ACL Reconstruction Rehab – What about Over-Pronators?


I wrote in my last post that ACL reconstruction rehab is for life, not just for the six months after surgery. Maybe this is less so if the ACL was torn by a simple rotational strain but in my case, where the knee was injured by serious impact, the repercussions seem to go on and on.

Why do I say that? Well, a non-impact injury to the ACL is unlikely to impact the other ligaments. So, while the ACL reconstruction leads to a degree of instability, the working MCL, LCL and PCL will enable the knee to recover strength quickly (and permanently) once the ACL recovery is complete. When the other ligaments are also damaged, then they have to recover too making overall recovery longer and also more tenuous.

I found that muscle atrophy became a matter of course when I stopped working my quads in rehab. Why did I not suffer the same atrophy in my good leg? Probably because I compensated excessively during recovery and continued to do so once I thought my recovery was complete. When I started to think about this I realized that I still stand up on the leg that wasn’t injured. Even today, over a year after surgery I still compensate by putting the weight on my good leg when I stand.

Which brings me to over-pronation. I don’t know if we’re born with flat feet but many of us have them. What we don’t realize is how much the body compromises for them in our everyday lives, how the muscles in the arch of our feet help, how our ankles compensate and the muscles in our legs all work to keep everything in good working order (and alignment). All of this is happening without us thinking about it.

I have flat feet. 6 months of ACL rehab followed by a couple of months fattening up for Christmas meant that those muscles in the arch of the foot of my injured leg stopped working. The daily connections with my ankle and the muscles in my leg that accommodated the over-pronation were not being used. All of this meant that one year after injury, my over-pronation was now a serious issue.

Over-pronation means that, under load, the foot will cave inwards and the ankle will follow. Through not using the leg sufficiently during recovery, the muscles in the foot, the ankle and the leg muscles are no longer going to be able to compensate for this which will lead to massive instability in the knee and a high likelihood of re-injury.

With this instability, a leg squat will see the knee follow the caving foot arch and ankle and the knee bend will occur inside the foot and likely lead to further injury. At least knowing this, squats can be undertaken that are controlled and limited in range so as to keep the knee over the foot.

The answer is to rebuild the muscles in the foot and ankle. Yes, more work!! Small, controlled squats that keep the knee in alignment are good. Use a stretch band to restrict lateral foot movements, i.e. pull against the strain. These are difficult to explain in a blog post so during May 2012 I will be putting some small video examples on YouTube. Here’s the one for over-pronators: