Note - we have received permission from Jo to share her recovery story to help motivate and inspire others.

Life Before the ACL Injury: An Endurance Athlete's Story

Meet Jo from Adelaide, Australia, an accomplished endurance athlete who completed her first marathon in an impressive 3 hours and 44 minutes. As a dedicated runner, cyclist, and swimmer, Jo believed completing that marathon would be her toughest physical challenge. Little did she know, her ACL recovery journey would test her resilience in ways she never imagined.

The Unexpected Turn: A Common ACL Injury Scenario

Ironically, Jo's ACL injury didn't occur during her intense endurance training. Instead, it happened during a casual game of touch football - highlighting how ACL injuries can occur in unexpected moments. While sidestepping around another player, Jo experienced the classic ACL tear sensation: her lower leg going in one direction while her upper leg moved in another. This non-contact injury mechanism is particularly common in ACL tears, regardless of the activity level or sport involved.

The Silver Lining: Maximizing Pre-Surgery Preparation

Due to Australia's public healthcare system, Jo faced a five-month wait for her surgery. While this might seem disadvantageous, it became an opportunity to optimize her pre-surgical condition. Using the Curovate app's pre-operative rehabilitation program, Jo achieved remarkable pre-surgery milestones:

• Performed weighted squats with proper form
• Mastered single-leg sit-to-stand exercises
• Maintained running capacity up to 7 kilometers
• Retained excellent knee range of motion

Digital Physical Therapy: A Global Solution

Jo's experience highlights a crucial advantage of digital physical therapy - its accessibility isn't limited by geography. Whether you're in Australia, Canada, the USA, or the UK, the Curovate app provides consistent, professional guidance through:

• Daily video-guided exercises tailored to your recovery phase
• Precise knee range of motion measurements using your smartphone
• Progressive milestone tracking
• Pre and post-operative exercise programs

Post-Surgery Recovery: Measuring Progress

After her hamstring graft surgery in July 2019, Jo approached her recovery with the same dedication she brought to marathon training. By following the Curovate app's daily exercise recommendations and tracking features, she achieved several key milestones ahead of schedule:

• Day 13: Completed full rotations on a stationary bike
• Week 2: Achieved 110 degrees of knee flexion
• Week 5: Performed single-leg sit-to-stand exercises
• Week 5: Matched her non-surgical knee's range of motion

Keys to Success: Consistency and Guidance

Jo's remarkable progress stems from her commitment to the rehabilitation process and proper guidance through digital physical therapy. Her dedication to the RICE protocol (Rest, Ice, Compression, Elevation) soon after her ACL injury 4-5 times daily, combined with consistent exercise progression through the app pre and post-operatively, created optimal conditions for recovery.

The Power of Digital Physical Therapy

Jo's experience demonstrates how digital physical therapy can provide professional guidance regardless of location. The Curovate app offered:

• Structured daily exercise programs
• Precise progress tracking
• Range of motion measurements
• Clear recovery milestones
• Exercise technique guidance

Conclusion

Jo's story exemplifies how digital physical therapy can support ACL recovery across international borders. Her advice to others? "Keep the end goal in mind! You can't build a skyscraper without a strong foundation. The basic exercises may be monotonous but they work!"

If you need further customized assistance during your surgery or injury recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Whether you're preparing for ACL surgery or starting your post-operative rehabilitation, having professional guidance at your fingertips can make the difference between good and optimal recovery outcomes.

Start your guided rehabilitation with Curovate today:

Note - we have received permission from Mohammed to post his recovery story to help motivate and inspire others.

Understanding Multiple Ligament Knee Injuries

The human knee contains four major ligaments, each playing a crucial role in stability and function. When Mohammed's car accident occurred on June 5th, 2020, it resulted in tears to three of these vital structures: the Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), and Medial Collateral Ligament (MCL). Only his Lateral Collateral Ligament (LCL) remained intact.

For context, this type of injury represents one of the most complex knee trauma patterns that medical professionals encounter. While single ligament injuries are common in sports, multiple ligament injuries often result from high-energy trauma, such as car accidents. The combination of torn ACL, PCL, and MCL creates a particularly challenging recovery scenario due to the knee's compromised stability in multiple directions.

The Mechanics of Car Accident Knee Injuries

Unlike sports-related injuries, knee trauma in car accidents presents unique characteristics. During a collision, the lower leg can be forced backward while the upper leg remains fixed by the seat belt, creating a complex injury pattern. This mechanism typically affects multiple ligaments simultaneously, as seen in Mohammed's case.

Understanding these injury mechanics is crucial for rehabilitation planning:

• The ACL prevents excessive forward movement of the tibia
• The PCL prevents excessive backward movement
• The MCL provides stability to the inner knee
• When multiple ligaments are compromised, the knee loses stability in multiple directions

Initial Recovery Challenges

Multiple ligament reconstruction presents unique challenges compared to single ligament repairs. During the initial phase of Mohammed's recovery, his rehabilitation team focused on carefully managing the widespread inflammation throughout his knee joint. This delicate period required a precise balance between protecting the surgical repairs and introducing gentle movement. The complexity of having three ligaments reconstructed meant that each movement needed to be carefully controlled. Mohammed learned to navigate the challenging balance between rest and activity, understanding that too much or too little of either could impact his recovery.

The Critical Nature of Early Knee Flexion

Regaining knee flexion emerged as one of the most challenging aspects of Mohammed's recovery journey. Multiple ligament reconstruction creates unique complications that aren't typically seen in single ligament repairs. The extensive surgical repair work meant that multiple tissues were healing simultaneously, creating increased post-operative inflammation throughout the joint. This inflammation, combined with the complex rehabilitation protocols needed for multiple ligament recovery, made the process of regaining motion particularly challenging. Despite these obstacles, early mobility work proved essential for laying the foundation for long-term recovery success.

Technology's Role in Complex Recovery

Modern rehabilitation benefits significantly from technological support. The Curovate app played a crucial role in Mohammed's recovery by providing:

• Weekly rehabilitation goals specific to multiple ligament recovery
• Daily exercise guidance with video demonstrations
• Progress tracking for range of motion
• Milestone monitoring
• Exercise progression based on healing timelines

Progress Through Dedication

At nine months post-surgery, Mohammed's recovery stands as a testament to the importance of consistent effort and proper guidance. While multiple ligament reconstruction typically requires 12-18 months for full recovery, his progress has been remarkable. His success stems from unwavering dedication to rehabilitation protocols and careful attention to exercise progression. Throughout his recovery, Mohammed maintained detailed tracking of his improvements, demonstrating the value of consistent monitoring. This commitment to understanding his condition and rehabilitation process, combined with proper utilization of technological support tools, has played a crucial role in his impressive progress.

Key factors in his successful rehabilitation include:

• Strict adherence to rehabilitation protocols
• Regular exercise progression
• Consistent tracking of improvements
• Understanding the injury and surgery recovery process
• Use of technological support tools

Educational Insights for Multiple Ligament Recovery

Mohammed's experience provides valuable insights for others facing similar injuries:

• Recovery timelines may extend beyond typical single-ligament rehabilitation
• Progress requires patience and consistent effort
• Technology can provide crucial support and guidance
• Regular monitoring and adjustment of goals proves essential
• Professional guidance combined with home exercise programs optimizes outcomes

Conclusion

Multiple ligament knee injuries present unique challenges requiring dedicated, long-term commitment to rehabilitation. Mohammed's recovery journey demonstrates that with proper guidance, consistent effort, and technological support, significant progress is achievable. His experience particularly highlights the importance of early mobility work, consistent exercise progression, and regular monitoring of improvements.

For those facing similar complex knee injuries, the combination of professional guidance and technological support through tools like the Curovate app can provide the structure and motivation needed for successful rehabilitation.

If you need further customized assistance during your recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Start your guided rehabilitation with Curovate today:

Other Blogs Related to ACL Recovery

Note - we have received permission from Elina on Instagram to post her recovery story to help motivate and inspire others.

When Life Takes an Unexpected Turn: The Injury

Meet Elina, a women's fitness and weight loss coach, certified trainer, and nutrition expert. In 2018, just three days before her 30th birthday, what should have been an exciting ski trip to Whistler, British Columbia, turned into a life-changing moment when she tore her ACL.

Instead of celebrating her milestone birthday as planned, Elina found herself following the crucial RICE protocol (Rest, Ice, Compression, and Elevation), preparing for the road ahead. As a fitness professional, she understood the importance of proper initial care - reducing swelling and maintaining range of motion before surgery would be crucial for optimal recovery.

The First Steps: Early Recovery Phase

Nine weeks post-injury, Elina traveled to Ukraine for her reconstructive surgery. The first 24 hours proved challenging, with pain management being a primary concern. The initial three weeks tested her patience as she adapted to using crutches for mobility.

