ACL Injury Rehab Protocol and Timetable

A feature article by Rob Tendick, Apr 29, 2007         

Summary: In the world of sports we often hear about knee injuries that derail at least an athlete's season, if not career. The most common major knee injury seen amongst athletes is a tear of the Anterior Cruciate Ligament, or more commonly known as the ACL. However, it is not just athletes that are experiencing troubles with their ACL; many people are injuring their ACL performing everyday activities.

 
In the world of sports we often hear about knee injuries that derail at least an athlete's season, if not career. The most common major knee injury seen amongst athletes is a tear of the Anterior Cruciate Ligament, or more commonly known as the ACL. However, it is not just athletes that are experiencing troubles with their ACL; many people are injuring their ACL performing everyday activities. Luckily for us there have been a number of advancements in the surgical treatment and rehabilitation of an Anterior Cruciate Ligament so that it is no longer a career threatening injury, for athletes and non-athletes alike.

Anatomy of the Anterior Cruciate Ligament (ACL)

Each one of our knees contains a number of ligaments that help stabilize its movements. Of the four major ligaments contained within the knee capsule, the ACL is considered by many to be the most important because it provides the majority of the knee's stability. The ACL's main objective is to stabilize the knee during planting and twisting motions, as well as prevent forward movement of the lower leg from the upper leg. It is able to do this by attaching to our upper leg at the front of the femur and crosses the knee to attach to the lower leg at the back of the tibia. When an injury to the ACL occurs it is either a partial or full tear of the ligament. The joint responds as it would to any other soft tissue injury by swelling. Some people hear a pop while others just notice an extreme lack of stability and a sense of the knee giving out when weight is shifted on to that leg. Depending on the extent of the injury a patient may or may not have surgery to repair a partial tear of the ACL. As previously mentioned it is not just athletes that experience tears of their ACL. Women tend to be more prone to an ACL injury, an unfortunate problem attributed to a number of factors. Anatomical factors that can contribute to one's likelihood of injury include: strength imbalances between the hamstrings and quadriceps, joint laxity, and a large Q-angle.

Typical Rehabilitation Actions

Whether or not a patient decides to have their ACL injury repaired surgically or not usually does not affect the plan of action for rehabilitation. Before a physical therapist is seen, the wounds must heal. Following that stage a good physical therapist will focus on reducing swelling, increasing and regaining full range of motion, strengthening the joint and surrounding muscles, as well as re-training the muscles to achieve optimum neuromuscular control. Obviously toward the beginning activities will focus on decreasing swelling, while toward the end of rehab the physical therapist will focus their patient's strengthening on functional motions.

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It is wise to follow the acronym PRICE during the early stages of recovery from an ACL tear. PRICE stands for protection, rest, ice, compression, and elevation. By following these five steps each day a patient will effectively decrease their pain and swelling and better prepare their joint for the recovery process. About one or two weeks following surgery the patient will begin physical therapy. The physical therapist will perform an initial evaluation consisting of background questions, and visual and physical inspection of the knee itself. With this information a physical therapist will develop a detailed plan specific to each patient's rehabilitation needs.

What to Expect During Rehabilitation

As with any injury the expected time of recovery is based on numerous factors, such as: age, extent of injury, success and type of surgery, work ethic during rehab, physical therapist technique and care to detail, and overall health and fitness of the patient. An average patient, who had a traditional ACL surgery, will begin light jogging about four months post-surgery with full strength and mobility not being full restored until about six to nine months after surgery. Most doctors will advise a patient to not return to more aggressive physical activities until their recovering leg has gained at least 90% of the strength of the healthy leg. There are more advanced surgeries that can put an athlete on the playing field in about six months. This option is intended for serious athletes only and a physician should be consulted before investigating this alternative.

Suffering a serious injury is no walk in the park for anyone and a tear of the ACL is no different. Surgery and recovery techniques are improving by the day and making the rehab process a bit easier. The secret to success in recovering from an ACL injury lies in the patient's desire to improve, their attitude toward their situation, the rehab protocol set for them by a physical therapist, and of course each person's ability to heal post-surgery. These factors and more will help a patient through the entire rehab process and put their knee in a position to participate in athletic events in the future.

Robert Tendick is a student preparing himself to earn a Doctor of Physical Therapy. Through his degree in Kinesiology and experiences as an athlete, Robert has become familiar with injuries to the ACL and common expectations for ACL surgery recovery. He has also had the opportunity as a physical therapy aide to help heal a number of Los Angeles physical therapy patients through the use of cutting edge injury rehabilitation techniques.

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