ACL Injury Pain Management
Strategies for managing pain throughout the recovery process.
Post Injury – Pre-Surgery
Pain management between the time of injury and surgery often focuses on reducing inflammation, protecting the joint, and maintaining as much comfort and function as possible. Initial strategies typically include the RICE protocol (Rest, Ice, Compression, Elevation) and the use of over-the-counter pain relievers like acetaminophen or NSAIDs, though the latter should be used cautiously and under guidance, especially as surgery approaches. (You will get a set of rules for pre-surgery that will include what drugs you can and can’t use.) Bracing or crutches may be recommended to stabilize the knee and reduce strain. Physical therapy may also be started before surgery to improve range of motion, reduce swelling, and maintain muscle strength, all of which can improve post-operative outcomes and help reduce pre-surgical discomfort.
There’s more issues for pre-surgery prep, such as making sure your knee is “quiet” and stable and ready for a surgical procedure. How you work out your pain management with your caregiver(s) will depend on everything from the type of injury you’re believed to have sustained to your tolerance, how long until you might have surgery and more.
Immediate Post-Operative Pain
Managing pain effectively in the first days after surgery is crucial for comfort and early rehabilitation participation:
- Medication approaches:
- Multimodal analgesia combining different medication types
- Scheduled non-opioid medications (acetaminophen, NSAIDs when appropriate)
- Limited opioid use for breakthrough pain
- Regional anesthesia techniques (nerve blocks) for initial post-operative period
- Non-pharmaceutical approaches:
- RICE protocol (Rest, Ice, Compression, Elevation)
- Cryotherapy (cold therapy) devices.
- If you talk to people who have been through this surgery, it’s easy to find plenty who will tell you their cold therapy regiment was as important or even more important than their pain meds for managing pain and discomfort.
- Proper positioning and bracing
Pain During Rehabilitation
As recovery progresses, pain management strategies evolve:
- Activity modification: Finding the balance between therapeutic stress and excessive pain
- Timing medication: Strategic use before challenging therapy sessions
- Physical modalities: Appropriate use of ice, heat, and other physical therapy modalities
- Addressing muscle soreness: Distinguishing between therapeutic discomfort and problematic pain
- Gradual progression: Systematic advancement of exercises to allow tissue adaptation
Managing Chronic Pain
For persistent pain beyond expected recovery timeframes:
- Identifying sources: Differential diagnosis of pain generators (graft site, donor site, patellofemoral, etc.)
- Advanced imaging: When needed to rule out complications
- Specialized interventions: Including targeted physical therapy approaches, appropriate injections, or referral to pain specialists
- Addressing contributing factors: Such as movement patterns, muscle imbalances, or kinesiophobia
Complementary Approaches
Many patients benefit from integrating complementary strategies:
- Mind-body techniques: Including relaxation training, mindfulness, and guided imagery
- Sleep optimization: Addressing sleep quality to improve pain tolerance and healing
- Appropriate nutrition: Managing inflammation through diet
- Acupuncture: Evidence supports benefits for some patients
- Psychological support: Addressing anxiety, catastrophizing, and other factors that can amplify pain
Clotting
Are you on an aspirin regimen? Besides the pain meds, you may be put on daily aspirin. It’s likely going to be a low dose so not as much stomach bother. But it’s specifically to help avoid clotting.
Anti-inflammatories
Careful.
Anti-inflammatories (like ibuprofen or naproxen) can reduce swelling and pain, but they may slightly slow down healing after ACL surgery because inflammation plays a role in tissue repair. They’re likely fine at some point like at least a week out. Again, as with all things, check with your doctor.
📰 Web Articles
Managing Perioperative Pain After Anterior Cruciate Ligament (ACL) Reconstruction: Perspectives from a Sports Medicine Surgeon
Reducing Opioid Use After ACL Surgery
How to Manage Pain After ACL Knee Surgery
Opioid Requirement After Anterior Cruciate Ligament Surgery: Opioid Use After Anterior Cruciate Ligament Surgery Is Low With a Multimodal Approach, and Fifteen Oxycodone 5-mg Tablets Are Sufficient
Editorial Commentary: Postoperative Pain Management After Anterior Cruciate Ligament Reconstruction Can Minimize Opioid Use and Allow Early Rehabilitation
Henry Ford Study Shows Non-Opioids Provide Effective Pain Relief After Knee Surgery
🎥 Videos
Post Operative Knee Pain Following ACL Surgery
Managing Pain with Fewer Opioids after ACL Surgery
Managing Pain and Discomfort During ACL Recovery