"The transition from crutches to a cane was mentally challenging," Elina recalls. Like many athletes, she wanted to skip straight to normal walking, but understanding the importance of proper progression helped her stay focused on long-term success.

Technology Meets Determination: The Rehabilitation Process

From day one post-surgery, Elina committed to her rehabilitation. Using the Curovate app to track her progress, she focused on improving her knee's range of motion, which initially wouldn't bend past 90 degrees. Despite this challenge, she maintained her determination, following her exercise program consistently while properly managing recovery through icing and rest.

Breaking Records Safely: The Results

Through unwavering dedication to her rehabilitation program, Elina achieved remarkable progress. For 20 consecutive weeks, she showed up every day, putting in the work that would lead to an impressively swift recovery. While she completed her initial recovery in approximately 5 months, it's important to note that every individual's timeline differs.

Important Note: While Elina's recovery timeline was shorter than average, we always recommend following your healthcare team's guidance for the safest, most effective long-term results. The standard recovery timeline of 9-12 months exists for good reason.

Looking Forward: Lessons Learned

Today, Elina reflects on her experience with gratitude: "Now looking back it's crazy but I'm thankful this happened - it built resilience in me in a way that nothing else could have. It pushed me past my limits and made me stronger."

For those beginning their own ACL recovery, consider using the same tools that helped Elina succeed. The Curovate app provides comprehensive support throughout your rehabilitation process, from pre-surgery preparation through return to activity.

Conclusion

Elina's story demonstrates that while ACL recovery presents significant challenges, success is achievable through dedication, proper guidance, and the right tools. Her experience as a fitness professional brings unique insights to the recovery process, highlighting the importance of both physical and mental preparation. Whether you're an athlete, fitness enthusiast, or someone recovering from ACL surgery, the key elements of success remain consistent: commitment to rehabilitation, proper progression through recovery phases, and utilization of appropriate support tools.

While every recovery timeline is unique, having the right resources at your fingertips can make a significant difference. The Curovate app provides the structure, guidance, and tracking tools needed to support your ACL rehabilitation journey, whether you're in the pre-surgery phase or working toward return to activity.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Start your guided rehabilitation with Curovate today:

Other Blogs Related to ACL Surgery and Rehabilitation

• Why do I feel weak after surgery?
• How to become more consistent with your exercise program using curovate
• ACL recovery timeline
• Is my ACL graft weaker than my original ACL or is my ACL graft stronger than my original ACL?
• When can I return to sport after ACL injury or surgery?
• Is there a difference in what I need to do if I had a quad tendon graft compared to a patellar tendon graft for my ACL reconstruction?

"I had to change a lot mentally to get better physically," says Lani Woods, perfectly capturing the essence of rehabilitation. Lani's remarkable journey through a complex knee injury and multiple surgeries offers hope and guidance for anyone on their own recovery path.

Note - we have received permission from Lani on Instagram to post her recovery story to help motivate and inspire others.

The Initial Injury and Diagnosis

In October 2019, Lani faced a combination of injuries that would test any athlete's resolve. During a training incident, she experienced:

• A tibial plateau avulsion fracture
• Complete ACL and PCL ruptures
• Lateral and medial meniscus tears

For those who aren't knee experts, think of an avulsion fracture as the ligaments actually pulling away a piece of bone – definitely not your average sports injury! Lani was looking at 6-9 months of recovery, but she took on this challenge with an amazing attitude, asking herself "how bad do you really want it?"

The First Recovery Phase

After her first surgery, where doctors used bioabsorbable screws to reattach the ligaments, Lani dove into rehab head-first. She knew there would be good days and bad days, but that didn't stop her from crushing the workouts she could do while wearing a plaster cast.

Using Technology to Track Progress

During her recovery, Lani found a game-changer in the Curovate app. "I specifically liked that I could use Curovate to measure my knee flexion and extension on my phone!" Lani says. The app helped her track her progress with precise measurements right from her smartphone.

A Twist in the Recovery Tale

By July, things got complicated. Lani's knee started swelling chronically, puzzling her doctors. Here's where her ultrasound tech training came in handy – she used diagnostic ultrasound to discover fluid and blood buildup in her knee. Talk about being your own health advocate!

The rare rejection of her bioabsorbable screws (happening in only 4% of cases) meant another surgery in November 2020.

The Comeback

One year after her final surgery, Lani proved that comebacks are possible. She's back to cycling, crushing obstacle races, and dominating workouts. As Lani says, "Be curious, be adventurous, be unapologetic in your pursuit to find what sets your soul on fire."

What You Can Learn from Lani's Journey

1. Your mindset matters as much as your physical therapy
2. Track your progress - it keeps you motivated
3. Listen to your body and speak up when something feels off
4. Focus on what you can do, not what you can't
5. Keep your eye on the prize, but celebrate small wins

Conclusion

Whether you're an athlete recovering from surgery or someone working through rehabilitation, Lani's journey offers valuable lessons in perseverance. Recovery isn't just about returning to previous activities – it's about emerging stronger, wiser, and more resilient than before.

Remember that every recovery journey is unique. Focus on your own path, celebrate your progress, and maintain faith in the recovery process. As Lani demonstrated, with determination, proper medical care, and the right mindset, coming back stronger is absolutely possible.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Start your recovery journey with Curovate:

Blogs related to ACL surgery

• Understanding numbness after ACL surgery
• When can I run after ACL surgery?
• How long does it take for my ACL scar to heal? Scarring after ACL surgery
• Can an ACL injury lead to knee arthritis in the future?
• Why does my knee hurt when it rains? Knee pain and rainy days

After ACL surgery, how much help will I need? And help with what?

Plan to have a care provider for 2 weeks after your ACL surgery. You may not need them for that long, but it is best to plan ahead! Make a list of the things you will need in your house before surgery because that is the last thing you will want to do afterward. Following ACL surgery have your care provider nearby before trying things for the first time, such as using the toilet, showering and cooking. From this first experience, you will be able to gauge what kind of support you will need. You will not be able to drive for at least 2 weeks after ACL surgery. If you have small children, plan to have a trusted caregiver for them until you are independently taking care of yourself.

Watch Andrew answer the question "How much help will I need? And help with what?" in the video below.

Read the full blog on how much help will I need and with what after my ACL surgery here

Read all 9 of Andrew's blogs here!

As your leg gets stronger, you will need less help and gain more independence. The best way to do this is to stay diligent with physical therapy and ACL rehab exercise. The Curovate physical therapy app provides you with an in-depth personalized physical therapy plan with video guided exercises, the ability to track your progress, and built-in reminders. All from the comfort of your home! You can download the Curovate from the App Store or the Play Store using the links below.

If you need further customized assistance during your surgery or injury recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a virtual physical therapy provider.

Other Blogs Related to ACL surgery and Rehabilitation

• How to use crutches after injury or surgery - ACL, Knee Replacement, Hip Replacement
• After I wake up from ACL surgery, what should I expect?
• Ice, compression, elevation and ankle pumps
• Is ACL Surgery Painful?
• Wound Care after Your ACL Surgery
• Is it normal to still have pain after an ACL reconstruction surgery?

References

1. Day Surgery Unit. After Your Anterior Cruciate Ligament (ACL) Repair. University Health Network. 2019.

2. Anterior Cruciate Ligament Reconstruction: What to Expect at Home. Accessed August 4, 2021.

3. Government of Western Australia. Suture care. Department of Health. Accessed August 4, 2021..

Image by AntonioGuillem, Getty Images from Canva Pro

This blog will try to tackle the tough question; does stretching actually work? In addition we will discuss if stretching can reduce injuries in sports and physical activity and if it actually lengthens muscles. Stretching works for certain people in certain conditions but not for everyone and not in every case. Stretching may help to prevent injuries in very specific instances. Stretching, in most cases, does not actually lengthen muscles.

Now that we have provided you with some brief answers let’s delve into this topic a bit further and explain the research in the area of stretching. Both Zach and I are very interested in this topic which is why we decided to collaborate on this blog. Admittedly, I have been a very infrequent stretcher and I would describe myself as always being “tight” in most major muscle groups. I am writing this blog to help people decide if stretching is useful but also to understand for myself if I should be stretching consistently or if it is a waste of time.

In this blog when we discuss stretching we are referring to holding a position for a number of seconds from 10 to 300 seconds. There are various forms of stretching but we are referring to the type of stretching that most people think of when they stretch their thigh muscles, quadriceps or hamstrings, or calf muscles, gastrocnemius, by holding a static position.

Can stretching prevent injuries?

