With the remarkable recoveries of professional athletes from ACL injuries, there is a natural accreditation to surgical advancements. While advancements in ACL surgery have improved, rehabilitation has evolved significantly over the past 25 years.
Everyone loves to see the advanced exercises and return, but the early phases of rehabilitation are the most important. The early phases of rehabilitation must go well to avoid complications and allow advanced exercises down the road.
Two weeks prior to the surgery, NaVorro Bowman had been rehabbing at the 49ers facility, keeping the knee loose and flexible. Severe injuries to the knee cause pain and swelling almost immediately. After an injury of this caliber, fluid in the knee develops and causes it to swell. Even small amounts of fluid in the knee can decrease the ability to contract the quad. The swelling can get so severe, it can shut down muscles surrounding the knee. Without proper strength in those areas, people tend to walk around with a bent and stiff knee. So, the stronger the quads and hamstrings are going into surgery, the better.
Thanks to 49ermaniac, I was made aware of the Instagram account of Bowman's girlfriend. She has been recording some of his progress since the day of surgery, and I thought some of you would like to see it.
Immediately after surgery, Bowman is all smiles.
After ACL surgery, restoring full knee extension as soon as possible is a priority. A common complication is loss of motion, with loss of extension being more troublesome than flexion. A post-surgical knee will gravitate to a slightly bent position. Keeping it this way is more comfortable, but if left too long scar tissue and arthritis can develop. Years ago, when ACL tears were career ending, almost every athlete developed arthrofibrosis. It is basically an abnormal accumulation of scar tissue. Restoring knee extension immediately after surgery is so important, because once it gets tight, it’s often hard to get your motion back.
Day 3 post surgery
Below, Bowman is working on control of his hamstrings and quads, stability and small work on the extension of the knee.
While hooked up to a Neuromuscular Electrical Stimulator (NMES), Bowman is working to restore volitional control of the quadriceps muscle. NMES generate electrical impulses and deliver electrodes on the skin fairly close to the muscles that you want stimulated. The impulses resemble the action potential coming from the central nervous system, causing the muscles to contract. Basically, NMES helps restore quad strength and function faster than just exercises without NMES.
On day 6, Bowman continues to work on the surrounding muscles, and stability and flexion of the knee. All of these therapies will lead to more advanced exercises.
On day 7, Bowman is working on restoring independent ambulation. Each exercise is really a building block. The idea is to put it all together to work on being able to walk without limitations or a limp.
By day 8, Bowman is working on his knee flexion. Although loss of knee flexion is not as common as knee extension, it does happen and you don't want to neglect working on flexion. The more you work on one, the more you tend to get stiff in the other direction. This is reduced by working on frequent (but gentle) range of motion. Knee flexion is restored gradually.
Day 9, Bowman is doing weight bearing exercises. These are called weight shifts and it focuses on transferring your weight and locking out your knee.
I hope the videos keep coming, because it really provides a glimpse of what goes on with early rehabilitation. We have a chance at seeing real footage of his recovery and seeing the significant gains. Thus far, it appears Bowman has made significant progress nine days post-surgery. This really inspires my confidence in his ability to make a full recovery.