So, you’ve just been diagnosed with an ACL tear. Ouch! It’s normal to feel overwhelmed and unsure about what to do next. While surgery is often the go-to solution, it’s not the only option. For many people, non-operative rehab can be a highly successful way to recover and get back to doing the things they love.1
As a physiotherapist, I’ve seen firsthand how effective non-surgical treatment can be for the right individuals. Let’s dive into what you need to know about this approach:
Who might be a good candidate for non-operative rehab?
- Those with less demanding lifestyles: If your daily life and activities don’t involve a lot of pivoting, jumping, or cutting movements (think desk jobs or recreational activities like walking or swimming), you might be an ideal candidate.
- “Copers”: This refers to individuals who naturally have good knee stability even after an ACL tear. Specific tests and assessments can help determine if you fall into this category.
- Kids and teens: In some cases, it’s best to delay surgery until skeletal maturity to avoid potential growth plate complications.
- Those who prefer to avoid surgery: Whether due to personal preference, medical conditions, or other factors, surgery isn’t always necessary.
What are the benefits of skipping surgery?
- No surgical risks: You’ll avoid potential complications associated with surgery, such as infection, anesthesia, or blood clots.
- Faster initial recovery: Without surgery, you’ll likely regain basic function and mobility more quickly in the early stages of recovery.2
- Less expensive: While you’ll still need physiotherapy, avoiding surgery can significantly reduce your overall medical expenses.3
- Maintain your natural knee: Surgery involves grafting and other procedures that can alter the structure of your knee. Non-operative rehab helps you preserve the natural integrity of your joint.
What does the research say?
More and more research is showing that conservative management can be just as effective as surgery for the right people. Studies have demonstrated that with a dedicated rehab program, many individuals can return to their pre-injury activity levels without going under the knife.4
What does non-operative rehab involve?
Non-operative rehab is a comprehensive and structured process, much like post-surgical rehab.5 Here’s a general overview:
Phase 1: Reduce Pain and Swelling (0-6 weeks)
- Goals: Decrease pain and inflammation, regain full knee extension, and restore a normal walking pattern.
- Techniques: This phase often involves rest, ice, compression, elevation (RICE), gentle range-of-motion exercises, and gradually increasing weight-bearing as tolerated.
Phase 2: Build Strength and Stability (6-16 weeks)
- Focus: Strengthen the muscles surrounding your knee, including your quadriceps, hamstrings, glutes, and calves.6
- Proprioception Training: This involves exercises that challenge your balance and coordination to retrain your knee’s awareness in space. You might use tools like balance boards, wobble boards, or resistance bands.
Phase 3: Regain Function (16+ weeks)
- Activities: Gradually introduce more demanding exercises like squats, lunges, and step-ups to mimic real-life movements.
- Progression: Your physiotherapist will carefully monitor your progress and ensure you’re safely loading your knee.7
Phase 4: Return to Activity (9-12 months)
- Plyometrics: These are exercises that involve jumping and hopping to help you rebuild power and explosiveness.8
- Agility drills: You’ll practice movements specific to your sport or activity to prepare for a safe return.9
Important Considerations:
- Commitment is key: Non-operative rehab requires dedication and consistent effort. You’ll need to diligently follow your program and work closely with your physiotherapist.
- Re-injury risk: While rehab significantly reduces the risk of re-injury, it’s important to be aware that it’s still a possibility, especially with high-impact activities.
- Individualized approach: Everyone’s recovery journey is unique. Your rehab plan will be tailored to your specific needs and goals.
A New Development: The Cross Bracing Protocol (CBP)
Recent research has shown promising results with the Cross Bracing Protocol.10 This involves wearing a specialized brace that positions your knee in a slightly bent position for a period of time, allowing the torn ACL to heal naturally.11 CBP has shown high success rates in certain types of ACL tears, enabling individuals to return to their desired activity levels without surgery.12
Ready to explore your options?
If you’re considering non-operative management for your ACL tear, the first step is to schedule a thorough assessment with a qualified physiotherapist. They will evaluate your knee, discuss your goals and lifestyle, and help you make an informed decision about the best course of action for your recovery.
Remember, you’re not alone in this journey! With the right guidance and support, you can achieve a successful recovery and get back to doing the things you love, with or without surgery.