Maybe! As many of the articles that we reviewed point out it is very hard to make a direct association between an intervention, in this case stretching, and exercise or sport related injuries.^[1] There are a lot of things that happen while playing sports and when injuries happen in sports there are many factors that lead to the injury. Here are a list of some factors that can contribute to sports injuries: the weather, the playing surface, the type of shoes, the skill level of other players, the rules of the sport, the individual's mental state, the individual's endurance and strength, and the individual's skill level among many other factors. Trying to make a direct correlation or association between stretching and injury prevention is very challenging. A 2008 systematic review concluded that static stretching did not reduce the overall incidence of exercise related injuries when they were used as a warm-up prior to activity.^[2] In this same article three high quality studies did show a reduction in muscle, tendon and ligament injuries after static stretching.^[2] This review evaluated a total of seven studies of which three were controlled clinical trials and four were randomized clinical trials.^[2] Because the evidence was not strong the authors of this study suggest that static stretching “may reduce musculotendinous injuries.”^[2]

Does stretching improve sport performance and resistance or weight training?

Unlikely. In most of the reviewed studies there is evidence to suggest that stretching immediately before playing a sport or starting weight or resistance training can reduce your overall performance. When stretching was done immediately before weight or resistance training there was an overall reduction in strength.^[3] Strength was reduced by stretching immediately before resistance training and therefore is not recommended prior to resistance training especially if stretching for long periods of time in this case more than 8 weeks.^[3] Stretching immediately before sports does not improve sprinting and jumping performance. There were some weak associations made in the research that point to some benefit of static stretching but these benefits were not significant enough to recommend static stretching to enhance sprinting or jumping.^[4] A systematic review in 2024 concluded that more research is needed because the current studies differ greatly making comparisons challenging.^[4] To date there are not enough studies or a strong enough level of research evidence to justified static stretching as a way to improve jumping and sprinting performance in sports.^[4] Other research studies have also stated that stretching actually reduces your overall jumping and sprinting performance and therefore is not recommended prior to a sport.^[5] Another important thing to remember is that there are sports such as jogging, running, swimming and cycling where the rates of muscle and tendon injuries are low and stretching is usually not required before starting.^[1] Stretching in these sports does not decrease or increase injury risk but it may reduce performance.^[1] One research study found that having a warm up and cool down for jogging did not reduce the overall injury risk and there is not enough research to show that stretching can help to prevent leg injuries for people who jog.^[1]

What should I do before playing sports or lifting weights?

Static stretching for a long period of time is not recommended based on the research reviewed above. However, dynamic movements that are similar to the sport are recommended.^[5,6] Dynamic movements actually improves jump height and distance and sprinting, whereas static stretching, particularly if it is done for a long period of time, can reduce overall jumping and sprinting performance.^[5,6] Dynamic movements should look and feel like the sport or activity you are about to play.^[5,6] For example, if you were to do dynamic movements before a basketball game you should take some jump shots, layups, dribble a ball, run, jump, pivot and change directions at or close to game speed before you start to play. You should take your whole body through movements that are similar to the sport you are about to play. If you are about to lift weights then the simplest dynamic movements would be to do the same motion you are about to do with lower weights. For example, a dynamic movement for a biceps curl if your highest planned lift is 30 lbs is a biceps curl with a lower weight and then increasing the weight gradually until you lift your maximum planned weight. For resistance training using the same movement with a lower weight will prepare your body for the heavier weights.

Are there any benefits to stretching?

Yes! There are benefits to stretching and the most important one to consider is the possible reduction in musculotendinous injuries.^[2] As I mentioned above there is some preliminary evidence from three high quality studies that shows that static stretching may reduce musculotendinous injuries.^[2] This means that injuries that occur in sports that are related to muscles, tendons, and ligaments may be reduced with static stretching.^[2] Please keep in mind that this study was not suggesting stretching immediately prior to playing sports. In relation to sports and injuries, less flexible people are more likely to incur overuse injuries, whereas people who are very flexible are more likely to get acute injuries while playing.^[2] Keep this in mind for yourself and think about how it applies to your body and playing sports. Another benefit to consider is that static stretching for long durations, between 120-300 seconds, reduced muscle stiffness.^[7] If reducing muscle stiffness is important to you then long duration stretching, between 2-5 minutes per stretch, can help reduce your stiffness.^[7]

When should I stretch?

Likely after sports or resistance or weight training. Since there is a fair amount of evidence presented above that suggests that static stretching can reduce your overall strength, jumping and sprinting abilities it is not ideal to stretch prior to playing sports or lifting weights.^[4,5] Static stretching can be completed at the end of sport participation or at the end of lifting weights or at another time when optimal strength and running or jumping are not required. For example, if you have just finished playing soccer or lifting weights you can stretch immediately afterwards to receive some of the benefits of stretching. The research suggests that you should stretch for between 120-300 seconds which is between 2 to 5 minutes, 3-4 times per week for at least 8 weeks to see any benefits.^[3,7] These longer durations of stretching have some research support but more studies are required to determine optimal duration and volume of stretching. One interesting thing that most of the stretching research points out is that the recommended time, between 2-5 minutes, and the recommended duration, 3-4 times per week and for at least 8 weeks, is much longer than what is often prescribed by physical therapists like myself.^[7] Also the researched duration and frequency of stretching is much longer than most people choose or continue to engage in stretching.

Am I making my muscles longer if I stretch? What is actually happening to my body when I stretch?

No! Your muscles are unlikely to actually get longer in most cases. The most likely thing that is happening when you stretch is that you are improving your tolerance to stretching.^[8] When you stretch you feel some discomfort and therefore you do not push too far and also prevent injuring yourself. As you continue to stretch your body adapts and gets more used to the feeling of stretching and allows you to go further into a position of stretch. As you stretch over time you will notice that your movement in that area of your body, also called range of motion, increases, this is because your tolerance for stretching has improved and not because muscles are longer.^[5,8] Other reasons for increased range of motion are due to less stiffness in the muscle tendon unit, a change in the viscoelasticity of the muscle and tendon unit, and a change in reflex activity.^[8] When you stretch you stimulate a reflex that resists the stretch but with longer durations of stretching you suppress this reflex and this allows you to go through more range of motion because you have inhibited this reflex.^[8] Now I would like to present some contradictory research that has some limitations. In a recent systematic review which included 19 studies the authors conclude that static stretching can increase muscle fascicle length.^[9] A muscle fascicle is made of a number of muscle fibers or muscle cells and a number of muscle fascicles make up a whole muscle.^[10] In this review study it was noted that only high stretching volumes caused longitudinal fascicle growth.^[9] High stretching volume was defined as stretching for between 30 to 300 seconds, on average 101 seconds, and between 4.4 to 16.8 weeks.^[9] Some muscle changes were reported at six weeks but most muscle fascicle changes took more than six weeks.^[9]

There were several limitations of this study that I will list below:

1. The average age of the participants was between 19.5-22.7 years old
2. 73% of the participants were male
3. There were 467 participants in this study
4. All stretching was for the lower leg and mostly the gastrocnemius or calf muscle
5. Only one study included an athletic population
6. The intensity of the stretch was defined qualitatively as being painful or comfortable making it very hard to reproduce

Based on this systematic review, with a small number of people tested, there is the possibility that long duration stretching can cause some physiological changes to the muscle fascicle for young healthy males.^[9]

If I have had an injury or surgery should I stretch?

Yes! If you have had an injury or surgery and you need to safely regain your movement, stretching is essential to restoring your normal range of motion. Most of the research about stretching does not apply to you immediately after injury and surgery. When you injure an area of your body you will likely lose range of motion due to pain, swelling and damage to structures around the joint.

Let’s take the example of a knee injury, specifically an ACL injury. If you have torn your ACL, which is one of the four ligaments in your knee, you will experience pain, swelling and a loss of knee range of motion. In the initial phase of healing you should not force your knee range of motion by stretching but once your knee has settled down it is critical to regain your knee range of motion. During your early recovery, even with knee swelling and pain, it is usually necessary to start bending and straightening your knee. If you do not do this you risk losing function and movement around your knee. It is important to consult with a health care provider before you start working on your knee range of motion to ensure you are safe to do so. After an ACL injury the typical rules of stretching do not apply. In most cases after an ACL injury, daily and possibly three times per day, knee range of motion exercises are required to improve knee bending and straightening. If you were to have an ACL injury and you were to decide stretching is not necessary you will delay your healing and compromise your recovery.

