ACL injuries and Physiotherapy
Anterior Cruciate Ligament tears are a growing issue in recent years, affecting high level athletes to the regular social exerciser. The anterior cruciate ligament, or ACL, is an important ligament that connects the thigh bone (femur) to the shin bone (tibia). It controls the forward translation of the tibia within the knee, and to a lesser extent gives stability when rotating and during side to side movement.
How do you injure your ACL?
The most at risk athletes for non-contact injury include rugby, soccer and basketball players. These players are also at risk of tearing their ACL during contact injuries with opponents. Non-contact ACL injuries can also happen to skiers and athletes competing in martial arts. The ACL is under most strain when twisting or pivoting the knee, while there is weight on the leg. Therefore, typically the injury occurs during activity that includes sudden changes in the direction, rapid stopping, jumping and landing abnormally, a direct blow to the lateral aspect of the knee, or slowing down while running. ACL tears can happen to non-athletes also, and similarly happen during sudden twisting or pivoting of the knee when standing, walking or running.
How is it diagnosed?
Your physiotherapist will ask you in detail the mechanism of the injury, and take into account all your symptoms from the day of injury until now. Using this information and some manual testing, your therapist will be able to diagnose your knee injury and tell if your ACL has been torn.
ACL treatment can be surgical or non-surgically managed. What will work for you is a decision that you and your physiotherapist can make together, but ultimately depends on your activity levels. Athletes and individuals who regularly partake in high level exercise and sport usually opt for surgical repair. This is due to the surgery’s success rate in restoring stability of the knee joint.
The non-surgical pathway is an option for individuals who do not regularly participate in high level activity or sports, but studies have shown a higher success rate of surgical treatment versus non-surgical.
Regardless of whether you opt for surgical or non-surgical treatment, the rehab process for ACL ruptures usually lasts between 9 months to 2 years.
Your physiotherapy treatment will aim to:
Reduce pain and inflammation.
Restore and normalise your knee range of motion.
Strengthen the muscles around your knee: esp Quadriceps (esp VMO) and Hamstrings.
Strengthen your lower limb muscles: Calves, gluteals
Improve patellofemoral (kneecap) alignment
Restore your flexibility
Improve your, neuromuscular control, proprioception, agility and balance
Improve your technique and function eg walking, running, squatting, hopping and landing.
Sports specific retraining and activity drills for return to sports
Minimise your chance of re-injury
Sounds intense – how do I prevent this happening to me?
You cannot plan for most contact injuries, and if you play rugby or ski down Black slopes every weekend, of course there are associated risks. Generally, the best way to prevent ACL injuries is to work on strength of the hamstring, quads and glutes, mobility of the hip, and the mechanics of jumping and landing. Talk to your physio about tailoring a specific program to prepare yourself and your knees for your own activity levels, and help prevent other injuries from occurring too.
ACL?, 1. (2019). What is the ACL? | 𝙏𝙝𝙚 𝙋𝙧𝙚𝙝𝙖𝙗 𝙂𝙪𝙮𝙨 | Online Physical Therapy. [online] 𝙏𝙝𝙚 𝙋𝙧𝙚𝙝𝙖𝙗 𝙂𝙪𝙮𝙨 | Online Physical Therapy. Available at: https://theprehabguys.com/what-is-the-acl/ [Accessed 19 Sep. 2019].
Evans, J. and Nielson, J. (2019). Anterior Cruciate Ligament (ACL) Knee Injuries. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499848/
Krause M, Freudenthaler F, Frosch KH, Achtnich A, Petersen W, Akoto R: Operative versus conservative treatment of anterior cruciate ligament rupture—a systematic review of functional improvement in adults. Dtsch Arztebl Int (2018); 115: 855–62. DOI: 10.3238/arztebl.2018.0855