In the United States, each year there are between 150,000- 200,000 injuries to the anterior cruciate ligament (or ACL). Roughly three quarters of the time, these injuries are non-contact injuries, such as an athlete planting their foot and pivoting quickly with 50% of ACL injuries occurring in combination with damage to other structures in the knee. Young women are two to eight times more likely to injure their ACL’s than their male counterparts.
What is the ACL?
There are two “cruciate” ligaments located in your knee joint – the anterior cruciate ligament, and the posterior ligament which cross each other to form an “X” shape, and run from your femur (thigh bone) to your tibia (shin bone). Together, the cruciate ligaments help to control the forward and backward motion of your knee. The ACL assists in controlling forward motion and rotation of the lower leg, therefore, providing stability to the knee.
How is the ACL Injured?
An injury to the ACL most commonly occurs when an individual stops suddenly, sudden changes direction, pivots on a planted foot, lands from a jump or receiving a direct blow. During an injury to the ACL, an individual may experience any of the following symptoms: an audible pop or a perceived popping sensation in the knee, severe pain, swelling, and reduced range of motion at the knee in addition to the perception that the knee is going to buckle or give way during weight bearing.
Injuries of the ACL are classified as a sprain. A sprained ACL will be diagnoses by your doctor, most commonly through an MRI. There are varying degrees of an ACL sprain; A Grade I sprain is a slight tear to the ligament, a grade II sprain is a partial tear of the ligament, and a grade III sprain is a full thickness tear (when the entire ACL is detached) or rupture of the ligament.
How Can Physical Therapy Help?
Research indicates that grade I-II ACL tears can often be rehabilitated through conservative treatment (or without surgery). There is also research indicating that some people may be able to rehabilitate from a rupture of the ACL with conservative treatment only. Your doctor will discuss your options with you once a definitive diagnosis is determined. Most often, physical therapy is prescribed in lieu of surgery.
In terms of a pre-operative view, physical therapy can help by reducing your pain, improving your range of motion, improving strength, and educating in functional mobility with an assistive device as required following surgery. Research has shown that pre-operative physical therapy can reduce post-operative pain, disability, and reduce rehabilitation time.
Post-Operatively, a Physical Therapist can help guide you along a very specific and structured protocol. Following ACL reconstruction, there are very specific, physician directed protocols which allow you to reduce post-operative pain, improve mobility, and begin addressing strength, flexibility and range of motion deficits while protective the surgical site. Training and supervision with assistive devices and bracing are also an integral part of your rehabilitation.
Conservatively, physical therapy can improve the strength of the muscles and structures around the knee joint to improve stability, reduce pain, and restore prior level of function with the goal of returning the patient to their prior level of function without surgical intervention.
Physical therapy can also play an integral role in preventing injuries such as ACL tears. Strength and flexibility imbalances can make a person more predisposed to experiencing an injury to their ACL. Treatments at this phase would include stretching and strengthening for the muscles around your knee and hips, therapeutic exercise aimed at stabilizing the knee joint plus patient education and training aimed at improving mechanics while jumping, landing, and performing agility activities.
At All Care Physical Therapy, a licensed Physical Therapist will perform a comprehensive evaluation and develop a personalized plan of care for you and your condition, regardless of your phase in your recovery.
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