Let’s consider another scenario where a person has had a knee replacement. Again the standard rules of stretching do not apply because early knee range of motion by doing knee straightening and bending exercises is critical to recovery. With a knee replacement or ACL surgery it will be necessary to do knee straightening for up to five minutes three times per day and knee bending for 20-25 repetitions three times per day. Regaining knee range of motion early is critical to a successful recovery. It is likely you will spend more time on range of motion and stretching than what is recommended for young healthy people without any injury or surgery. To learn about some typical knee range of motion goals after an ACL surgery go to this link. To learn about some typical knee range of motion goals after a knee replacement go to this link.

If I have knee osteoarthritis should I be stretching?

Yes! One area where stretching has been studied and shown to reduce overall pain is in the area of knee osteoarthritis. Knee osteoarthritis is a progressive wear and tear of the knee joint that can result in pain, limitations in motion, reduced strength of the muscles around the knee and functional limitations of daily life activities. Research on stretching for people with knee osteoarthritis does show that it reduces a person's pain.^[11] In this review article stretching was more effective at reducing pain for people with osteoarthritis when compared to a control group who did not stretch.^[11] It does seem reasonable to include stretching as part of the rehabilitation for people who have knee osteoarthritis.^[11] The limitation of this review article is that most studies include stretching with an overall program to manage osteoarthritis so it is not always possible to separate out stretching from strengthening and other interventions for managing knee osteoarthritis.^[11]

For joint contractures, arthrofibrosis and neurological issues does stretching help?

Unlikely. This topic is beyond the scope of this blog but the brief research review that was done in this area suggests that stretching is ineffective for joint contractures, arthrofibrosis and for most neurological conditions such as stroke, multiple sclerosis, and parkinson's.^[5,12] Joint contractures are when a joint does not move past a certain position and is “stuck” due to injury or surgery. Arthrofibrosis is an abnormal formation of tissue around a joint that prevents it from bending or straightening through the normal range of motion. There is some evidence that a range of motion mechanical device may help to improve range of motion in the case of arthrofibrosis.^[13] The primary author of this blog has piloted an at-home and in-clinic method of producing sustained knee flexion and extension that he has found to be clinically useful with his patients.^[14] The method used to improve knee bending and straightening are outlined in this clinical suggestion article. The primary author of this blog has seen improved knee extension and flexion utilizing the method described in this article but there are no large studies utilizing this method that we are aware of.

Neurological conditions cause stiffness and tightness that is mediated by the central nervous system and therefore are not altered by stretching.^[5,12] If you have any of the conditions mentioned above please speak to a health care provider to determine if stretching is appropriate for you.

Practical suggestions based on the stretching research

1. Stretch one muscle group, for example your quadriceps, for 120 seconds or two minutes, four times per week for at least eight weeks.
2. Stretch at a time separate from resistance or weight training and not immediately before playing a sport.
3. Prioritize areas where you feel tight and muscle groups that are used primarily in your sport or physical activity. You do not need to stretch every muscle group.
4. Prior to jogging, swimming and cycling you do not need to stretch. An appropriate warm-up would be to start with walking, then walk faster and then start jogging.
5. Prior to sports you should do at least 10 minutes of dynamic movements that look and feel like the movements of the sport you are about to play. It is important to take your body through the movements that you may go through while playing the sport.
6. After sports and after resistance or weight training may be a good time to stretch.
7. For injuries and surgeries the rules of stretching change and you will likely need to do very regular range of motion exercises, up to three times per day, until you regain your full range of motion. In these cases you should seek out the advice of a health care provider to ensure that you are engaging in the appropriate amount of range of motion exercises. Within our app, Curovate, you will receive your daily physical therapy exercises following a knee replacement, ACL injury or surgery, hip replacement, knee osteoarthritis, or for knee and hip strengthening. Find our app at the Apple and Android links below.
8. If you have joint contractures, arthrofibrosis or a neurological condition you should seek the advice of a health care provider to determine if stretching can provide any benefit.

Conclusion

This blog helps to answer many of the common questions related to stretching and I have summarized the answers below. You can read the details of each section in the blog above.

Can stretching prevent injuries?

Maybe!

Does stretching improve sport performance and resistance training?

Unlikely.

What should I do before playing sports or lifting weights?

Dynamic movements.

Are there any benefits to stretching?

Yes.

When should I stretch?

Likely after sports or resistance or weight training.

Am I making my muscles longer if I stretch?

No!

If I have an injury or surgery do I need to stretch?

Yes but you should seek out the advice of a health care provider to determine the appropriate time and amount of stretching.

If I have knee osteoarthritis should I be stretching?

Yes!

For joint contractures, arthrofibrosis and neurological issues does stretching help?

Unlikely.

What are some practical suggestions I can follow for stretching?

Go to the section above called "Practical suggestion based on stretching research" and follow the 8 simple suggestions.

If you have had an injury, surgery or need some daily stretching and strengthening try the Curovate physical therapy app. Curovate provides rehabilitation for people before or after a knee replacement, knee osteoarthritis, ACL injury, ACL surgery, hip replacement, or for knee and hip strengthening to prevent injuries. Curovate provided daily video-guided exercises, progress tracking and the ability to measure knee and hip range of motion.

If you need further customized assistance during your surgery or injury recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Blogs related to range of motion and the Curovate app

• How does measuring my knee range of motion at home compare to a physical therapist measuring my knee?
• How to measure knee range of motion in the Curovate app
• What if the Curovate exercises are too hard for me?
• What if the Curovate exercises are too easy for me?
• How Can I Improve My Knee Bending and Straightening | Curovate

References

1. Witvrouw E, Mahieu N, Danneels L, McNair P. Stretching and injury prevention: An obscure relationship. Sports Medicine (Auckland, NZ). 2004;34(7):443-449. doi:https://doi.org/10.2165/00007256-200434070-00003

2. Small K, Mc Naughton L, Matthews M. A Systematic Review into the Efficacy of Static Stretching as Part of a Warm-Up for the Prevention of Exercise-Related Injury. Research in Sports Medicine. 2008;16(3):213-231. doi:https://doi.org/10.1080/15438620802310784

3. Thomas E, Ficarra S, Nunes JP, et al. Does Stretching Training Influence Muscular Strength? A Systematic Review With Meta-Analysis and Meta-Regression. Journal of Strength and Conditioning Research. 2022;Publish Ahead of Print. doi:https://doi.org/10.1519/jsc.0000000000004400

4. Warneke K, Freundorfer P, Plöschberger G, Behm DG, Konrad A and Schmidt T (2024), Effects of chronic static stretching interventions on jumping and sprinting performance–a systematic review with multilevel meta-analysis. Front. Physiol. 15:1372689. doi: 10.3389/fphys.2024.1372689

5. Page P. Current concepts in muscle stretching for exercise and rehabilitation. International journal of sports physical therapy. 2012;7(1):109-119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273886/

6. Reynolds G. Stretching: The Truth. The New York Times. https://www.nytimes.com/2008/11/02/sports/playmagazine/112pewarm.html. Published October 31, 2008.

7. Takeuchi K, Nakamura M, Konrad A, Mizuno T. Long‐term static stretching can decrease muscle stiffness: A systematic review and meta‐analysis. Scandinavian Journal of Medicine & Science in Sports. 2023;33(8):1294-1306. doi:https://doi.org/10.1111/sms.14402

8. Bryant J, Cooper DJ, Peters DM, Cook MD. The Effects of Static Stretching Intensity on Range of Motion and Strength: A Systematic Review. J. Funct. Morphol. Kinesiol. 2023, 8, 37. https://doi.org/10.3390/jfmk8020037

9. Panidi I, Donti O, Konrad A, et al. Muscle Architecture Adaptations to Static Stretching Training: A Systematic Review with Meta-Analysis. Sports Medicine - Open. 2023;9:47. doi:https://doi.org/10.1186/s40798-023-00591-7

10. Wikipedia Contributors. Muscle fascicle. Wikipedia. Published November 27, 2018. https://en.wikipedia.org/wiki/Muscle_fascicle

11. Luan L, El-Ansary D, Adams R, Wu S, Han J. Knee osteoarthritis pain and stretching exercises: a systematic review and meta-analysis. Physiotherapy. 2021;114. doi:https://doi.org/10.1016/j.physio.2021.10.001

12. Harvey LA, Katalinic OM, Herbert RD, Moseley AM, Lannin NA, Schurr K. Stretch for the Treatment and Prevention of Contractures. Cochrane Database of Systematic Reviews. 2017;1(1). doi:https://doi.org/10.1002/14651858.cd007455.pub3

13. Bonutti PM, Marulanda GA, McGrath MS, Mont MA, Zywiel MG. Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2009;18(2):194-199. doi:https://doi.org/10.1007/s00167-009-0947-1

14. Shah N. Increasing knee range of motion using a unique sustained method. North American journal of sports physical therapy : NAJSPT. 2008;3(2):110-113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953321/

Former University of Toronto basketball team captain Nick Snow talks about his recovery from ACL surgery using the Curovate app.

