screw come out?

The chances are low. You’ll need to do something really extreme. It’s not like your leg will allow those movements anyway. Also, rehab is started as early as a week after surgery (to a few days), if there was a chance then rehab would start later.

Should I be worried that my leg is so much smaller than my “good” leg?

It’s normal. Every single person has their leg shrink in size. The quad muscle “disappears” after surgery. It takes quite a bit of time before the muscle looks like the “good” leg, but that doesn’t mean that it can’t support you.

When I lift my leg my knee hurts, like it’s temporarily dislocating. Will it stop?

It will stop. It’s a lag in the muscle response. When you lift your leg, the quad gets a delayed signal to keep the lower leg and upper thigh together. When the muscle finally “wakes up” it’s somewhat like an elastic recoil that slingshots the lower leg “back into place”. It feels like it dislocates but it really doesn’t, it's the recoil that makes it seem like that. Eventually, the muscle will get stronger and that delay will stop happening. Unfortunately, it’s going to be uncomfortable for a bit of time.

I don’t feel confident my leg will support me when I’m doing things while standing.

This is normal. The muscles are weak. At the beginning of rehab, you did most of the exercises seated or lying down. Once you start standing, you have to be able to support your whole body weight, not just a portion of your weight. When you walk, you transfer your body weight from one leg to the other so a lot of your body weight is supported on that operated knee. Using the stairs is even more challenging since all your body weight is on the operated knee and you're bending your knee (not just leg straight).

Once again, you’ll have to build the muscles of your whole leg. By pushing limits slowly, you’ll begin to feel more stable walking. Eventually, walking downstairs face forward will be easy too.

I’m finding that my lower back hurts, and my “good” leg is also bothering me. What’s happening?

You are compensating when you move. When you were using crutches and a cane, you shifted more pressure to one side. The “good” leg took over since the muscles were too weak to support your daily activities. In the beginning, it’s difficult to avoid the compensations since you weren’t able to walk easily on the operated knee. As soon as it’s possible, exercises will help to rebalance and undo compensations.

People are telling me I’m still limping. I don’t have pain, so why am I still doing it?

You’ve been compensating and protecting your operated knee for so long that your limp became your normal walk. You’ll have to concentrate to correct the limp. Walking backward is my go-to move to help undo this walking habit. Unless you walk backward often, you can’t help but concentrate.

I don’t have my full bending range back (flexion). It’s missing some range compared to my “good” leg.

We worry so much about the extension (straightening) of the knee since we need it to walk, so we focus on getting it back as soon as possible. Knee bending (flexion) has more flexibility. What I mean is that we don’t need full flexion to do our daily activities. The goal is always to get back everything but most activities need about 5-10 degrees less than we have naturally (depending on our activities). So we allow a bit more time for flexion so we can fully focus on extension. I’ve found in most of my clients that it’s the weak hamstrings that restrict getting those last 20degrees again. Unfortunately, it’s usually a weak muscle already and surgery usually uses one of the hamstrings to rebuild the ACL, so it means that the hamstrings get even weaker. We really have to focus on the hamstrings early on in the rehab.

Will I be able to continue my sports?

This depends but not because of the surgery. It depends on how confident you feel about your leg. I’ve had people return while others didn’t feel confident, and we made sure they were really ready to get back. So this all depends on you.

I’ve been told I can run 3 months after the surgery.

In some cases, yes that’s possible without issues. So far most clients would not be ready. They could simply go out and run, but the muscle weakness and compensations are still there. So while technically their knee is capable of running, there would be a risk of other injuries. Normally, my answer is no since my goal is never to get your knee ready to run. Getting you to where your whole body is ready to run, and doing my best to help you avoid compensation injuries is my goal.

Hopefully, these questions helped prepare you for the surgery or at least answered some questions you may have while on your rehab journey.

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