Anterior Cruciate Ligament Injuries – ACL Rehab at Physiofusion with Leroy McKechnie

 

 

 

 

 

 

 

 

 

ACL tears are commonly mentioned in sports journalism and news bulletins due to the enforced lengthy absence from sport that a player endures following the injury. In Ireland, sports which carry the highest risk for ACL injury include soccer, rugby, the GAA games and skiing.

 

How do you know if you have an ACL injury?

The ACL is an important ligament deep within your knee – you cannot feel or palpate it from the outside. Doctors and physiotherapists may suspect you have an injury to your ACL if some of the following symptoms and signs are present:

  • There was a traumatic injury – ie there was a moment when you felt sudden pain in your knee during activity. It is not an overuse injury, and so you will not tear your ACL while jogging or running in a straight line.

  • You may report feeling a ‘pop’ at the time of the injury.

  • You were most likely unable to continue playing and you had to be assisted off the pitch/ski slope.

  • Your knee swelled – and the swelling occurred almost immediately – or within the first hour or so. Less frequently, a small joint swelling is possible.

  • Your knee is usually difficult to bend beyond 90 for the first 2-3 weeks.

  • Your quad muscle (at the front of your thigh) feels very weak within 24 hours of the injury, and

you find it difficult to tense the muscle as effectively as on your non-injured side.

 

Most people who sustain an ACL tear in sport will see a doctor or physio as they are unable to walk, the pain while walking is significant in that initial period and may require crutches, and they are worried as the ‘pop’ sensation alerted them to the possibility of a ‘serious’ knee injury.

Sometimes however, patients report that resting the knee/leg for a few weeks results in an apparent recovery – however when they try to return to sport again, the leg ‘gives way’, or it feels like it will ‘give way’ when they turn or change directly at speed.

The sensation of ‘giving way’ should prompt a physio or doctor to further examine the knee for the possibility of a cruciate ligament tear.

There are clinical tests which a physio or doctor can do to determine whether the likelihood of an ACL tear (or ‘rupture’), and the diagnosis is then usually confirmed by an MRI scan.  An MRI scan will also show if there is any cartilage (meniscal) or bone damage alongside the ACL injury. These findings may influence the decision that a patient and orthopaedic surgeon will make together to decide if surgery is the best option for the patient’s recovery and return to sport if desired.

 

Surgical Option with Physio guided Rehab

Most sportspeople involved in field sports where the ability to change direction at speed is required will opt to undergo surgical repair of the torn ligament. The waiting list to have this surgery is significant in Ireland, and those with private health insurance will almost always choose to enter the private system to speed up the surgery waiting time. At Physiofusion we liase with some of Ireland’s leading orthopaedic surgeons to ensure you get the best outcome from your surgery and rehabilitation. There can be several different surgical approaches to ACL reconstruction surgery, and your surgeon will discuss this with you (hamstring graft/patellar tendon graft etc).

 

Non-surgical option - Physio guided Rehabilitation

Sometimes people decide that they do not want to undergo surgery, and they opt to undertake a comprehensive rehabilitation programme to maximise their recovery. For people who have sustained the tear in an awkward fall, or possibly on an annual ski holiday this can be a good option, as the muscles around the knee can be very effective at stabilizing the knee. Physiotherapists are key leaders in this process, as the rehabilitation of an ACL injury requires thorough knowledge of the anatomy and biomechanics of the knee, and our university level of study and postgraduate experience provides us with the necessary background to competently guide the rehabilitation process. We have also spent years working pitchside and with sports teams to see what is required of you in your sport.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exercises following an ACL injury – What is the role of the physiotherapist?

Immediate post-injury phase

In the initial phase following the injury, it is commonly the physiotherapist who suspects the ACL tear and liases with your doctor for MRI scan referral for confirmation of the diagnosis. It is likely you will have a lot of questions, and so we provide an objective and experienced setting for you to gain the information you need during this often stressful time.