Following his playing career Nick tore his ACL playing basketball in a local men's league. He has been treated for a variety of injuries over five years and there is no one he trusted more than Nirtal Shah, physical therapist and CEO of Curovate, to help him get through this last one. Together they decided that the best way to extend his benefits was to schedule less frequent in-person appointments and use the Curovate app daily. According to Nick "this was the best decision I could have made." The app tracking component made it easy for him to keep on schedule and ensure he was doing his exercises and the ability to measure his range of motion allowed him to see progress immediately which he found quite motivating.

In the video below, watch Nick talk about his experience with using Curovate for his ACL recovery

Since using the Curovate app, Nick started playing basketball again, riding his bike, and he playing a variety of other sports. He confidently says that using the app helped him speed up his recovery and save his money on physiotherapy appointments.

Find out how Curovate can help with your ACL tear and recovery. Download our Curovate physical therapy app from the links below. Curovate is an app for at-home physical therapy exercises following a knee replacement, ACL surgery, ACL injury or hip replacement. Curovate also provides daily video guided strengthening exercises, the ability to measure knee range of motion, in-app chat with a physical therapist to answer your surgery and recovery questions, and educational blogs and webinars.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other recommended blogs

• How does cycling help with my ACL recovery? Is a stationary bike good after ACL surgery? Do I need a stationary bike after ACL surgery
• After ACL surgery, how much help will I need? And help with what?
• Is my ACL graft weaker than my original ACL? Or is my ACL graft stronger than my original ACL?

Are you recovering from an ACL surgery and wonder what exercises you can do to help with your recovery? This video will go over the early phase of recovery, explaining what factors are important during this stage, and outlining key exercises that you can do every day to help with your recovery.

During the early stages of recovery following an ACL surgery, the most important goals are to achieve full range of motion and regain neuromuscular control of the knee.^[1] To achieve these goals, it is essential to control pain, swelling and inflammation of the knee to ensure you are able to complete your rehabilitation exercises. Using ice , applying compression, elevating your foot and doing ankle pumps is a great way to control pain, swelling and inflammation.

While achieving both flexion and extension range of motion is important for daily activities, achieving full extension of the knee is emphasized for those recovering from an ACL surgery.^[1] Knee extension is particularly important during the early phase of recovery as numerous studies have found that a loss of full knee extension can be a predictor for post-operative complications and poor outcomes.^[2][3][4][5] Thus, exercises to increase knee range of motion are especially important during the early phase of ACL recovery.

Achieving neuromuscular control of the knee is another important goal following an ACL surgery. Neuromuscular control of the knee refers to the coordination of your brain, nerves and muscles to create movement and stability.^[6] Regaining neuromuscular control is imperative to not only ensure proper movement and function but to also protect your knee from further injuries.^[6] Some ways to regain neuromuscular control of the knee are to strengthen the supporting muscles around your knee and to make sure you complete balance exercises.^[1]

During the early phase of recovery after an ACL surgery, exercises that focus on knee flexion, knee extension, knee muscle strengthening and proprioception are recommended during the first 4 weeks after surgery. Five safe and effective exercises that you can do daily to help you achieve functional recovery include cocontraction of quadriceps and hamstrings, heel slides, knee extension over a roll, straight leg raises and squats supported by a chair. Click on this link for a more detailed description of these exercises. Please keep in mind that everyone recovers at their own pace so your ability to do these exercises may vary depending on your condition. Please consult with your healthcare provider to ensure that these exercises are safe for you.

The Curovate Physical Therapy App has detailed videos and descriptions of these 5 essential exercises as well as many other important exercises for your recovery. Click on one of the download links below to start your ACL recovery today! Curovate is an evidenced-based app with guided physical therapy plans, daily guided video exercises, ways to measure and monitor your progress, and measure your knee range of motion! Download the Curovate App by clicking on the links below.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Blogs related to ACL surgery

• Understanding numbness after ACL surgery
• When can I run after ACL surgery?
• How long does it take for my ACL scar to heal? Scarring after ACL surgery
• Can an ACL injury lead to knee arthritis in the future?
• Why does my knee hurt when it rains? Knee pain and rainy days

References

1. Van Grinsven S, Van Cingel REH, Holla CJM, Van Loon CJM. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2010;18(8):1128-1144. doi:10.1007/s00167-009-1027-2

2. Delaloye JR, Murar J, Sánchez MG, et al. How to rapidly abolish knee extension deficit after injury or surgery: A practice-changing video pearl from the Scientific Anterior Cruciate Ligament Network International (SANTI) study group. Arthrosc Tech. 2018;7(6):e601-e605. Published 2018 May 7. doi:10.1016/j.eats.2018.02.006

3.Noailles T, Chalopin A, Boissard M, Lopes R, Bouguennec N, Hardy A. Incidence and risk factors for cyclops syndrome after anterior cruciate ligament reconstruction: A systematic literature review. Orthopaedics & Traumatology: Surgery & Research. 2019;105(7):1401-1405. doi:10.1016/j.otsr.2019.07.007

4.Ouweleen AJ, Hall TB, Finlayson CJ, Patel NM. Predictors of arthrofibrosis after pediatric anterior cruciate ligament reconstruction: What is the impact of quadriceps autograft? Journal of Pediatric Orthopaedics/Journal of Pediatric Orthopedics. 2021;41(7):395-399. doi:10.1097/bpo.0000000000001860

5.Guerra-Pinto F, Thaunat M, Daggett M, et al. Hamstring contracture after ACL reconstruction is associated with an increased risk of Cyclops syndrome. Orthopaedic Journal of Sports Medicine. 2017;5(1):232596711668412. doi:10.1177/2325967116684121

6.Hewett TE, Paterno MV, Myer GD. Strategies for Enhancing Proprioception and Neuromuscular Control of the Knee. Clinical Orthopaedics and Related Research. 2002; 402 76-94.Hewett TE, Paterno MV, Myer GD. Strategies for Enhancing Proprioception and Neuromuscular Control of the Knee. Clinical Orthopaedics and Related Research. 2002; 402 76-94.

Image by Luka Banda from Canva Pro

Did you recently have an ACL reconstruction surgery and want to learn essential exercises to help with your recovery? This blog will go over the early phase of recovery following an ACL surgery, explaining what factors are important during this stage, and outlining key exercises that you can do every day to help with your recovery.

What is the purpose of my ACL surgery and what does rehabilitation do?

The anterior cruciate ligament (ACL) is one of the two cruciate ligaments that stabilize the knee joint by preventing excessive forward movements of the thigh bone and limiting rotational knee movements.^[1] Despite its important function in stabilizing the knee joint, the ACL may heal in some cases and may not heal in other cases of knee injury. While the purpose of ACL surgery is to reconstruct and repair the torn ligament, the purpose of rehabilitation is to protect and strengthen the ligament repair.^[2] Following ACL reconstruction, a daily physical therapy exercise program is critical to recovery and return to sports and physical activity.^[2]

What are the most important goals during the early phase of recovery?

During the first 2-4 weeks of recovery after an ACL surgery, the most important goals are to achieve full range of motion and regain neuromuscular control of the knee.^[3] To achieve these goals, it is essential to control pain, swelling and inflammation of the knee to ensure you are able to complete your rehabilitation exercises. One way to control pain, swelling and inflammation is to use ice, apply compression, elevate your foot and do ankle pumps. Ice is a free and easily accessible tool to relieve pain and swelling. To learn more about how ice affects pain and swelling, click on this link!

Following your ACL surgery, achieving full knee range of motion is one of the most important goals for your recovery.^[3] In this context, range of motion refers to how much you are able to flex (bend) or extend (straighten) your knee. Although achieving both flexion and extension range of motion is important for daily activities such as walking, climbing stairs or getting up from a chair, achieving full extension of the knee is emphasized for those recovering from an ACL surgery.^[4] Knee extension is particularly important during the early phase of recovery as numerous studies have found that a loss of full knee extension can be a predictor for post-operative complications and poor outcomes.^[5][6][7][8] As well, lacking knee extension can lead to pain at the front of your knee, disruptions to normal walking patterns, and decreased quadriceps function.^[5] The quadriceps are the muscles at the front of your thigh and their main action is to straighten your knee from a bent position such as when you are standing up from a chair. If you lack the ability to straighten your knee, this affects your quadriceps as they can not contract and extend properly, which can lead to deterioration of the muscle over time.^[3] Thus, exercises to increase knee range of motion are especially important during the early phase of ACL recovery.

