Your anterior cruciate ligament, usually called the ACL, is part of a team of four knee ligaments that connect your thigh bone to your tibia. Its two major responsibilities include limiting rotation and forward motion of the tibia. Three specific circumstances usually trigger an ACL tear.
- Planting and cutting moves
- Straight-legged landing jumps
- Pivoting with a hyper-extended knee.
You are playing your favorite sport, and suddenly you hear an ominous popping sound in your knee. In some cases, the pain might be excruciating, and in really serious cases, you might find yourself unable to walk or bear weight. You watch as your knee swells to the size of a golf ball. The results of your physiotherapists examination and MRI indicate that you have torn your ACL.
Surgery and Sports Physiotherapy
In most cases, your doctor will recommend ACL repair surgery, but if you have not incurred a complete tear, your doctor might offer you the option of avoiding surgery by committing to an ongoing program of sports physiotherapy for ACL injury. Whilst this might be a viable option if you do not plan to return to sport that requires planting, cutting and twisting movements, professional and serious recreational athletes will usually opt for the surgery. Whether you choose to have the operation or not, sports physiotherapy for ACL injury is crucial to the future functionality and pain-free movement of your injured knee.
Sports physiotherapy for ACL injuries takes place in four stages:
- Prehab Exercise: Performed prior to surgery
- Post Operative Exercise: Performed immediately after surgery
- Strengthening Exercises: Performed two to three weeks after surgery
- Balance, Coordination and Performance Training: Performed about six weeks after surgery
Preparation for Prehab Exercises
Reducing inflammation will make the exercises much easier to perform. Assume a supine position and place a book or a pillow under the foot of your injured leg. Place an ice pack on your knee, and rest that way for 20 minutes.
Warning! Do not put the pillow under your knee! This is a common, but very serious mistake! If the pillow is under your knee, it keeps your joint in a constantly flexed position, which will trigger a state of unpleasant surprise when you try to straighten your knee!
Prehab for ACL Injuries
Modern orthopedic surgeons and physio’s doing sports physiotherapy favor a newer rehabilitation concept called “prehabilitation” or “prehab.” These pre-surgery exercises are designed to restore some of your pre-injury leg strength and flexibility. Whilst performance of even the most minor movements might hurt, failure to regain adequate strength an flexibility prior to surgery will make the post-rehab period even more painful and longer.
Typical Prehab Exercises
Your physiotherapist will advise you of the number of repetitions required for each of these exercises:
- Heel Slides: Sit upright and place a long towel around the foot of your injured knee. Hold the ends of the towel with each hand. Begin with your knee extended, and slide your heel along the physiotherapy table, gradually bending your knee and bringing your heel closer to your body.
- Quad Sets: Sit upright with your legs extended in front of you. Take a breath in. As you exhale, try to press the back of your knee into the physiotherapy table. Hold for 10 seconds and repeat.
- Leg Raises: Remain in the upright position. Take a breath in. Exhale and lift the injured leg a few inches from the table. Hold for a few seconds, then repeat.
After Your Surgery
Sports physiotherapy for ACL injuries usually begins shortly after the doctor wakes you up from anesthesia. Whilst exercise might be the last thing you feel like doing, joint mobilization will increase circulation and prevent further loss of flexibility. Ankle circles, along with ankle flexion and extension movements are some of the exercise involved with sports physiotherapy you might have to perform, along with the exercises you performed in the prehab stage of treatment.
Two to Three Weeks Post-Op
Once you are able to bear weight, your sports physiotherapy may include stationary bicycle training, treadmill walking and side leg raises with ankle weights.
After Six Weeks
When you have full range of motion, your physiotherapist will begin to prescribe exercises that simulate the movement patterns used in your sport. These patterns will include squats, lunges, and exercises on balance-training equipment. When your official physiotherapy treatment reaches its conclusion, your physiotherapist might recommend Clinical Pilates sessions or Personal Training.