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The ACL (anterior cruciate ligament) is a ligament that runs diagonally in the middle of the knee. A torn ACL is one of the most common and debilitating knee injuries and can put you out of a commission for an extended period of time. Because our bodies are designed to move in a specific way, it’s important to be sure that you’re moving correctly to prevent against these types of injuries. Although they’re known to be injuries that affect athletes in high demand sports like basketball, football, and soccer, it’s crucial to be cognizant of your body’s movement and positioning during everyday activities to prevent against sidelining injuries like a torn ACL.

What causes an ACL injury?

Over time, we develop ways of moving our bodies through space that allow us to accomplish a task. Sometimes we learn the incorrect way to move which puts us at a higher risk for injury. A torn ACL can occur while exercising or playing sports but it can also blindside you and happen during simple activities like changing directions rapidly, stopping suddenly, slowing down while running, or bending over to pick something up with your knee torqued in an awkward way. A few ways to ensure that you’re not putting yourself at risk include:

• Avoiding the “position of no return”: Eliminate torque in your knees by keeping them from going inward past your ankles, keeping an arch in your feet, and not letting your hips rotate. This may require adjusting some of the daily movements that you’re used to, but it will surely be worth it in the long run.
• Using your hips and ankles to control your knees: Your knees are primarily a hinge joint, moving mostly in a single plane. The rotational control comes from the hip, foot, and ankle. Putting most of your weight on the muscles in your hip will help you avoid becoming quad-dominant and will alleviate extra stress on your knees.
• Visually inspecting yourself: Stand in front of a mirror and do a squat or sit down in a chair. Pay attention to your knees during this action and make sure that they’re tracking over your foot, not inside. If your knees come together during either of these movements, it may be a sign that you are more prone to injury. Additionally, your knee should not progress forward over your toes during a squat, which increases the force in your knee. To fix this, place more weight through your heels and stick your hips back.

When should I seek out treatment for my ACL injury?

If you’ve injured your ACL, you may experience symptoms of pain, swelling, loss of full range of motion, tenderness along the joint line, or discomfort while walking. It’s important to seek out treatment at the first sign of injury to put you on track for a speedy recovery. Surgery may be required but it is a good idea to see a physical therapist no matter what to ensure that you don’t lose the function of your quadriceps.

How can physical therapy help with my ACL injury?

Because re-tearing the ACL is fairly common, your physical therapist will design a treatment plan designed to ward off future injury and address your individual needs. The pain and swelling will typically subside after 3-6 months but it can take up to a year or more for the knee to completely heal. Your physical therapist will take you through multiple tests to ensure that you’re in full control of your knees under high-stress circumstances like when you are fatigued or conducting high-impact activities like running or jumping. They may also include treatment techniques such as:

• Manual therapy: skilled, hands-on techniques performed on the surface of the knee joint and the surrounding muscles to reduce inflammation and address common post-surgery complications like stiffness and loss of range of motion.
• Balance training: incorporating one-legged activities to improve your body’s movement, building up strength and full flexibility.
• Custom exercises: to target areas surrounding the knee, such as the hips and core, to strengthen weakened muscles and to reduce the risk of ACL reinjury.

Physical therapy is an essential part of your recovery plan to ensure that you don’t experience long term damage and that you can return to your peak performance as soon as possible. Although the timeline for recovery varies depending on your specific injury, you should expect 4-6 months of one-on-one treatment with your physical therapist. A typical timeline for ACL recovery may go something like this:

• Treatment before surgery: “Prehab” is a form of physical therapy that begins prior to surgery and focuses on increasing strength and flexibility of muscles. It also educates you on proper movements during recovery post-surgery. The surgery will fix the tear but it will also cause the muscles in the knee to become weak and stiff. Going through prehab treatment is an effective way to speed up your recovery post-surgery.
• 0-4 weeks: The main priorities of treatment during this stage of recovery are reducing inflammation, regaining range of motion of the knee, and beginning to slowly withstand bearing weight. Your physical therapist may incorporate manual therapy and exercises targeted toward strengthening the quadricep.
• 4-10 weeks: At this point, the goal is to start getting your natural walking pattern back and to control your movements while doing so. Your physical therapist may incorporate balance training into your plan of care to put decrease pressure on your healing ACL and to strengthen muscles surrounding your hips and knee.
• 12-16 weeks: The swelling will likely subside by the 3 month mark and you should have full range of motion in your knee, meaning you can extend and bend the leg without restriction. Your personal ACL treatment program will continue building strength in your core and lower body muscles. More advanced balance training may be incorporated along with endurance training on a stationary bike, elliptical, or treadmill. You may begin lightly running, jumping, or getting back into physical activities that you used to do.
• 4 months+: Time to get back in the game. Although the severity of your ACL tear will affect your recovery time, there’s a range of what patients with a healing ACL injury may be able to do around the 4 month mark. Without halting any progress by over-exerting the knee, your treatment program will focus on building up the body’s strength and flexibility in ways that prevent future ACL tears. Your one-on-one treatments will incorporate your favorite physical activities to steadily get you back to 100%

Physical therapists can provide the necessary tools to treat a torn ACL and help you to make sure that you aren’t at risk for future injury, allowing you to return to your favorite activities pain-free and stronger than ever. To learn more about how to prevent ACL injuries or to eliminate any current discomfort, book a physical therapy assessment today.

“I came to Therapydia in the middle of ACL recovery for three months. The physical therapists took me under their wings and nurtured me back to running and jumping. I enjoyed my time here and felt like PT was fun. I would hang out with these guys all the time!”

-Lucyann

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Video: ACL Injury Prevention Screening

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