Achieving neuromuscular control of the knee is another important goal following an ACL surgery. Neuromuscular control of the knee refers to the coordination of your brain, nerves and muscles to create movement and stability.^[9] Neuromuscular control involves proprioception, which is your body’s ability to sense your knee alignment and position without having to look at it.^[9] Proprioception is important for knee stability because, in having awareness of your knee position, your body can respond by contracting or relaxing the muscles around the knee to ensure a stable position.^[9] After an ACL surgery, your knee may feel unstable and so, regaining neuromuscular control is imperative to not only ensure proper movement and function but to also protect your knee from further injuries.^[9] Some ways to regain neuromuscular control of the knee are to strengthen the supporting muscles around your knee and to make sure you complete balance exercises.^[3]

What are the 5 most important exercises to do daily after ACL surgery?

Given that the goal in the early phase of recovery is to achieve full range of motion and regain neuromuscular control of the knee, exercises involving knee flexion, knee extension, knee muscle strengthening and proprioception are recommended during the first 4 weeks after surgery.^[3] Outlined below is a list and description of 5 exercises that you can incorporate into your daily routine. It is important to remember that everyone recovers at their own rate so it is possible that you may not be ready for some of these exercises. To ensure that these exercises are safe and suitable for you, please make sure to discuss them with your healthcare provider beforehand.

1. Co-contraction of quadriceps and hamstrings

• While lying on your tummy, tense the muscles above your knee cap and the muscles at the back of your thigh at the same time and hold this for 10 seconds.
• Complete 10 repetitions holding each for 10 second.

2. Heel slides

• While sitting with your legs straight, wrap the bottom of your ankle with a towel or bed sheet so that you are holding both ends of the towel as indicated in the photo above. Slowly bend your operated knee as far as possible by sliding your heel towards your butt and pulling the towel up towards your chest. Hold this for 5 seconds before slowly straightening the leg back to the starting position. This exercise works on knee flexion and knee extension range of motion.
• Complete 25 repetitions and 2 sets.

3. Knee extension over a roll

• While sitting on the floor, place a rolled up towel under your ankle. Straighten your knee as best as you can and keep it straight for 5 minutes. This exercise works on improving your knee extension range of motion.
• Complete 5 minutes, 3 times per day.

4. Straight leg raise

• While lying on your back, keep your non-operated knee bent and contract your quadriceps muscles on the operated leg to keep the knee straight. Continue to contract your quadriceps muscles as you gently lift your whole leg up from the floor. Lift your leg as high as you can without your knee bending and then slowly lower the leg back to the starting position and relax the muscle. This exercise also targets knee extension range of motion as well as quadriceps strengthening.
• Complete 15 repetitions and and 3 sets.

5. Squat supported by a chair

• With a chair or table in front of you, place your hands on the chair or table and use it as support. Slowly lower your body down so that your knee bends to 60^o as indicated in the photo above. Remember to stick your butt out as you lower your body. Then, push up to straighten your knees. This is a dynamic exercise that works on flexion and extension range of motion, quadriceps and hamstrings strengthening as well as neuromuscular control.
• Complete 12 repetitions and 3 sets.

Conclusion

After an ACL surgery, exercises focusing on restoring range of motion, strength and neuromuscular control are essential to ensure successful rehabilitation and to prevent reinjury. Exercises targeting knee flexion, extension, muscle strengthening, and proprioception can be incorporated into your daily routine within the first 4 weeks after surgery. Because everyone's pace of recovery may vary, it's important to discuss these exercises with your healthcare provider to ensure they are safe and suitable for you! While there are many other exercises and activities that are necessary for ACL surgery recovery, given the important goals of restoring range of motion and neuromuscular control in the early phase of recovery, the exercises mentioned in this blog are the most important ones to focus on during this stage.

These exercises and all other essential exercises can be found in the Curovate Physical Therapy App. Simply use one of the download links below to start your ACL recovery today! Curovate is an evidenced-based app with guided physical therapy plans, daily guided video exercises, ways to measure and monitor your progress, and measure your knee range of motion. Download the Curovate App by clicking on the links below.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Blogs related to ACL surgery

• How can I keep up with all of my exercises after ACL injury or surgery? Advice and tips for exercise
• Why is it taking me so long to get better after ACL surgery?
• Why is my knee making weird sounds after ACL surgery? Is a grinding sound normal after ACL surgery?
• Did I retear my ACL? How do I know if I reinjured my ACL graft after surgery?
• Recovery Tips After ACL Surgery - 5 things you need to know before you have ACL surgery
• How does cycling help with my ACL recovery? Is a stationary bike good after ACL surgery? Do I need a stationary bike after ACL surgery?

References

1. Yoo H, Marappa-Ganeshan R. Anatomy, bony pelvis and lower limb, knee anterior cruciate ligament. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559233/

2. Saka T. Principles of postoperative anterior cruciate ligament rehabilitation. World J Orthop. 2014;5(4):450-459. Published 2014 Sep 18. doi:10.5312/wjo.v5.i4.450

3. Van Grinsven S, Van Cingel REH, Holla CJM, Van Loon CJM. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2010;18(8):1128-1144. doi:10.1007/s00167-009-1027-2

4. Cascio BM, Culp L, Cosgarea AJ. Return to play after anterior cruciate ligament reconstruction. Clinics in Sports Medicine. 2004;23(3):395-408. doi:10.1016/j.csm.2004.03.004

5. Delaloye JR, Murar J, Sánchez MG, et al. How to rapidly abolish knee extension deficit after injury or surgery: A practice-changing video pearl from the Scientific Anterior Cruciate Ligament Network International (SANTI) study group. Arthrosc Tech. 2018;7(6):e601-e605. Published 2018 May 7. doi:10.1016/j.eats.2018.02.006

6.Noailles T, Chalopin A, Boissard M, Lopes R, Bouguennec N, Hardy A. Incidence and risk factors for cyclops syndrome after anterior cruciate ligament reconstruction: A systematic literature review. Orthopaedics & Traumatology: Surgery & Research. 2019;105(7):1401-1405. doi:10.1016/j.otsr.2019.07.007

7.Ouweleen AJ, Hall TB, Finlayson CJ, Patel NM. Predictors of arthrofibrosis after pediatric anterior cruciate ligament reconstruction: What is the impact of quadriceps autograft? Journal of Pediatric Orthopaedics/Journal of Pediatric Orthopedics. 2021;41(7):395-399. doi:10.1097/bpo.0000000000001860

8.Guerra-Pinto F, Thaunat M, Daggett M, et al. Hamstring contracture after ACL reconstruction is associated with an increased risk of Cyclops syndrome. Orthopaedic Journal of Sports Medicine. 2017;5(1):232596711668412. doi:10.1177/2325967116684121

9.Hewett TE, Paterno MV, Myer GD. Strategies for Enhancing Proprioception and Neuromuscular Control of the Knee. Clinical Orthopaedics and Related Research. 2002; 402 76-94.Hewett TE, Paterno MV, Myer GD. Strategies for Enhancing Proprioception and Neuromuscular Control of the Knee. Clinical Orthopaedics and Related Research. 2002; 402 76-94.

Have you ever suffered injury or gone through surgery and your doctor or physiotherapist has advised you to apply ice to the affected area?

Why do they do that? The two main benefits of ice after injury or surgery are:

1. Pain Management: The cooling effect of ice acts as a numbing agent that reduces pain in the area and ice basically acts as an alternative to pain-killer medications for many people.
2. The other benefit is that when you apply ice along with a little bit of pressure you can help reduce swelling and inflammation in that area.

In the video below, watch Dimitri answer the questions "Why should I use ice after my injury or surgery?" and "Why does my physical therapist tell me to use ice?"

Read the full blog on how does ice contribute to my recovery and should I use it here.

Read all 3 of Dimitri's blogs here!

Remember, icing is generally safe but it’s always safest to consult your healthcare professional for advice before icing your recently-operated or injured area. And remember if you have had surgery and are using ice, keep your knee or hip clean and dry while applying ice for pain relief.

You can find more information about recovery from hip replacement, knee replacement, as well as ACL tears and surgery from our Curovate App! Curovate is an app for physical therapy. Within the Curovate app, there are personalized rehabilitation plans which include video-guided exercises and precise scheduling of when to perform these exercises at your stage of recovery. Proper rehabilitation, which is accomplished with diligent exercise and pain management, is key to ensuring your body can recover at (near) 100% of its ability before sustaining the injury. Click the links below to download the Curovate physical therapy app, available for iOS and Android devices!

