The anterior cruciate ligament (ACL) is one of the ligaments that connects the upper leg to the lower leg. It helps keep knees stable, but the ligament can be injured if the knee is moved in a stressful way. Unfortunately, it is a common sports injury. People often associate players colliding with each other as the cause of sports-related knee injuries. In fact, 70 percent of ACL injuries occur when players land hard on the ground or twist their leg in an attempt to maneuver out of the way of another player.
An ACL injury can cause sudden, severe pain and weakness in the leg. One young woman soccer player described the feeling as “like glass breaking”. The injury may be mild to severe and can range in seriousness from a simple small tear to a total separation of the ligament from the bone.
Rehabilitation is generally required no matter how minor or severe the injury is. The type and amount of rehab depends on the seriousness of the injury and treatment that was required. Some ACL injuries can be treated with conservative measures. More serious injuries may need surgical intervention. Whether surgery is needed or not, physical rehabilitation is necessary.
Physical Therapy for Rehabilitation
A doctor, working with a physical therapist, prescribes a specific regiment for each patient taking into consideration the physical condition of the patient, the extent of the injury and the patient’s level of normal activity. Rehab in general requires exercises that strengthen the leg and allow the knee to bend. It usually begins with treatment at aphysical therapy center with the physical therapist also instructing the patient as to what exercises to do at home. As home exercises therapy is increased, trips to the physical therapist generally decrease.
- Purpose of rehab: To return the leg to as close to normal function as possible.
- Expected time it will take: Several months to even years, depending on the severity of the injury and how much time the patient is willing to devote to therapy every day.
- Success rate: Those who have surgery and physical therapy have a greater success rate than those who only do physical therapy. Athletes are more likely to be able to return to their sport if they have both treatments.
- Rehab prior to surgery: Even if surgery is the ultimate resolution, those who have undergone physical therapy rehabilitation prior to surgery heal faster and are more successful at post-surgical rehabilitation.
- Risks: Patients are often anxious to return to their normal activity and push too hard, even to the point of pain, in their rehabilitation. This delays the healing process.
Specific Exercises Required for the Most Effective Rehabilitation
The program for each patient is individualized. Some of the most common types of exercises for ACL rehabilitation include:
- Stretching: The tendency is to hold the leg bent at the knee due to pain, particularly after surgery. Keeping the leg bent for long periods of time will make it difficult, and possibly impossible, to be able to stretch it to its normal extension. Stretching exercises need to be performed hourly.
- Range of Motion (ROM): ROM exercises should be performed once an hour, even though it will be painful at first.
- Knee flexion: The road to normal knee flexion is a long one and starts slowly. Deep knee bends and lunges are the ultimate goal.
- Mobility of the patella: A physical therapist will instruct the patient on how to do this.
- Quadriceps exercises: Strengthening the quadriceps makes extension of the leg and mobility of the knee easier and less painful.