Episode 82 | When To Ditch Your Crutches Post-Op ACLR

What is up guys, and welcome back to another episode. If you are new to the podcast, then thanks for joining us. If you have been a longtime listener, I appreciate you. Now, let’s dive into today’s episode: When to Ditch Your Crutches Post-Op ACL? Now, this is a very interesting question and it’s one that I’ve given a lot of thought about after working with lots of ACL athletes, and after having many conversations with you, when we’re thinking about the principles of post-op ACL, the crutches can play into being a very valuable tool. And look, I’m going to be completely honest here. Too many of you get off your crutches way too soon. I get it. You’re tired of lugging them around, you’re tired of people staring at you, you want to have your hands free. I get all of the concerns with them.

As a side story, in eighth grade, I broke my ankle, not once but twice. I was in a cast at the beginning of my eighth-grade year after playing tackle football in the backyard with some friends. One of my friend’s brothers jumped on my back and all that force and I guess the way that I was stepping broke my ankle. I was in a cast for eight weeks to start my eighth-grade year. I mean, how cool am I? I got off my crutches and then I started playing sports again. I wrestled and played some baseball, and then I remember dropping into a halfpipe that I was peer-pressured into dropping into in eighth grade. And I came down and my ankle didn’t like it, and it actually broke in the same place. And this was months after. I was on crutches for six more weeks and then got off. Luckily, no more ankle breaks after that. But for a total of 14 weeks in my eighth-grade year, I was on crutches. It was super cool. And talk about constantly being stared at. But the only perk was that the girls had a soft spot for me. And so it wasn’t all that bad. But it still sucks to be on crutches so I feel you guys here. 

And there was one time when I do remember almost falling to my death at the top of the gym bleachers because I was going down. And I decided to step down and leave my crutches, both my crutches on the stairs. You can imagine trying to step down stairs with crutches on your sides, and you’re stepping down with the leg that you can put down. And guess what? It’s not long enough to touch the stairs, so then you start tumbling forward. Luckily, my best friend caught me and the crisis was avoided. This was all before my two ACL injuries. So trust me, I wanted to be off of them as soon as I could be. 

And I often hear stories from ACLers getting off crutches within days and then resorting to a limp in their gait. And this could be for a number of reasons. Maybe they got tired of them, their PT said so, or maybe the protocol said so. I know what ends up happening is that you start off with two crutches and then eventually you’re like, all right, I’m good enough to just kinda hobble around in your house. And then that kind of carries over to a little bit of that independence where you don’t necessarily need the crutch and then PT may reinforce that and then you end up not having your crutch.

There’s good and bad ways to go about doing this, and there’s always going to be this small window of adjustment if you will. But I hear about athletes multiple weeks and months out, still with a limp walking. And one of the major milestones in this process, definitely getting off the crutches and a big one, is being able to run. Now, do you think if you are walking with a limp that you’re running is also going to have that piece or aspect to it? Now, maybe not because you’re moving dynamically. But I guarantee you that your body is going to compensate for that movement, especially if there’s not certain prerequisites that we need for it.

And this is simple, you need to crawl before you walk, walk before you run, and run before you sprint. And these are all pieces that are going to build up to make sure you’re progressing appropriately. And you guys know each athlete will be different. We’ve talked about this in many different episodes where this will be very individual based on what is going on and the factors with each person. And you can almost think of this as your own individual DNA or fingerprint. It’s going to look different from person to person. And so I’ve seen athletes come successfully off crutches within days post-op, and I’ve seen some that take weeks to even months plus. And there’s so many things that play into that.

And I remember for my first ACL injury, I worked really hard on my extension and my gait and my flexion, like all of you are. And especially to get my quads going. I was able to start walking pretty quickly and get rid of my two crutches to one crutch and then went down to no crutches within days, and it was really great. My PT was clearing me for it. And I never really felt much of a limp. In my second one, it took me a little bit longer. My injury itself had more concomitant issues. I had a meniscus tear, I had MCL damage. There were other things that impacted my recovery and my surgery. I ended up getting off of my crutches a little after 7 to 10 days roughly. And I know some of you listening are on crutches right now, and you’ve been on it for weeks, and you’re like, wow, 7 to 10 days. That seems short compared to where I’m at. And one thing I’m going to say is don’t compare yourself to my own journey or the other people around you. 

The other piece is going to be the factors related to you. And this is what we are going to dive into next. That’s going to be the factors related to your initial injury. And concomitant issues play such a huge role here. If you have a tibial fracture, if you have a bone bruise, if you have some sort of cartilage damage, if you have a meniscus tear, a meniscus repair, maybe this is your second ACL injury on the same knee, maybe you tore part of your MCL or your PCL or your LCL, and then the type of surgery you have. Whether that’s the meniscus repair or you had to have some sort of MCL repair. Obviously, the ACL reconstruction itself, the graft type that you got, maybe the graft site pain and discomfort. And then there’s the whole post-op healing. You got to get through this acute phase where there’s been holes drilled, there’s been a graft taken, there’s maybe some other areas that have been repaired. Think about all of that that has happened to the knee, and what I would say is a second trauma essentially. And that’s to help build your knee back up to being in a place where you can do the things you want to. But it’s going to take time, especially in that acute early phase. And so that’s going to impact your ability to weight bear and your ability to get back to a normal gait. And most importantly, when you can ditch your crutches. 

