As hockey and football seasons start again, the risk of ACL injuries increases. Even over the course of the last few months, I've already been coming across a lot of them. Read on to find out more about them!
Overview
The anterior cruciate ligament (ACL) is one of the four major stabilizing ligaments of the knee. The ACL and PCL (posterior cruciate ligament) form an X on the inside of the knee joint, and respectively, they prevent the lower leg from sliding back to front and front to back. The ability to bend and straighten the knee without excessive movement of the leg is crucial for activities such as walking, running, jumping, standing, stair climbing, pivoting, and other daily functional tasks. An ACL sprain occurs when the ligament is stretched or partially torn. An ACL tear occurs when the ligament is fully torn.
Causes
ACL injuries are caused by trauma: direct contact or collision, suddenly stopping, rapidly changing direction or pivoting, slowing down or decelerating, incorrectly landing, etc. Half of all injuries to the ACL occur alongside damage to other structures, such as the meniscus, articular cartilage, or other ligaments of the knee. It's been shown that female athletes have a higher incidence of ACL injuries compared to male athletes.
Signs and symptoms
- "Popping" noise at the time of injury
- Pain with swelling
- Instability or sensation of knee giving out
- Loss of full range of motion
- Tenderness along the joint line
- Discomfort when walking or weight bearing
Physiotherapy Treatment
The natural course of recovery from an ACL injury without surgical intervention varies from person to person and depends on the degree of injury, other structures damaged, activity level, and signs and symptoms. Nevertheless, physiotherapy is generally required regardless of whether or not the case is surgical.
Nonsurgical Treatment
Nonsurgical treatment is appropriate for those who are less active and do not participate in high intensity sports that require sprinting, jumping, and pivoting. These people require physiotherapy to help manage their symptoms, to regain their range of motion and strength, and to return to daily functional activities.
- Rest: Resting means not participating in sports and avoiding activities that aggravate the pain. Resting after an injury is important to protect the area from further damage. It is also necessary in order to decrease swelling in the knee. After the swelling subsides, the knee may start to feel "normal" again; however, the feeling of instability or giving way may worsen.
- Activity modification: You may have trouble performing simple tasks such as standing, walking, or going up and down stairs. If it's too painful or too difficult, it is recommended to use crutches to assist. If you normally run or jog, you might have to look into alternative exercises, such as cycling or swimming, that don't cause as much impact to the knee.
- Modalities: Modalities such as ultrasound or laser may be used to decrease swelling and inflammation. Electrotherapeutic modalities like TENS and IFC may be used for pain management. Ice is often recommended to minimize swelling and inflammation as well.
- Acupuncture and dry needling: Acupuncture may be considered for swelling and pain management.
- Manual therapy: Soft tissue massage of the surrounding muscles can be beneficial to relieve tightness and tension. Joint mobilizations may be performed if there are limitations in joint range of motion.
- Exercise: After an ACL injury, you may lose range of motion in the knee due to swelling and possible debris inside the knee. Exercises are aimed at restoring full range of motion. Without an ACL, the knee can also become quite unstable; therefore, it is important to maintain (and build) strength in the surrounding muscles of the knee to provide support. Functional training is performed to return patients to daily activities.
- Bracing and taping: Due to instability after an ACL injury, bracing and taping may be recommended to provide support to the knee. Bracing will help to prevent the knee from giving out.
Surgical Treatment
Surgical intervention is often considered for those who are active and participate in high level sports. It is also recommended for people who have significant damage to other structures in the knee that might be causing severe instability or locking.
An ACL reconstruction rehab protocol is followed post surgery. I won't go into details about that in this post. However, I will say that if surgery is planned, there is usually a significant waiting time. During this time, it is important to receive physiotherapy for prehabilitation to make the outcome as successful as possible. Stay tuned for my next post about prehab!
