My daughter recently had ACL reconstruction surgery and is in early stages (2 months in) of rehab. We had some PT in the US and the rehab done there was intensive. She had exercises 3x a day for about an hour. She has since moved PT here in Switzerland and they are recommending exercises one time a day. As ACL reconstruction is very common, I was hoping that some of you would be willing to share your experiences with regard to physical therapy. I keep reading how important rehab is and want to make sure we are on the right track!
Hi,
When I tore my ACL I did not have the surgery, as according to my doctor i was too old but rather a minimum of six months in a cyborg-like brace and PT was prescribed.
Honestly - PT was not helpful. Looking back, I probably chose the wrong facility.
PT sessions were 25 minutes, three times a week. Total 9 sessions paid for by the KK. Of those 25 minutes per session, 5 were setting up the machines, a few minutes discussion, 5 minutes cleaning the machines afterwords - leaving only 10-15 minutes for exercises. Of that time, the therapist often quickly showed me what to do, then went to work with another patient. So I was pretty much on my own.
I've heard from other friends that there are better places to do PT.
So I guess my recommendation is to ask for a trial session with the therapist you are considering before you sign up for the sessions paid for by the KK - even if you have to pay for that trial session out of pocket. You want to be satisfied that your physical therapist is willing and able to actually try to help you.
The tear never healed. A few years on I still wear a brace much of the time. I'm going back in two weeks - a different therapist this time, one highly recommended by friends - to see if another round of sessions might do any good, or not. (KK won't pay, so that will be on me.)
If I like this guy, I'll PM you with his details.
Wishing your daughter all the best.
Thank you for the well wishes.
When it first happened, I asked anyone and everyone I knew if they had any experience with ACL reconstruction surgery and I was surprised at the various responses. Many older people I spoke with never got their ACL reconstructed, and just learned to live with it. I guess now it depends on your age and level of activity you want to do.(at least, thats the impression I got in the US). My daughter is a competitive athlete and wants to continue to be able to compete but has a long road of recovery ahead, at least 9-12 months. I have often read that the physical therapy after the op is the most important part of recovery. Not all physical therapists are the same and we are shopping around to make sure we find the best candidate for the job.
Regarding a brace, the doctor in the US said she should try and move her knee as much as possible and should not wear the brace after 7 days post-op. Here, I understand that they recommend you wear your brace for at least 6 weeks after surgery. These discrepancies (the amount of PT and the brace) seem too big to ignore so would like to investigate further, and where better to do that, than on the English forum 🙂
Thanks for sharing your experience. I am really surprised that KK will not pay for your therapy. It is an injury that needs to be treated, I would think, regardless of your age.
My husband did his ACL skiing (he’s an instructor). He is properly lazy when it comes to rehab type exercise though and he did pretty much nothing. He was back skiing 6 months after surgery and is absolutely fine now - so I wouldn’t stress too much!
Just to clarify: the KK paid for the first round of 9 sessions. It's the second attempt that they will not cover. Because the first round was not successful, there is no justification for additional PT.
If your doctor can justify additional PT and writes an RX for that, the KK will likely cover the additional sessions. And if you have private insurance, that's a game changer.
Have you looked at Balgrist and Schultess clinics?
As meloncollie wrote, a standard prescription for physiotherapy is for 9 sessions of max. 30 minutes. However, in my experience, a doctor can write another prescription immediately following the first, and even a third.
The doctor may or may not be asked by the medical insurance for a report justifying why more is necessary. Sometimes the doctor bases this report on their own assessment after a new examination. You can also ask the physiotherapist to write something for you, and then take that to the doctor to include in the report.
Reasons to continue physiotherapy could be that it is working and some slow progress is being made and this must not be lost, or indeed that it is not yet working so the approach in the treatment will need to be changed or intensified.
Super sorry to hear about your problems with your PT. I am currently in rehab following knee surgery and I also initially saw a physio who in retrospect was worse than useless. Saw them for 5 sessions before deciding to quit, and started with a new one with only 4 sessions left on my prescription. This was not enough time to obtain reasonable results, and my orthopedic surgeon was happy to provide me with a second prescription for 9 sessions, and the insurance is paying. I am surprised your insurance will not cover additional physio beyond the first 9 sessions: the fact that the first round did not achieve adequate results isn't your fault, it's incompetence on the part of the therapist. And also maybe your injury/surgery requires more than 9 sessions of PT to give a reasonable result. Have you tried pushing the issue a bit with your doctor for a second prescription?