An example of this is, let’s say someone has an ACL, MCL, and a meniscus tear. The surgeon decides to repair the meniscus. And the way that it is repaired it is going to need non-weight-bearing for six weeks. Guess what? You’re going to be on crutches for six weeks. And I know some of you listening are probably going through that process and it’s really tough. And for six weeks, non-weight-bearing on crutches. And then you have to keep in mind that the joint loading, once you can put the weight on it, is going to be different as well. You’ve offloaded the weight on the knee to allow the meniscus to heal. There’s not as much of that friction and compression. And then you eventually will be able to start putting the weight down. And often what I’ll see is that people will react with some swelling once they start putting weight down, when they reintroduce walking and gait because it’s a new shock and stress to the system. Nothing necessarily bad and pretty normal and on par for the process, but it’s all about these expectations and understanding the game plan that is going to be specific to you.

When your protocol says you need to be off crutches in six weeks, and you’ve had a meniscus repair, has that taken into account all the factors associated with you. And then let’s not also forget that a lot of the time there’s atrophy and weakness post-surgery, especially when you’re non-weightbearing. So that is all going to play into when can you ditch your crutches and when can you even get to maybe one crutch? 

We’ve talked on previous podcasts about the prerequisites needed to walk normally with our gait. And this plays into when you can get rid of your crutches, essentially. Our goal is to get the knee quiet, you want to get full terminal knee extension, matching the unoperated side. You want your flexion to at least get roughly around 120 degrees, definitely 90 at the least. You want your quads very active and going and be able to play into that whole knee extension process. You want to decrease your pain and your swelling as much as possible post-op because that’s going to play into you potentially compensating or activating certain muscles or gaining a range of motion. Those will all play into how your gait is going to come out. And some of that is in your control, some of it’s not.

And then we also talk about gait training, so doing intentional drills in order to know if your gait is ready and if your walking ready to go with maybe two crutches to one crutch, or maybe you’re ready to ditch the crutches altogether? And this is going to be something that will depend on person to person where they’re at in the process. And one thing I have changed my stance on personally, after working with a lot of ACLers, going through it myself and just thinking about the principles and the physiology and what’s going on at the knee. 

My advice is to stay on your crutches a little longer than you think. They provide stability. They have that extra one or two arms that provide that support and stability. And more importantly, it provides the ability to offload your knee some. And what I mean by that is just joint compression and pressure. And anytime we put our foot on the ground, there is the force pushing back through the ground, and that is going through our joints and going through our knee joint. And when you’re not putting it on the ground, there’s no force going through it. And that could be very helpful post-op because your knee is trying to heal from the injury or from the surgery. And it allows it to have a good environment for healing to occur, and there’s not as much stress coming to it. 

There’s always going to be a sweet spot, what we call the Goldilocks’ zone, of not too much and not too little. You want to be right in the sweet spot of offloading. And this might start with maybe just some weight-bearing type movements and then progress towards your gait patterns and your crutches are going to help facilitate that. They basically allow your leg to try to relearn how to walk. And basically, be a leg again. They allow you to take some of that thinking out or try to depend on other muscles and compensate and allow you to work on the technique and the pattern of it, rather than just forcing yourself to get from point A to point B.

 Practice your gait with your two crutches and then go towards one crutch as much as possible until there is basically no difference between your one crutch and crutch less or no crutch gait. And the one caveat I want to add to this is, especially if your knee is swelling during this process, that means that the joint is taking on a bit too much, whether that’s the gait walking itself, the exercises you’re doing, or maybe you’re just being on your feet a lot. I have some people who can’t sit still and they want to walk around or do whatever. And then it’s early in the post-op process, and then their knee reacts by swelling. And so there has to be that sweet spot as I said earlier, that Goldilock’s zone of finding a way to offload. And if you feel like you need to do something, then that might be upper body or some off-feet type conditioning to make yourself exercise and move. But something where it’s not putting a ton of stress on the joint as it’s healing. And that way it also doesn’t impact your gait.

Take this slower than you think. And for some of you, this might be five days, and for some of you this might be weeks, and that’s okay. Just know each person will be different. You have to take into account, whether are you non-weight-bearing for a little bit or are you weight-bearing as tolerated immediately. Those will all play into it. And just allow yourself to build up each and every single day and make sure that you are pushing yourself. But to find that sweet spot and stay on those crutches longer than you think.

And the main takeaway here, and to answer the question: when can you ditch your crutches? My suggestion is once your crutching gait and no crutching gait feel and look the same with no limp, you meet those prerequisites that we discussed earlier. That is going to be key. The thing that you need to keep coming back to is if you continue to limp or if there’s an issue, you need to start asking why, you need to ask your PT why, who you’re working with and why. And that way you can be detectives and intervene in this process, as opposed to the protocol saying you need to be off crutches and your months post-op and you’re still limping. And we want to make sure that that doesn’t happen to you. 

All right guys, that’s going to do it for today. I appreciate all of you. Make sure that you are not that person who is walking with a limp post-ACL. If you are, figure out why. And if you need any help, reach out. Until next time, this is your host, Ravi Patel, signing off.