Manual Therapy following ACL reconstruction

Hi PT's

Just wanted to hear some of your brief opinions regarding the value of manual therapy following ACL reconstruction surgery (arthroscopic). I deal with many post-op ACL patients in my clinic and I'm constantly challenging myself as to the efficacy of massage and passive mobs (other than CPM) post-op.

As far as I see it, in the initial weeks following surgery friction massage is great to reduce scarring/adhesions, and massage can be used to reduce swelling, but as the rehab progresses past the first (let's say) 3 weeks, I'm not so sure what the patient gains from their half an hour on the bed. Would it not be better to simply focus on exercise therapy (strength, flexibility, proprio etc, depending on the surgeons protocol) and forego the manual therapy after a few weeks?? (my current ACL patients have about 30min manual therapy, then about 2 hours of exercises, and electro etc etc).

Happy for any thoughts you have on the matter!

Hi,

In my opinion, continuing some form of manual therapy is useful to keep track of soft tissue restrictions while re-introducing exercise. Now I don't mean this in a sense of 30mins massage prior to a rehab session, more a quick Ax before exercise based rehab. In my experience, trigger point therapy etc. is something that is maintained throughout the rehabilitation process. It depends on what you are trying to achieve with the hands-on work?

I would agree that a run-of-the-mill massage may have some limitations once the swelling and mobility has improved.

Would be interested to hear some other thoughts too.

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