SYMPTOMS, TREATMENT, AND RECOVERY TIME FOR ACL INJURIES
Have you sustained an ACL injury from pivoting movements?
Do rapid changes of directions or kicking cause knee pain?
The anterior cruciate ligament (ACL) is located in the knee joint and plays a big role in joint stability. The ACL’s main purpose is to prevent excessive forward translation and rotation of the tibia (the shin bone) under the femur (the thigh bone).
Therefore; sports that involve pivoting, rapid changes of direction and kicking can cause ACL injuries and in the event of a torn or ruptured (think of a rope that snaps), the affected knee becomes unstable. This instability can cause the knee to give way and cause further damage to surrounding structures.
This blog will outline the symptoms and recovery involved post ACL injury that will allow you to return back to normal function. This is by no means an exhaustive list, each program is individualised to suit your needs. However, if you require further assistance with your ACL rehab, please book into our Jindalee or Darra clinics where our friendly physiotherapists will get you the rehab result you’re after.
Not all ACL tears require operations. The decision is ultimately made between the surgeon and the patient and is influenced by a range of factors such as age, functional capacity, occupation, and type of tear.
Normal Ligament: No tear, no deficit Grade 1: Small, partial tear Grade 2: Bigger tear but still partial. Ligament still intact Grade 3: Full thickness tear. Completely torn and ligament not intactACUTE STAGE: INITIAL INJURY PHASE Once the ACL is injured, regardless of whether surgery is being considered, the focus of physiotherapy is to maintain or regain strength, range of movement and stability. Outlined below are a range of exercises that can be utilised in order to prevent deterioration of the knee pre-operatively.
Straight leg raises
Inner range quadricep contraction
Active knee extension
Passive knee extension
Ankle active range of motion
All directions: (from top left to bottom right) Dorsiflexion, plantarflexion, inversion and eversion
Knee flexion in prone
Knee active range of motion in sitting
Gluteus maximus (hip extension) strengthening
Gluteus medius (hip stabiliser) strengthening
Weight transfers in standing
PRE-OPERATIVE STAGE: PREPARING FOR SURGERY
After the initial injury, proper implementation of rest, ice, compression and elevation (RICE) will help to reduce pain, swelling and restoration of full range of motion in the knee. This allows the knee to be in good condition before the surgery. A list of guidelines has been provided to achieve an optimum pre-operative state for the knee.
An example of a knee immobiliser brace worn pre-operation
- An immobiliser brace helps to protect the site of injury. During this time, exercises can be done outside of the immobiliser to maintain muscular strength and stability of the knee.
- Anti-inflammatories and icing can be used to effectively control pain and swelling.
- Normal range of motion restoration is vital. As shown in the ACUTE STAGE, isometric quadriceps activation, straight leg raises and range of motion exercises should be commenced post-injury to achieve full range of motion pre-operation.
- Low impact exercises to maintain muscle strength after full range of motion is achieved
- Knowledge of the procedure to be undergone: to understand what the surgery entails and the phases of rehabilitation that will follow. This is important to make sure the patient’s expectations are the same as the specialist’s expectations.
This phase of the process is split into sections and outlines the functional milestones.
- 1 week post-op: Rest, ice, compression and elevation (RICE) during this phase is vital.
- Goals: Full knee extension (straightening) + continued use of crutches and brace
- Goals: Increase weight-bearing + weaning off both crutches to walking with one crutch
- Painkillers can be useful during this phase due to the gradual activity increase
- Goals: Wean off the knee brace and crutches
- Further improvement in quadriceps and hamstring strength with bilateral and single leg exercises
- Exercises such as stationary bike work, leg press and steps can be commenced if pain is minimal and muscle control is good
- Balance can also be commenced during this phase if muscle control is good
An example of single leg balance progressions
- Goals are to start forward, backward and sideways movements
- Further progression of resistance exercises
- At 12 weeks post-op, running and jumping can be commenced
- Implementation of balance, coordination, power and agility is gradual during this phase.
- Goals are the ability to rapidly accelerate and decelerate, change direction and explosive generation of power through the knee.
- Joint mobilisations are important in the acute phase and post-operatively to assist with range restoration.
- Advice and educationis the guiding pathway to full function. Our expertise helps to set you back on track and achieve a full recovery.
- Exercise monitoring and progressions ensure that progress does not stagnate. It also covers aspects that are harder to monitor such as balance and plyometrics (power).
Manual therapy of the knee cap helps to reduce stiffness
Retraining power in the legs with squat jumps during end-stage rehabilitation
An ACL reconstruction is not a small event and neither is the rehabilitation process post-operation. Having the correct team behind you to facilitate return to sport or daily life is crucial. It is our strong recommendation to book an appointment at Physiophi so that we can guide you through to the finish line. PLEASE CONTACT US ON: (07) 3172 4332 TO HAVE A CHAT WITH OUR FRIENDLY STAFF OR SIMPLY BOOK ONLINE ON: WWW.PHYSIOPHI.COM.AU REFERENCES
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