[This is ACL reconstruction surgery, Series Part 3, especially focused for rock climbers and active folks. Start here for the full index.]
Congrats, you're past the first 7 days!
After week 1, I used the ice machine about 2x/day when I felt like I needed it--usually at lunch and in the evening. After week 2, I discontinued the ice machine and used regular gel ice packs when I felt I needed it.
After being super diligent in week 1 with using the continuous passive motion (CPM) machine 6hrs/day, I went down to 4hrs/day. My knee had great range of motion, mostly thanks to my diligence with the ice and CPM machines in week 1. After week 2, I returned the CPM machine back to the hospital.
Week 2, I was on crutches with "toe downs," or no more than 20% weight. After week 2, I could walk without crutches as much as pain would allow. I basically attempted a few steps on day 15, which felt pretty good after I remembered how to fire my muscles at the right time to walk, and went on my way without crutches from there.
When in public, I often carried 1 crutch with me to ward off people from walking into me. You'll be paranoid at every kid running around you, at every person in the grocery store in narrow aisles, at every car that doesn't stop 5ft from the crosswalk. Despite the fact that you're wearing a full-leg brace, there's a lot of people who don't pay attention. It's not you, it's them.
In week 2, my brace was still locked at 10 degrees. OK, I might have made it more like 15 degrees to do touch-downs on crutches more easily. For weeks 3 and 4, I had it unlocked so I could walk, but put the stopper at the point that I had flexion, so I wouldn't fall on a swollen knee and shock bend it. Until end of month 1, I wore it all the time around the house and even slept with it.
At first I was dubious about still sleeping with the brace, but persisted through week 4. Getting up in the middle of the night in the dark to pee, when you're coming out of a deep sleep, is risky without a brace. Remember you're just learning to walk again after being on crutches. I've heard horror stories about people falling out of bed or stumbling their first few steps. Invest in a good knee pillow so you can sleep on your side without feeling the metal brace.
Milestones through Week 4
- Leg to full extension (primary)
- Leg to full flexion (secondary)
- Walk normally
- Start working out again
I started physical therapy in week 2, going 2x/week for the next 6 months. PT focused first on getting my leg to full extension, then full flexion, and on activating muscles, especially quads. I literally couldn't hold a quad contraction for more than 5 seconds.
For my 1st surgery using a cadaver graft, I had virtually no pain and took whatever PT threw at me. For my 2nd surgery using my own hamstring tendon, my hamstring was too painful until after week 5 to weight it too much. Lifting my heel to my butt was too painful. I concentrated on lunges and squats and using those sand-filled ankle weights to lift my leg up, to the side, and behind me.
PT is really fun and rewarding, especially in the first few weeks. You'll make quick gains, which is satisfying, and you learn a lot about how your body heals and reacts to stimulus.
Week 2 I was getting cabin fever, so I'd go on excursions around the block on crutches. It got my blood moving, my heart rate up, and saved my upper body. It's actually pretty fun doing crutches workouts on Strava and comparing day-to-day. I got up to 1.5mi on crutches!
Week 3 was my first outing to the gym. I was hangboarding for rock climbing in week 3 and doing physical therapy exercises on my own. I started suspension trainer exercises, like TRX, for my core. You can do a lot with your upper body--pullups, hanging core exercises, push-ups, IYTs, lockoffs, exercises on gymnast rings. Kettlebells are great for presses for your shoulders. Stationary bike was a staple of my workout. All exercises had forward-only mechanics, nothing side-to-side.