ACL Injury, Repair, Recovery & Rehab from the PT - Patient Perspective • Posts by EIM | Evidence In Motion Skip To Content

ACL Injury, Repair, Recovery & Rehab from the PT – Patient Perspective

February 8, 2023 • Dry Needling • JJ Thomas

You can’t understand someone until you’ve walked a mile in their shoes (or immobilizer). 

Almost anyone who’s witnessed an ACL tear of a professional athlete can recognize it—the  classic grab of the knee and rocking motion makes the injury evident to even someone without formal medical training. As clinicians, we are trained to ask questions like, “ Did you hear or feel a pop?”  Yet when it’s happening to you (especially if you’re an optimist), those signs become less concrete, and much more easily blurred into DENIAL.

The Injury Event 

The very second I felt my knee shift and pop after a seemingly benign take-down in my jiu jitsu training, I knew I had just entered a door that was going to lead to a long road to recovery.  Yet somehow, I dove into my experience with pain neuroscience education and convinced my brain that I was safe as I waited for my MRI approval from insurance.

I was basically raised with pain neuroscience before it was a thing. My mother frequently chanted things to us like, “Thoughts are things,” and, “You’re such a fast healer.”  So I continued to work through my knee limitations (and my denial) while I waited for my MRI approval.

As a trained optimist, I was somewhat shocked when my MRI came back with a torn ACL. Looking back, while I knew it on the rational level of my brain, I was so conditioned to remain positive that I was able to suppress the acceptance of reality until the facts were undeniably staring me in the face…and maybe until I was really ready to accept the journey I was about to embark on.

So I put my big girl pants on and started working through some decisions. Do I try to rehab it conservatively? I am a strong, trained, healthy individual who has a lot of potential to do so. The research is in my favor for potential success and also for delayed surgery should I not succeed with conservative treatment.

What’s interesting is I’ve had the “pros/cons” conversation with my patients thousands of times. The dialogue with them has always been complete in my mind. However, I was very wrong—a patient cannot express the entirety of the inner dialogue their brain is working through during this process. Like a high stakes cocktail party, our brains are working overtime to check in with all the interested parties, relevant memories, and invested interests of our past, present and future. It’s something that no bystander can replicate or begin to really address fully in a few side conversations. Experience is key to this type of insight.

Now I’m not saying our role as clinicians in this process is not valuable, because there are many times people need help accessing their thoughts and decision-making values. But now that I’ve been “on the other side,” I have a greater appreciation for the personal nature of this process.

The Decision to Operate 

  1. I wanted to continue to do things like heli-skiing without hesitation or wonder if I “should’ve” had surgery.
  2. I have a doctor in whom I have 100% faith and trust in his work.
  3. As my mother said, I’m a fast healer.

So with my big girl pants buckled and my clinician hat on, I moved forward with the surgery, and can say I’ve learned a TON of nuggets that will help me be a better clinician in the future.

What I learned… 

  1. Pain neuroscience education (and having the clinical background to truly understand the nature of tissue healing and symptoms associated with tissue healing) saved me from having to use a nerve block for the surgery OR use any pain meds. Armed with these two things, I had barely any complaint of pain throughout the recovery. (I also must credit my surgeon here too, as his work is meticulous and clean, which we all know helps tremendously).
  2. Little things matter. Coming out of surgery with the full understanding of the importance of early rehab goals such as limiting swelling, restoring passive extension, getting that quad to fire, and early weight bearing, allowed me to progress at a very rapid rate. This fueled a positive cycle of allowing me to bear weight, manage my pain through movement, and recover faster altogether.
  3. Three days a week of therapy is not enough early on. Having the opportunity to rehab like it was my full-time job for three weeks was key. I know it’s not realistic to ask patients to come into therapy for five days a week. However, I will say I’ve changed my expectation for patients’ post op “homework” ACL reconstruction after my experience. I now give clear but lofty goals for home exercises, especially during those first few weeks. They are cycling through exercises to address goals throughout the entire day, and we are very clear in the expectations. Quad sets up the wazoo. Passive knee extension and E-stim 2-3 times per day are non-negotiables that first week. Progressions and out-of-the-box thinking like doing accessory work through the ankle and hips as soon as possible. And the difference we are seeing in patients has been remarkable.
  4. For the athlete, feeding their need to burn energy (within the boundaries of the post op protocols) is HUGE. Finding creative ways to challenge my body, get the blood flowing, and keep the rest of me strong through the early phases was empowering and also helped my knee regain power and control faster. The rest of my body was “ready to go” when my knee was.
  5. While the first four months of rehab allowed me to progress faster than what’s typical, tissue healing time for the graft is not negotiable. I’m 4.5 months out now. I am running (still progressing slowly), jumping, lifting, and controlled drilling jiu jitsu with safe partners. I feel good. I feel antsy. I KNOW I need to respect the healing time and I will continue to do so. The patient in me sympathizes with athletes who are jonesing to get back to their sport before the recommended 9-12 months. While the therapist in me is thankful I understand the importance of our processes and testing protocols on a higher level.


The Bottom Line  

Recovery is a balance of many factors. Living this experience has highlighted some really important lessons for me. We are human, and the injury grieving process is real and different for everyone. Knowing something and KNOWING something are two different things. Our minds are very powerful, and learning to tap into that power is a skill worth cultivating. Our bodies respond when given the opportunity and challenge to do so. Details matter. Consistency is critical. We are resilient beings when given the right conditions and allowing ourselves to tap into our own potential.

JJ Thomas

JJ owns Primal Physical Therapy, a private cash-based practice in Bryn Mawr, PA. With over 20 years as a physical therapist, her unique experiences and training have shaped her into the successful clinician and educator she is. JJ holds certifications in a variety of advanced specialty techniques and methods, all of which complement her role...

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