Enduring a torn ACL is one of the most frightening injuries in all of sports. It can also be psychologically challenging. Starting your treatment program immediately after surgery is one of the most important things you can do to reduce your recovery time.
This article discusses the various stages of ACL tear rehabilitation. Though it is a lengthy, trying process, if you commit yourself to it and remain consistent, you should be able to fully recover from your injury and perform at a high-level once again. There are plenty of places to receive physical rehabilitation such as integrated spine centers, wellness clinics, physical therapy offices, athletic facilities, and
What Is an ACL Tear?
The Anterior cruciate ligament (ACL) is one of the most important ligaments in your knee and it is responsible for much of the mobility you enjoy whenever you perform lateral or sudden movements. It is one of the major ligaments that connects the femur with the tibia at the knee joint and it can tear if you apply too much force or torque to the knee joint. Common causes to ACL tears include:
- Twisting your knee while keeping your foot planted on the ground.
- Stopping suddenly while running.
- Suddenly shifting weight from one leg to the other.
- Jumping and landing on an extended (straightened) knee.
- Stretching the knee farther than its usual range of movement.
- Experiencing a direct hit to the knee.
How Does It Feel?
People who tear their ACL report a wide range of symptoms. You might hear or feel a pop upon twisting your knee in a given direction. It can cause intense pain but it might also feel like you can bear weight on the affected leg. Torn ACLs typically cause swelling immediately and your knee might give when you put weight on it or walk on it.
How Is It Diagnosed?
Following your injury, you should have the affected knee examined by a physical therapist, athletic trainer, or orthopedic surgeon. If you see your therapist first, they should conduct a thorough evaluation that includes reviewing your medical history. During this evaluation, your therapist will ask the following questions:
- What were you doing when the injury occurred?
- Did you feel pain or a “pop” when the injury occurred?
- Did you experience swelling around the knee in the first 2 to 3 hours following the injury?
- Did you feel your knee buckle or give way when you tried to get up from a chair, walk up or down stairs, or change direction while walking?
Your physical therapist might also perform a hands-on evaluation of your knee to determine the likelihood of it tearing. They can use additional tests to assess possible damage to the other parts of your knee. Orthopedic surgeons might perform additional tests such as magnetic resonance imaging (MRI) before prescribing a course of action that may or may not include corrective surgery. This MRI will also rule out further extensive damage to the knee.
How Can a Physical Therapist Help?
After diagnosing an ACL tear, you will likely have to undergo arthroscopic surgery to repair the ligament. After the surgery, your doctor can recommend a physical therapist to decide your rehabilitative program. It should be noted that not all ACL tears require reconstructive surgery. For some partially torn ligaments, physical therapy can be the only prescriptive recommendation.
If you undergo surgery, you will need to speak to a physical therapist that can prescribe a comprehensive program to improve your muscle strength, agility, and balance so you can return to your normal physical activity.
ACL rehabilitation is a multi-faceted process that can take anywhere from 6-9 months depending on the intensity of your program, the severity of your tear, and how fast your body responds to surgery.
The immediate concern following ACL surgery is the amount of pain a patient feels. Ice can reduce swelling and TENS may also be used on your knee to reduce inflammation.
You will have to be on crutches following your ACL surgery and therapy should aim at restoring your normal gait. Not being able to bear weight on one leg can result in muscular imbalances that will be the focal point of the initial stages of physical rehabilitation for ACL tears.
The R.I.C.E. principle holds true for ACL rehabilitation much like other injuries. This acronym stands for rest, ice, compression, and elevation and it can reduce the swelling in your knee.
Reactivating Quad Muscles
After an ACL tear, muscles become inactive and go into a somewhat atrophic state. This inhibits your range of motion and stifles the healing process. One of the main portions of the physical rehabilitative process is to regain control over the quadriceps. Your physical therapist will also use a form of electrical stimulation called NMES to help facilitate this process. Simple exercises such as straight leg raises may also be prescribed.
After regaining the stability of your quadriceps muscles, you will be able to start strengthening other muscle groups such as the hamstrings and the glutes. These exercises include range of motion exercises, balance exercises, and finally plyometrics to ensure the stability, functionality, and performance of your knee.
Range of Motion Exercises
Range of motion exercises include those exercises that improve mobility and are some of the earliest exercises you can complete following surgery. They include the prone hang and therapists can even manually manipulate the knee to improve range of motion.
After a knee injury, you might have difficulty maintaining balance on the injured leg. Balance exercises on wobble boards, BAPS boards, or BOSU balls can help improve proprioception and stability.
Athletes trying to return to their sports after enduring an ACL tear will have to go through a section of rehabilitation that includes plyometrics, which are exercises that involve jumping and landing properly. Since jumping and landing is one of the most high impact movements you can make, this is typically the final stage of therapy.
Rehabilitating your torn ACL is a lengthy, trying process that you need to complete in stages. One of the most challenging aspects of rehabilitation is its slow progression. It can take people up to six months to run again, and for some, that can be psychologically challenging.
The most important thing with ACL rehabilitation is persistence and consistency. You should work closely with your physical therapist to continuously hit your goals and modify them as needed.