My doctor's stance is "You are old. What's the point?"
PT isn't that expensive out of pocket here, around CHF 75-100 per 25 minutes.
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For the OP:
From my limited experience, there seems to be quite a difference between the approach to PT for injuries in the US and in CH. For lack of a better description, back home physio seeems to be more 'medical' than I have experienced here, and back home my doctor was more involved.
Which is why you might want your daughter to work with one of the well known ortho clinics or a sports medicine specialist.
Honestly, with all your comments over the years, you do have the 'wrong' doctor!
However, each case is different- due to size, age, damage, life-style, medical history, and so so much more, so as per usual, advice on internet is not really the best thing.
OH did the same falling off a cliff when skiing in fog when he was 38- was also told he was too old for surgery!!! He was furious at the time, but he made great recovery and was back playing squash after 6 months, and back on his skis, with knee support, next year, and still going strong at 76. He had no time for PT/physio as he was back at work very quickly looking after others ... but did his exercises at home, after a few sessions and shown what to do. Surgery is not always the best thing, and certainly not always necessary, and exercises can be done at home once shown what to do.
We are currently at one of the well-known Clinics and I know the doctors have great reputations, but I am not sure about the physical therapists. I was hoping she could just have one therapist but unfortunately, she will be seen by 3 different ones. After the summer holidays it might be different. They obviously have lots of experience with ACL reconstruction rehabilitation but for example when asked if the physical therapist had experience dealing the particular graph used for reconstruction, she said no, it wasn't used often here in Switzerland. Rehab should be based on the graph type utilized by the surgeon for reconstruction, since each graph type presents with different deficits. Her ACL injury involved the MCL and LCL and this can require a much different approach than an isolated ACL tear. Understanding the specifics of the surgery is important and I dont want to take any chances with a poor physical therapist, who doesn't take the time to understand the specifics. I think she is in good hands now but just wanted to hear others experience. We know of 2 other girl athletes who have undergone ACL reconstruction here in Switzerland and both of them had a retear shortly after returning to the sport. Physical therapy is the key to getting back to pre-injury performance.
The surgeon in the US has prescribed physical therapy for a year. I have sent the doctor's prescription to the insurance and the clinic and she is scheduled until the end of September so I am assuming everything is ok. I haven't heard otherwise. I better double check.
Like my grandfather who smoked unfiltered cigs and drank all his life and lived until 95. Sometimes its just in your genes.
Good lord, find a new doc asap. Everyone deserves a good quality of life, no matter what age they are.
I once (briefly) had a GP with the same attitude your GP has and it was horrible. What they brushed off as "normal age-related pain" turned out to be cancer, and it took the doctor months to believe the diagnosis.
I put all my trust in a doctor and was told that there was nothing to be concerned about. Turns out there was something terribly wrong and it was too late to do anything about it. I will not blindly trust any doctor again. I do my research and try to make sure I go to someone who has a lot of experience, and a good reputation. From my personal experience, and unfortunately, I have a lot of it, it makes a world of difference!
I am so sorry to hear- but truly you can't compare this to ACL and PT!
No surgery is definitely an option, but not due to age, but due to stability of the joint. My husband's knee was very stable after the accident, he was definitely swaying towards not having surgery, but occasionally the remains of the ACL would cause his knee to lock - because of this he went for surgery, but otherwise I don't think he'd have bothered.
Of course it is an option- never said it is not. But that each case is different, and surgery is not always 'the' solution in many cases.
OH is of course not a Ski Instructor, just a keen amateur. He is also a doctor and has never regretted not choosing the surgical route. As said, each case is different for 100s of reasons.
That seems quite expensive tbh. I was just discussing this with my therapist yesterday. For a normal treatment, they’re only allowed to charge 48 - .
I think it’s a bit ridiculous that they cost less than my hairdresser but I guess that’s just how it works around here :
Interesting.
I did a quick look around a few other area facility's websites, and the cheapest I could find ws CHF 60 per 30 min.
Maybe the price is higher because in this case it's not covered by insurance?
Yeah if it’s through insurance then they have to charge the insurance set tariff. If it’s private they can charge what they want.