Regaining Knee Flexion During ACL Rehab: What's getting in the way of a smooth journey and how to get ROM back with less pain

Getting knee flexion back after ACL surgery can feel slow and painful. But it doesn't have to be.

Is it feeling really hard to get your knee flexion back after ACL surgery?

Do you dread going to physical therapy because of the pain and discomfort you feel when your PT tries to bend your leg…

And then leave feeling even more discouraged than you were before the session started because it doesn’t seem like you’re making any progress?

Is your surgeon suggesting that you might need another surgery to remove the scar tissue so that your knee can bend normally again?

If you’ve been super dedicated to your home exercise program and you feel like you’ve been a straight-A student at doing everything you’ve been told in your rehab, I feel you and ooooooh my heart goes out to you!

🛑 Pause. Take a big breath in. Let it go slowly. And then remind yourself that it is totally human to feel the way you do – and you’re ALLOWED to. 

These feelings do not mean that you’re weak or oversensitive. They’re trying to tell you something important. 👇🏻

The problem with your knee flexion is not about how hard you (or your PT) have been working.

There’s nothing wrong with your body. And you are definitely not broken (even though I know it is sooo easy to think these things... and they make sense, too).

The reason for so much hard work and very little progress could be that the approach to getting your flexion back is not the approach that works best for the whole version of YOU – body AND mind.

Hear me out. 💖

Every human is designed to protect themselves from threats, and pain is often a warning sign that a threat is present.

Plus, when you’re feeling scared about something, the drive for self-protection becomes even stronger.

Short and sweet – the thoughts and feelings that bubble up in your mind directly impact what happens in your body.

So when you go to PT for the first time after a major surgery like ACL surgery that involves lots of pain, swelling, bruising, and stiffness… and then your therapist says she’s going to bend your leg for you, your brain senses danger because pain is already present.

And then when she bends your knee and you get the burst of pain accompanied by sweating and the feeling you might throw up, your brain is sending off every siren saying “DANGER, DANGER, DANGER” !!!

🤔 So what does your body do? It tries to protect you.

Your muscles tighten up no matter how hard you tell them to relax.

And when your body is clenching every muscle as hard as possible, it’s almost impossible for your knee to bend anywhere close to its full potential. 

🤦🏼‍♀️ Cue endless pattern of frustration and defeat… 

That is until you learn that things can be different and discover what you can do differently to finally achieve the success and freedom in your body that you’ve been craving. 🙌🏻

Before I reveal this, though, let's dive a little deeper into what's currently happening.

After digging holes into your PT's treatment table while you sweat through your clothes and try to hold back tears (all in a matter of 5 minutes that actually feel like an eternity), you and your PT decide that’s enough for one day and you’ll try again next time.

😮‍💨 Phew – sigh of relief. 

You can relax now… until tomorrow when you’re already dreading your next appointment that’s 3 whole days away, because you’re scared that it will be the same experience as last time.

Painful, nauseating, defeating, useless.

🙋🏼‍♀️ I get it – I’ve felt all of this, too. It totally sucks (and it shouldn’t have to be this way… more on this in a minute).

This does not mean that your body is less capable than another ACL warrior who seems to be hitting their milestones easily and passing their tests with flying colors.

The truth is that your body and brain have been traumatized by the process of getting your knee flexion back. 

And as it should, your body is demonstrating a trauma response. (Invitation here to let your body know how much you appreciate it’s hard work and now see that it’s working on the same team as you! Script: “Thank you, body, for trying to keep me safe.”)

The solution is not pushing harder and powering through… because as you’ve already experienced, this approach exacerbates that trauma response even more.

👉🏼 So what do you do instead?

The details will differ from one person to another, but the rewiring process can be simple.

1. Take a break from the approach that you/your PT have been using. If your PT isn’t up for that, then search for a new one. (Note: it's totally okay for you to break up with your PT and find one that feels like a better fit. This does not make you or your PT a bad person. It's a sign that you respect your experience and are committed to your recovery goals).

2. Give yourself the space to acknowledge, experience, and heal the trauma (Not sure how to do this? Coaching from a Certified Mindset Coach who knows what it’s like to be an ACL-injured athlete can be AWESOME here – and hint: that person is me!)

3. Identify what was/wasn’t working in the original approach and create a new one.

4. Continue to evaluate the process honestly and openly with your rehab team to ensure a successful journey.

In my experience both personally and professionally when it comes to rehabbing an ACL injury – especially when it comes to getting your motion back – I’ve learned that most of us humans feel safest when we also feel in control (ie. you’re the one in charge of how hard and fast you bend your knee.. Not your PT).

When you feel safe and in control, your body can finally relax and move into its full potential of available motion. 

This is why I always let my patients stay in the driver’s seat when we’re working on flexion and extension exercises – and not surprisingly, the process always seems to happen faster and smoother.

This is not to say that I don’t ever put my hands on your knee during your rehab process – because sometimes manual therapy is needed to free things up in your body to help your knee move more easily.

But when you work with me, I will never force your knee into a certain position with my full body weight until you’re crying on the table and blue in the face. It’s just not worth it for either of us.

And honestly, you deserve WAY better than that!

📍So if you live in Bend, OR and you’re awaiting ACL surgery or have already had it and are looking for a PT who knows how to get you through this recovery feeling strong, confident, and free in your body so that you can get back to the sports you love, I’d love to work with you!

You can book a free Discovery Call here, during which we can talk about your story, ideal rehab experience, and ACL comeback goals and then get you scheduled if it feels like the right fit.

💻 If you’re NOT local to Bend, I am happy to support you virtually and coach you through your rehab journey! Book a free Discovery Call here to start the conversation.

In summary, here are the major takeaways for a smooth and successful process in regaining your flexion after ACL surgery:

1. Work with a PT who can help you get your motion back in ways that push your body but allow you to feel safe and in control at the same time.

2. Be patient – this is not an overnight process!

3. Monitor your pain and swelling. If your swelling is up, this is a huge barrier to getting your motion back. Focus on getting your swelling down while continuing to work on motion gently.

4. Trust your gut – if it feels like what you’re doing in PT isn’t working, then speak up. YOU are the only one living in your body and you’re the only one who knows how it feels and what it’s asking for. When you share this information with your PT, this could be exactly what your PT needs to help adapt the current approach into one that does work for you.

Still feeling stuck? Let’s chat and find a way to help you move forward. You can send me a message at jen@kneeptbend.com with your questions.

Cheering you on and always in your corner!

Jen