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One of the most devastating injuries to happen to athlete’s, from Sunday league to professional levels, an ACL tear or rupture can be the end of the line. As time has gone on, the treatment and rehabilitation of such injury has developed and has shown great improvement, but it doesn’t stop the injury from happening.
In this blog, I am going to go through a few subjects concerning an ACL rupture, from how it occurs in the first place, to what can happen following surgery, in terms of a rehabilitation plan.
How does an ACL Rupture typically occur?
The Anterior Cruciate Ligament (ACL) is vital in the control of the Knee joint. It mainly stops the Tibia (your Shinbone) from moving too far forwards away from your Femur (your Thigh bone), but it also plays its part to control the Tibia from moving too far backwards and rotating.
As such, the main cause of a rupture is a quick and impromptu change in direction when the Knee is slightly Flexed and rotated (for example, during competition when an athlete has to move away from/ around an opposing player). Alternatively, there are also cases when this injury has occurred following a very high landing, or in situations where the Tibia has been forced forwards. After a few moments, most individuals will have heard a “pop”, they will then feel the swelling start to build, and they may feel very unstable through that leg.
What are the next steps to complete before surgery?
Whether surgery has been deemed necessary or not, the Knee is going to need to rest for a short period of time, however, there are still exercises which can be completed without placing stress on the Knee itself. Without these, the leg will start to atroph, and muscle will start to breakdown. Some exercise examples are;
· Ankle ROM practise (Dorsiflexion, Plantarflexion, Eversion and Inversion).
· Patella Mobilisation (pushing the Knee cap side-to-side when the Knee is slightly bent).
· Glute Medius activation in side-lying.
· Weight transfers (leaning forwards, backwards, side-to-side).
What is expected of me following surgery?
ACL rehabilitation usually takes months of consistent treatment and planning. The ligament is crucial in so many ways that it has to be treated with the proper methods, and is tracked purposefully. Below is a rough schedule to how rehabilitation would go, it is taken from Physiopedia.com, the link below will allow you to go into more depth about the overview of an ACL injury.
Week 1-2 – Due to the short time since surgery, the priority to focus on is PASSIVE Knee ROM. By the end of the first week, you should be able to fully extend the knee, and also be able to Flex the Knee to approximately 70°.
Weeks 3/4 – At this point, you will have been using two crutches and most likely a Knee brace to support the joint. From now though, you should try to limit the use of the second crutch, focusing on the control of the Knee whilst standing.
Week 5-10 – Progressively, you should begin to leave the next crutch behind on short trips, relying on the surrounding musculature to relieve the joint and weight-bear. Closed-Chain exercises should also begin to come into play. These exercises will increase more normal motions to the Knee, and also increase natural proprioception. By the end of this stage, you may be able to start working on specific balance/ proprioception exercises (like on a balance board or Bosu Ball).
Week 11-3 Months – This is the part where the focus starts to turn from Knee stability and ROM (these are still important, but part of the progression is to continue moving forward with more difficult scenarios) to muscular development.
Months 3-4 – Nearing the end of the programme, there will be a dramatic improvement in functionality, returning to situations relevant to your sport or hobbies. This will, most likely, include running and jumping situations, changing direction quickly, improving muscular and ligamentous coordination, and performing more single-leg exercises (placing more trust in the joint).
Months 5+ - From this point on, your rehabilitation and personal goals should be more sports-orientated. You should be performing movements similarly to how you were before the injury occurred, and attributes like endurance, strength, balance and proprioception should slowly be returning to normal.
If you need help with an ACL injury, or would like to know more on the subject, just let me know!
Dominic
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