Acute knee injuries are common in all sports that require twisting movements and sudden changes of direction, especially the various types of football, basketball, netball and alpine skiing. One of the most common structures to get injured is the Anterior Cruciate Ligament (ACL). The ACL is one of four main ligaments that stabilise the knee joint and provides nearly 90% of the stability required to prevent the knee translating forwards. Two common mechanisms that cause ACL tears is a cutting manoeuvre (accompanied with a sudden deceleration/stop) and landing on one step.
Many surgeons would recommend ACL reconstructions. This decision is dependent on the demands required by the knee. A young athlete who wishes to return to a pivoting sport, such as football or basketball, is more likely to need an ACL reconstruction than an athlete who is prepared to confine activity to those sports that do not involve a large amount of twisting, turning and pivoting. The good news is that rehabilitation without surgery (conservative management) has been scientifically and clinically proven to have good outcomes for patients of both categories*.
How can a physio help?
There are four rehabilitation phases. Our goal in the first phase is to eliminate swelling, increase range of motion(ROM) and increase muscle strength. We achieve that through manual therapy and exercise prescription. Manual therapy may consist of soft tissue release on muscle/structures around the knee that can stiffen as a result of the injury. This may include structures such as the Vastus Lateralis, Iliotibial Band, Gluteus, Hamstrings and Calves. We may also need to work on increasing mobility in the Patellofemoral joint (located at the front of the knee( and also the Tibiofemoral joint (located between the femur and tibia).
Exercise at this point in rehabilitation may consist of active range of motion for the knee such as seated bending and straightening of the knee, calf raises, muscle activation exercise and gait drills. This phase typically lasts for 2 weeks.
In the second phase of recovery, our goal is to achieve full knee range of motion, further increases in muscle strength, good balance and control, a full squat and also unrestricted walking. Manual therapy will continue with a transition to accelerate your exercise rehabilitation program. Examples of rehabilitation are perfecting your squats and lunges, step-ups, single-leg calf raises, bridges, more complete gait re-education drills and balance and proprioceptive (stability) drills. This stage typically ranges from 2-12 weeks.
In the third stage of recovery our goals are to:
Achieve full strength and power
Return to jogging, running and agility and return to restricted sport-specific drills
Manual therapy may still continue if required but the shift of focus becomes a lot more on functional outcomes and being able to return to sports and normal body movements. Jumping and landing drills may be introduced in addition to agility drills. Progressively sequenced sport specific running and agility may commence as well such as running forwards, sideways and backwards. This phase typically lasts 3-6 months.
Phase 4 is the final and best part of your journey as it is where we get you back to your sport or what you love doing. We will involve high-level sport- and task- specific retraining, conditioning and strengthening. This will ensure all the musculature around your knee has the necessary strength, coordination and stability to adapt to the requirements of your sport and activity.
This is just a general guide of what can be done for an ACL. Every knee and person is different so for more personalised information and advice, please call (02) 9870 0250 and one of our physiotherapists will be happy to provide a complementary phone consultation.
*A high level performing athlete should consult an orthopaedic surgeon for further opinion regarding surgical or non-surgical options.
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