If you need further customized assistance during your recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other Related Blogs

• Am I too young to get a knee replacement?
• I injured my ACL what should I do?
• After I wake up from ACL surgery, what should I expect?
• Ice, compression, elevation and ankle pumps
• Physical therapy advice after knee or hip surgery to keep up with your exercises! – Part 1

References

1. Pan, L., Hou, D., Liang, W., Fei, J., & Hong, Z. (2015). Comparison the effects of pressurized salt ice packs with water ice packs on patients following total knee arthroplasty. International journal of clinical and experimental medicine, 8(10), 18179–18184.

2. Adie S, Kwan A, Naylor JM, Harris IA, Mittal R. Cryotherapy following total knee replacement. Cochrane Database Syst Rev. 2012;9

3. Macedo LB, Josue AM, Maia PH, Camara AE, Brasileiro JS. Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial. Physiotherapy. 2015;101:155–160.

4. Block J. Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: A narrative review. Open Access J Sports Med. 2010;1:105–113.

5. Fang L, Hung CH, Wu SL, Fang SH, Stocker J. The effects of cryotherapy in relieving postarthroscopy pain. J Clin Nurs. 2012;21:636–643.

6. Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold, and pain tolerance. Br J Sports Med 2007;41(6):365-369; discussion 369.

7. Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Phys Ther 2010;90(4):581-591.

8. Clarke, H. A., Manoo, V., Pearsall, E. A., Goel, A., Feinberg, A., Weinrib, A., Chiu, J. C., Shah, B., Ladak, S. S., Ward, S., Srikandarajah, S., Brar, S. S., & McLeod, R. S. (2020). Consensus statement for the prescription of pain medication at discharge after elective adult surgery. Canadian Journal of Pain, 4(1), 67–85.

9. Mayo Foundation for Medical Education and Research. (2020, December 1). Edema. Mayo Clinic. Retrieved October 11, 2021, from https://www.mayoclinic.org/diseases-conditions/edema/symptoms-causes/syc-20366493.

10. GW;, S.-S. (2006, April 7). Analysis of inflammation. Annual review of biomedical engineering. Retrieved November 1, 2021

11. Weber, K. (n.d.). The technical benefits of icing - inverse med. The Technical Benefits of Icing. Retrieved November 1, 2021

We hope this physical therapy advice will help you keep up with your daily exercises following a knee or hip surgery. There are a few reasons why people have a hard time keeping up with their daily rehab programs:

1. Pain: After any kind of surgery, you will feel pain in the affected area and you will likely feel pain during the first couple of months of the rehab process. What you need to remember is that the pain is temporary and exercises helps to reduce pain over time. The functional gains and the long-term benefit for outweighs the pain that you are feeling at the moment.
2. Fear: After any kind of surgery, people have a natural fear that they might re-injure themselves during the rehab process but it's important to remember that the likelihood of re-injuring yourself during the rehab is very low if the program is both effective and done consistently.

Check out the video below, where Dimitri answers the question "How can I keep up with all of my exercises after ACL injury or surgery?" and provides advice and tips for exercise.

For more information about physical therapy advice check out the 4 part Curovate blogs, starting with part 1, on how to keep up with your injury and surgery daily exercises here.

Read all 3 of Dimitri's blogs here!

The Curovate app has rehab protocols for ACL injury. Download our Curovate physical therapy app from the links below. Curovate is an app for at-home physical therapy exercises following a knee replacement, ACL surgery, ACL injury or hip replacement. Curovate also provides daily video guided strengthening exercises, the ability to measure knee range of motion, in-app chat with a physical therapist to answer your surgery and recovery questions, and educational blogs and webinars.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other recommended blogs

• How do I stay consistent with my physical therapy exercises after surgery or injury? Part 2
• How do I stay consistent with my physical therapy exercises after surgery or injury? Part 3
• How do I stay consistent with my physical therapy exercises after surgery or injury? Part 4

References

1: Chan, D. K., Lonsdale, C., Ho, P. Y., Yung, P. S., & Chan, K. M. (2009). Patient motivation and adherence to postsurgery rehabilitation exercise recommendations: the influence of physiotherapists' autonomy-supportive behaviors. Archives of physical medicine and rehabilitation, 90(12), 1977-1982.

2: Gignac, M. A., Cao, X., Ramanathan, S., White, L. M., Hurtig, M., Kunz, M., & Marks, P. H. (2015). Perceived personal importance of exercise and fears of re-injury: a longitudinal study of psychological factors related to activity after anterior cruciate ligament reconstruction. BMC sports science, medicine and rehabilitation, 7(1), 4.

3: Pizzari, T., McBurney, H., Taylor, N. F., & Feller, J. A. (2002). Adherence to anterior cruciate ligament rehabilitation: a qualitative analysis. Journal of Sport Rehabilitation, 11(2), 90-102.

4: Barber-Westin, S. D., Noyes, F. R., & Andrews, M. (1997). A rigorous comparison between the sexes of results and complications after anterior cruciate ligament reconstruction. The American journal of sports medicine, 25(4), 514-526.

5: Jack, K., McLean, S. M., Moffett, J. K., & Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Manual therapy, 15(3), 220-228.

6: Naugle, K. M., Fillingim, R. B., & Riley, J. L. (2012). A meta-analytic review of the hypoalgesic effects of exercise. The Journal of pain, 13(12), 1139-1150.

Curovate is a physical therapy app for ACL injury, ACL surgery, knee replacement, knee strengthening, hip strengthening, and hip replacement. This blog focuses on how to seamlessly sign up for Curovate once you have downloaded the app and want to start using it. To download the app simply click on any of the Apple App Store or Google Play Store links at the top of bottom of this page.

How to sign up for Curovate: The one-click sign in method

When you open Curovate, you can use Apple, Google or Meta (also called Facebook) as a one-click method to create an account with Curovate. These three, one-click methods make it easy for you to start an account with Curovate with an existing account. The adviantage here is that you do not need to remember another username and password to log into Curovate!

• For Apple, you only need to type in your Apple ID and password in order to start an account with Curovate.
• For Google, you need your gmail address and password.
• For Facebook or Meta, you need your Facebook ID and password.

Curovate keeps your health data secure

Please rest assured that even though we provide these one-click sign in methods, Curovate is committed to keeping your health data secure. We do not share your data with Apple, Meta or Google, nor do we sell, barter, or share data with any other company.

Alternate sign up method: Creating a Curovate username and password

If you prefer not to use Apple, Meta, or Google to sign up with Curovate, you can create an account using your email and a secure password. To sign up with this method:

1. Provide your email. A verification code will be sent to this email.
2. Verify your email by going to your email inbox, finding the verification code sent to you, and inputting the code into the Curovate app. If you do not receive an email in your inbox please check your "junk" "spam" and "social" mail folders as the verification code may be accidentally classified as junk.
3. After verifying your email, you will be able to create a new email and password specific to your Curovate account.

For a step by step guide, with a screen recording taken directly from the Curovate Physical Therapy App, watch the video below to learn how to sign up in the Curovate app.

What information is required for creating a Curovate Account?

Curovate will ask you for your date of birth and gender to complete account creation. Once you provide this information, you will be directed to a screen that asks you to input your surgery and injury information:

1. You will be asked about what injury or surgery you are recovering from or what area of the body you wish to strengthen. For example, if you had a knee replacement, select “total knee replacement” in the surgery options.
2. You will then be asked to select the date of your surgery and the date of your injury. It is important that you input the most accurate information about your surgery because this is used to place you in the proper physical therapy exercise stage in the app. Being in the proper exercise stage will enable you to complete exercises and rehabilitation that accounts for your current abilities.
3. After inputting your surgery or injury date Curovate will take a few seconds to load your rehabilitation protocol. This rehabilitation protocol consists of daily exercise videos, progress tracking of all of your exercises, the ablility to measure your knee or hip range of motion, the option to ask a physical therapist any questions through our in-app chat, or book a 1-on-1 physical therapy appointment.
4. From the home screen of Curovate, you will be able to see what stage you are placed in for your recovery.
5. Select “play day 1” to see the exercise list and videos that are necessary to complete for that day. Review the stage goals and daily exercises to make sure they are appropriate and not too challenging. We have a great video to show you how to use Curovate if the exercises in your starting stage are too challenging. We also have a video to show you how to use Curovate if the exericses in your starting stage are too easy.

To learn more about how to switch stages when exercises are too easy or too hard, check out our blogs on How to use Curovate if the exercises are too easy? and How to use Curovate if the exercises are too hard?

How many days of exercise are in each Curovate stage?

Each stage has seven days. In the seven days, the exercises are the same. Each day, you will be provided with a list of equipment you need to complete the exercises. You will also have access to a condensed exercise program in case you do not have enough time to complete the entire exercise session. Each exercise stage contains different exercises. Only stage one (1) has one day of exercise, all other stages have seven days. You must complete each day fully in order for the app to move you onto the next day. After completing all seven days of exercise, the app will move you to the next exercise stage.

