Knee pain after an ACL reconstruction?  

ACL reconstructions are a very common surgery/injury in the athletic population.  Once someone has had a surgery like this, it is not uncommon to have anterior knee pain or pain in the front of the knee after the surgery.  This type of pain can typically occur around 1-2 months after and can persist for periods if not addressed appropriately.

There are a multitude of reasons why someone may have pain after a knee surgery. Make sure to check out Part I, HERE, for other reasons why this may occur.

1. Quadriceps Specific Loading

All the movements mentioned in Part I are great, but specifically, after this type of surgery, isolated quadriceps work is needed.  Lunges, etc. will work the quad, but if there is weakness present, the glutes, hamstrings, etc. will take over and not provide the necessary workload to strengthen the quad.

Movements that are great at isolating the quads are:

Resisted Knee Extension

Quadruped Resisted Knee Extension (Single or Double Leg)

TRX Assisted/Unassisted Nordic Quads

These can be added into a well-structured PT/strength and conditioning program so that athletes have a sufficient base of quadriceps strength when they start doing higher-level activities.

2. Learning to Absorb Force

After ACL reconstruction and once an athlete has built up their strength and conditioning base, the athlete needs to learn how to absorb force properly again.

A few drills that I like to use are:

Drop Squat Variations

Pain can sometimes occur with these variations.  I will speak with the athlete and tell them that the pain should be:

• No > 3-5/10

• As you do more reps, the pain stays the same or lessens

• As you do more sets, the pain stays the same or lessens

• When you stop, the pain stops

• The next day, the pain is no worse than it normally is.

If these principles are true, I am fine with having the athlete work with some type of pain and discomfort.  If it is worse than a 5/10, I will advise them to go to an easier variation until these principles are true.

Patella tendon pain after an ACL Reconstruction using or not using a patella tendon graft can be quite common.  Make sure to find a Massachusetts physical therapist and/or strength and conditioning coach that has worked with these types of athletes and surgeries to help you.