A torn or strained Anterior Cruciate Ligament (ACL) is a common injury, especially in athletes, and often requires surgery for a full knee reconstruction. For many people with a significant tear, ACL surgery is crucial to regaining the use of the knee because of the importance of the ligament. As one of two ligaments that connect your femur (the large bone in your thigh) to your tibia (one of the two bones in your lower leg), the ACL is a key component in knee movements such as twisting and turning.
After you have undergone surgery to replace the damaged ACL, you may find that you struggle to achieve a full night of rest due to the pain and limited ability to move.
After your ACL surgery you should sleep on your back, with your recovering leg straight, and slightly elevated above your heart. You can achieve this elevation by using a pillow, cushion, or perhaps, most comfortably, a leg elevation pillow.
If this sounds like a restricted position to you, know that you’re not alone, but it’s a vital step toward healing from the operation.
Because each person and their healing process is different, you may find that your sleep position and routine will vary slightly as time goes on.
A full recovery from ACL surgery can take anywhere from six months up to a few years. Some people discover that even upwards of four years on, they still haven’t been able to return to their previous condition.
In order to prepare yourself and promote the most effective recovery, getting enough sleep and avoiding additional damage while you do so is one of the best things that you can do for yourself each day.
How to Sleep After ACL Surgery
Many ACL patients find that they adjust their sleeping position to what feels most comfortable, depending on how their knee feels that day. Throughout your healing process, you may learn that some days are better than others. This is perfectly normal. Follow these tips on how to sleep directly after your surgery and as time goes on.
On Your Back
Sleeping on your back after surgery will likely be the most comfortable position, even if you are usually a stomach or side sleeper. If your usual sleep position is not on your back, it may be worth practicing for a few weeks prior to your surgery to avoid losing more sleep over the new position.
Since you need to keep your leg straight and elevated, sleeping with a firm cushion or bolster under your calf or ankle will help to rest your leg comfortably. Ideally, you should keep your knee elevated above your heart, so if you need more than one pillow, don’t be afraid to stack them.
When elevating your leg, it’s important to remember not to settle with the pillow directly under your knee. This placement prevents the knee from staying as straight as possible. Keep in mind that elevation is necessary to help with the swelling, so be sure not to skip this part.
If you are a restless sleeper and know that you move around through the night, you should also consider placing multiple pillows on both sides of your body, from your arms down to your legs. They will act as a barrier to discourage you from rolling around. As you can imagine, unconscious turning at night will cause extreme pain in your knee and will undoubtedly wake you from your sleep.
I recommend using a leg elevation, cervical pillow (to keep you on your back), and two full length body pillows to also prevent you from turning in your sleep. I did hours of research after my husband required ACL surgery last year and found the best luck with the following products:
- LightEase Memory Foam Leg Elevation Pillow (link to Amazon)
- Cervical Pillow For Sleeping on Your Back (link to Amazon)
- BioPEDIC Body Pillow (link to Amazon)
Having the peace of mind that he wasn’t doing any unnecessary damage in his sleep was a great comfort to the both of us!
On Your Side
Once you begin to regain some mobility in your knee. You might find it comfortable to change positions and sleep on your side. If you find that this position is better for your knee, try sleeping on the non-operative side with a pillow between your knees.
One benefit of this side position is that it allows for adjustment as your healing progresses, and you’re able to bend your knee more.
If you choose to sleep on the operative side, you should wait to do so until after the six-week mark. Be sure to still place the pillow between your knees. Having a cushion between your legs will help keep your body alignment, and will also keep the angle of the top knee in line with the hip (rather than falling inward).
On Your Stomach
For the first couple of months after ACL surgery, it isn’t advised to sleep on your stomach. Sleeping in this position prevents your leg from remaining completely straight and also increases the chances of twisting or turning at the knee joint.
Once you begin to regain the range of motion in your knee, speak to your surgeon about sleeping on your stomach. Depending on the progress, your doctor may clear you to relax in whichever position you feel most comfortable.
Other Sleep Tips After ACL Surgery
As we all know, achieving a decent amount of sleep is about more than just the position that you sleep in. Laying flat on your back is no guarantee of falling and staying asleep, especially in the first week or two. Because sleep is more complicated than that, you will need to take a few extra steps to help you get some rest.
- Pain medication – As mentioned, you may find that the pain can feel better or worse from day to day, especially within the first few weeks. This will happen if there are complications or if you have a long day using the joint (such as physical therapy). Keeping up with your pain medication and taking it as prescribed will help keep the discomfort at bay while you are trying to sleep.
- Consider sleeping downstairs at first – Because of the limited range of motion in your knee, it may be helpful to minimize the number of steps that you need to climb. Moving your mattress to the first floor in the early days will help you avoid the pain and extra time that it takes while trying to navigate the staircase. After clearance from your doctor, and as you progress in rehab, you will be able to weight bear and bend the knee with more ease, making stairs less daunting and time-consuming.
- Use a splint or knee brace – A knee brace is recommended (or required) by some surgeons, but not by others. Be sure to ask your surgeon before the surgery if you will be required to wear a brace, and whether it is a good option for you to prevent your knee from painful movements while you sleep. Because it encourages your leg to stay straight, it’s an excellent option for people who can’t help but bend.
- Apply ice – If you have ever sustained any kind of injury, you’re well aware that ice is your friend. To help minimize the swelling, apply ice just before bedtime. Less swelling means less throbbing and pain. When you’re trying to sleep, less pain is always a good thing. Keep the ice on for no more than 20 minutes at a time, and remember to never press ice directly onto your skin or the incision as this can lead to ice burns. I additionally bought a specially designed ACL compression ice pack for use throughout the day, and especially before bed – Vive Knee Ice Pack Wrap (link to Amazon).
In addition to the above tips, online forums for ACL surgery patients are an excellent place to ask questions and gain general sleeping advice.
Common Post-Surgery Effects On Your Sleep
After your ACL surgery, you may find that you are left with some side effects that are getting in the way of your much-needed rest. Here are a few common complaints after surgery and how you can try to combat them:
- Tiredness – While it sounds like a good problem to have, the feelings of fatigue don’t actually make it easier to sleep. Many people report being unable to sleep for more than a few hours at a time due to pain and discomfort. Add in exhaustion from the extra effort that it takes to do the smallest tasks throughout the day, and the frustration with being unable to sleep is sure to rise. Fix it by staying on top of your pain medication, experimenting with your sleeping position, and asking your doctor about sleep aids, such as melatonin.
- Constipation – As a result of some prescription pain medication, constipation may cause added stomach pain and restlessness. Fix it by taking a fiber supplement or try an over-the-counter laxative.
- Swelling – If your knee continues to be incredibly swollen, the tightness from the inflammation can contribute to your inability to sleep. Elevation and ice will help, but you can fix it by taking anti-inflammatory medication such as aspirin. You should consult with your surgeon before adding any other medication to what you have already been prescribed.
While side effects are common after any operation, finding ways to minimize them will help in your efforts to sleep.
Keep in mind that even though the actual operation won’t take too long (roughly 2 hours), healing afterward is a lengthy process. Because no one wants to lose months of sleep, it’s essential to find a suitable position and routine to help you sleep after ACL surgery.
Sleeping on your back, with your leg elevated, has proven to be the best option for many patients, but be sure to listen to your body and surgeon to make adjustments as you continue to heal.