We also start the rehab process from day one, with advice on how to help reduce the swelling, appropriate activity level modifications (how far can I walk, when can I start an exercise bike, when can I swim/cycle etc), and your exercise programme starts from day one with an assessment of your muscle function around your knee and hip, and detailed explanation of the importance of maintaining and building muscle strength and bulk whether you will go on to pursue surgical repair or the more conservative rehabilitation option.

 

Surgical preparation

When you meet your orthopaedic surgeon, you will receive a date of for surgery if you have chosen that route, and he or she will have advised you to strengthen your leg as much as possible before the surgery. This is because the surgery is essentially another injury to your knee, with more swelling naturally occurring, and this causes further wasting of the important quads muscle which helps to protect the new graft and restore normal knee function. Your physio will assess your lower limb muscle function and prescribe a specific home and gym-based exercise programme for you. We will liase with your gym instructor, sports coach or personal trainer if you have one to facilitate good communication so that you receive the best of care during this period.

Immediate post-op phase

You will be seen by the physiotherapists in the hospital before you go home, and they will show you which exercises you should start at that point. You will usually be advised to follow up with a local Chartered Physiotherapist for further progression of your exercises and rehabilitation, and that often starts one week from hospital discharge. We understand that this is a difficult time as the knee will be swollen and painful, and will not bend fully. With years of experience with ACL rehabilitation behind us, our physiotherapists can assess your progress and give you goals and targets for the weeks to come. It is very important that you regain full knee extension (that you can straighten your knee fully) as soon as possible post-op, and this is something where a physio can have a hands-on role, aswell as positioning advice to speed up full range of movement in your knee.

Generally, you can expect to begin jogging in a straight line after (at least) 3 months, and you will have a check up with your surgeon at 6 weeks to monitor progress. It is common to attend physiotherapy twice weekly for the first three to four weeks, with a once a week visits for the following month thereafter for exercise monitoring and progression. It can be very rewarding for patients to see how much the knee improves from week to week during these early weeks.

Exercise Prescription.

Exercise prescription following ACL repair requires a physiotherapist to have a strong understanding of the anatomy of the knee, the biomechanics of the lower limb, the behavior of the ACL graft through the varying angles of movement in the knee, and the load capacity of both the new graft, and the recovering muscles. This is a specialist role for a sports physiotherapist, and best delivered on a background of years of experience. For this reason we only employ senior physiotherapists who are both competent and confident with ACL rehabilitation.

                       

Rehabilitation should be an enjoyable and challenging experience, with a combination of home-based and gym-based exercise programmes to maximise your recovery and expediate your return to sport. We can provide videos of your exercise programme, links to online video resources, and written programmes where requested.

                                         With ACL rehab, it is not ‘how often’ you do the exercises – but ‘how well’ you perform them.

 

Examples of the range of exercises in the ACL journey:

 

  • Proprioceptive and balance drills

  • Exercises to restore full range of movement

  • Quads and hamstring co-contraction drills

  • Speed drills

  • Jumping, hopping (and landing!) strategies

  • Plyometrics

  • Power driven exercises

  • Explosive movements

  • Rotational exercises

  • Functional exercises

  • Field based drills

  • Sports-specific exercises

  • Return to sport assessment and advice

 

 

Have you sustained an ACL tear?

Learning that you have torn your ACL can be an upsetting and uncertain time. It is worth remembering that many elite athletes have sustained an ACL tear and have returned to competing at the top level of their sport.

  • Peter O’Mahony

  • Alan Shearer

  • Ruud Van Nistelrooy

  • Jonathan Davies

  • Rhys Webb

  • Jamie Roberts

  • Quade Cooper

  • Aaron Cooper

Contact us at 01 6077104 or email us on info@physiofusion.ie to speak to our senior sports physiotherapist Leroy McKechnie, and start your rehabilitation in experienced hands.

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info@physiofusion.ie

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