How do I play all of the exercises assigned to me each day within an exercise stage?

Selecting “Play All” will play all of the exercise videos in a session. A session can be morning, afternoon and evening. Some stages have 3 sessions and some have 2 or just one session per day. If you complete all of the exercises assigned within the day, the app will mark all of your exericses as complete and progress you to Day Two. Completing all assigned exercises regularly will allow you to progress along your recovery journey, so try your best!

The Curovate App provides you with guided exercises, rehab reminders, progress tracking, and can even measure your range of motion all with your phone. To get started, simply download the Curovate App for iOS or Android using one of the links below.

If you need further customized assistance during your surgery or injury recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other recommended blogs

• How to use Curovate if the exercises are too easy
• How to measure knee range of motion in the Curovate app
• How to use Curovate if the exercises are too hard

Image by Canva

One of the most impressive features of the Curovate Physical Therapy App is the evidence-based exercise stages that the app provides you with along your recovery journey. Once you input information regarding your injury or surgery or answer Curovate's exercise questions, Curovate you will be provided with a particular stage within the Curovate app with specific morning, afternoon, and evening exercises to complete. If you complete all of the exercises within the stage, you will achieve the specific exercise goals that define that particular stage. Check out the Curovate App for iOS and Android by selecting one of the download links below!

How do I move back or forward between the exercise stages?

Among the most common questions people have regarding the Curovate app is how to move back or forward between the exercise stages to figure out where they should be starting their recovery. This blog will focus on how to use Curovate if the stage assigned to you provides you with exercises that are too hard for your recovery.

How long is each exercise stage?

Each stage in the Curovate app is 7 days long, with the exception of stage 1, which only lasts one day. Stage 1 is intended to be the first day after surgery which is why it only lasts one day. The rest of the stages in the Curovate app last 7 days each. Keep in mind, the early stage exercises are purposely made easy because they are designed for people who just had surgery or an injury, so their physical capacity for exercise is limited.

Follow these steps to effectively use Curovate if the exercises in your current stage are too challenging:

1. Open the Curovate app.
2. Input your injury or surgery information. For example, if you have had an anterior cruciate ligamnet (ACL) surgery using the hamstring tendon graft, select ACL. Then select the hamstring tendon in the “select the type” drop down option.
3. Enter the date your surgery took place. For example, if your ACL hamstring tendon surgery took place November 24th, 2023, enter this in the surgeyr date section. Optionally, you can also specify the date your injury took place. For example, if your ACL injury took place February 18th, 2023, enter this into the injury date section. Keep in mind that the injury date will not determine the stage you are started in for the Curovate app. Based on the surgery date Curovate will place you in an exercise stage. Let's assume Curovate starts you in in Stage 10.
4. From the home screen, select “Play Day 1” of the assigned stage.
5. Take a look at the goals presented to you within this stage.
6. Review the exercises provided in the morning, afternoon, and evening sessions. Based on the stage goals and assigned exercises provided, if you find that the exercises are too hard for what you can do at this time, follow the next steps:
7. Go back to the Curovate home screen.
8. Select “past stages”. Select a previous stage. Let's assume you select stage 5.
9. Once again, review the stage goals in this stage and the exercises within the morning, afternoon, and evening sessions.
10. If this stage corresponds to your current physical abilities, start with the stage 5's day 1 exercises instead of the original stage 10 exercises provided to you.

For a step by step guide, with a screen recording taken directly from the Curovate Physical Therapy App, watch the video below to learn How to use Curovate if the exercises are too hard.

The Curovate App provides you with guided exercises, rehab reminders, progress tracking, and can even measure your range of motion all with your phone. To get started, simply download the Curovate App for iOS or Android using one of the links below.

If you need further customized assistance during your surgery or injury recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other recommended blogs

• The Benefits of Active Recovery
• How to measure knee range of motion in the Curovate app

I am very proud to announce that after many years of work and feedback from people around the world Cuorvate is now completely updated! Curovate was started at the University of Toronto by myself, Nirtal Shah a physical therapist, and some very smart software engineers. Annie Mao, Harris Chan and Sherry Shi worked with me to develop our very first version of Curovate in 2016. Now 8 years later the company is still woking on solving the problem of global access to affordable physical therapy all while improving rehabilitation adherence. To put this is in simple terms, I want more people to have access to the critical physical therapy after injury or surgery and I want more people to get better without needing surgery. I acknowledge that as a profession, physical therapists, have to do more to improve how often and how well people do their necessary exercsies and Curovate is my contribtuion to help address the low rates of rehabilitation adherence.

Since we first launched in 2016 a lot has changed! We still provide rehabilitation for people before and after an Anterior Cruciate Ligament (ACL) injury or surgery. But we now also provide rehabilitation for people before and after a Total Knee Replacement or Hip Replacement, people who suffer from the pain and disability of Knee Osteoarthritis and people who want safe and effective exercises for knee and hip strengthening. Our brand new app incorporates the feedback of hundreds of people who have used Curovate for their daily rehabilitation. Here is the app preview of the brand new Curovate App!

You can learn more about our Physical Therapy App, Curovate, on our website or you can download the Curovate app for iOS and Android devices from the links below this blog.

If you need further customized assistance during your surgery or injury recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Numbness is a normal side effect after ACL surgery. Why this happens will depend on a couple of factors specific to your ACL reconstruction. It can depend on the type of medication that you are given during your surgery and what type of ACL graph you receive. If you got a hamstring tendon autograft you are at a higher risk of feeling numbness. If there was damage to the nerve during surgery it may cause numbness or tingling. Damage can be permanent or temporary. Most people feel numbness in a little circle near the incision site or anywhere from their inner knee down to their ankle. Most people will start to feel this numbness decrease about 6 to 12 months after surgery but, in rare circumstances, it can be permanent.

This video answers the question "why does my knee feel numb and tingly after an ACL surgery?" Physical Therapy student, Lauren, explains how medications, type of ACL surgery graft, and nerve injury during surgery can affect this feeling. This numbness usually goes away within 6-12 months after ACL surgery. Usually the numbness is nothing to worry about and is perfectly normal.

Read the full blog that discusses the reasons your knee feels numb and tingly after ACL surgery here.

Read all 5 of Lauren's blogs here!

An easy and effective way to receive video guidance, similar to this video, after your ACL surgery is to use the Curovate physical therapy app for ACL recovery. Curovate provides daily video guided strengthening exercises, the ability to measure knee range of motion, in-app chat with a physical therapist to answer your surgery and recovery questions and educational blogs and webinars. Find our iOS and Android app for your recovery by clicking the links below.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other recommended blogs

• How does cycling help with my ACL recovery? Is a stationary bike good after ACL surgery? Do I need a stationary bike after ACL surgery
• After ACL surgery, how much help will I need? And help with what?
• Is my ACL graft weaker than my original ACL? Or is my ACL graft stronger than my original ACL?

References

1. Horteur, C., Cavalié, G., Gaulin, B., Cohen Bacry, M., Morin, V., Cavaignac, E., & Pailhé, R. (2020). Saphenous nerve injury after anterior cruciate ligament reconstruction: Reduced numbness area after ligamentoplasty using quadriceps tendon compared with hamstring tendon. The Knee, 27(4), 1151–1157.

2. Inderhaug, E., Strand, T., & Solheim, E. (2015). The impact of sensory deficits after harvesting hamstrings autograft for ACL reconstruction. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 23(4), 1060–1064.

3. Kjaergaard, J., Faunø, L. Z., & Faunø, P. (2008). Sensibility loss after ACL reconstruction with hamstring graft. International journal of sports medicine, 29(6), 507–511.

4. Nerve Blocks For Surgery - Yale Medicine. (2020, July 02). Retrieved from https://www.yalemedicine.org/conditions/nerve-blocks-for-surgery

5. Ochiai, S., Hagino, T., Senga, S., Yamashita, T., Oda, K., & Haro, H. (2017). Injury to infrapatellar branch of saphenous nerve in anterior cruciate ligament reconstruction using vertical skin incision for hamstring harvesting: risk factors and the influence of treatment outcome. Journal of orthopaedic surgery and research, 12(1), 101.

6. Sanders, B., Rolf, R., McClelland, W., & Xerogeanes, J. (2007). Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 23(9), 956–963.

7. Wang, H. D., Zhang, H., Wang, T. R., Zhang, W. F., Wang, F. S., & Zhang, Y. Z. (2018). Comparison of clinical outcomes after anterior cruciate ligament reconstruction with hamstring tendon autograft versus soft-tissue allograft: A meta-analysis of randomised controlled trials. International journal of surgery (London, England), 56, 174–183.