Reviewed and contributions made by Sr Director Access Management Operations Dallas Reynolds PT, DPT, Cert. DN, COMT
What is the ACL?
The knee’s bone structure is made up of three parts – the femur (the thigh bone), the tibia (the shin bone) and the patella (the knee cap). The Anterior Cruciate Ligament (ACL) is one of the ligaments part of the knee’s structure. A ligament is a tough, elastic tissue that attaches bones to form a joint. In this instance, the ACL forms a cross, connecting the thigh and shin bones.
The ACL is responsible for creating knee stability. When a basketball player pivots suddenly or a football player cuts across the field, the ACL keeps the knee stable during those quick directional changes.
Get Your Free Physical Therapy Screening
Not sure where to start with physical therapy? Get a free screening and let us help you start the path to recovery today.
GET MY COMPLIMENTARY SCREENING
What is an ACL Injury?
ACL injuries occur most often in sports where an athlete must quickly change direction, such as football, soccer or lacrosse. It also occurs in sports like gymnastics or basketball, where an athlete lands a jump incorrectly. While every injury is specific to the individual, poor body positioning – whether pivoting or landing a jump, for example – can lead to an ACL injury.
When an athlete experiences an ACL sprain, they may experience the following symptoms:
- A “popping” sensation in the knee
- Pain
- Range of motion loss
- Swelling
- Inability to stand or bear weight on injured knee/leg
Your symptoms depend on the severity of your injury. ACL tears range anywhere from a partial tear to a full rupture. Each is determined on an individual basis and is measured in grades:
- Grade 1: The ligament is stretched slightly but the knee is still relatively stable.
- Grade 2: The ligament is partially torn; this type of sprain is rare.
- Grade 3: The ligament is a fully torn and the knee is unstable as a result. Surgery is typically necessary for full repair.
If you have experienced an ACL tear, it is important to get a proper diagnosis right away so you can begin the right treatment. The severity of your injury will determine your treatment. However, whether your injury requires surgery, you will likely receive a recommendation to begin physical therapy.
ACL Physical Therapy
ACL Physical Therapy Protocol – Nonsurgical
Not every person who tears their ACL will need surgery. Patients with a low-grade tear may take the nonsurgical route, pending a doctor’s recommendation. PT can begin shortly after the swelling surrounding the joint subsides if given the go-ahead.
Patients will likely be encouraged to use a brace or crutches before beginning therapy and while in recovery. A brace or crutches will take unneeded pressure and compression off the knee.
During physical therapy sessions, your PT will also avoid exercises that cause direct pressure to the knee. Instead, they will likely work on maintaining and strengthening the muscles surrounding the joint, including the quadricep and hamstring. Increasing quadricep and hamstring strength will naturally increase your range of motion so your knee does not remain in a locked position.
Your commitment to your physical therapy plan will be a determining factor in how quickly you recover from your injury. But with a concerted effort on your part, supported by your partnership with your physical therapist, patients can typically recover from a partial tear in about three months.
Physical Therapy after ACL Surgery
The timeline for physical therapy post-surgery varies and depends on the severity of your injury and whether you had a partial or complete ACL reconstruction. Typically, individuals can return to normal activities, including sports, approximately nine months post-operation. Although for some individuals, it may take up to a year before normal activities resume.
ACL Physical Therapy Protocol
Like individuals who pursued the nonsurgical route, physical therapy protocol will focus on the following:
- Increasing range of motion
- Promoting hamstring and quadricep strength
- Reactivating muscles in the hips, hamstring and quadricep
Individuals may begin PT 3-5 days post-surgery. You, your doctor and your physical therapist will work in coordination to restore the knee’s function and strength so you can return to your everyday activities, including sport.
Restoring Range of Motion
When you begin physical therapy, one goal will be to increase your range of motion. The range of motion measures the joint’s ability to move. Right after surgery, you will not be able to bend or extend the knee fully, so it is important to restore the knee’s ability to bend and extend to a normal range.
Exercises that you may complete to increase your range of motion include:
- Stationary bike riding
- Heel slides
- Long sitting calf stretch
- Prone hip extension
- Quad sets ankle pumps
Your PT will implement these exercises at various stages of your rehab plan. But increasing your range of motion is crucial to rebuild your strength.
Promoting Strength
Post-surgery, it is natural for the injured leg to lose muscle due to inactivity. While you will still be performing exercises immediately post-operation, these exercises decrease swelling, improve your range of motion and reconnect your body’s ability to move the leg. As you progress through the early stages of your care plan, you will move on to strengthening the quadricep, hamstring and hip.
Some of the exercises you will likely encounter during this stage of your treatment include:
- Quadriceps contractions
- Straight leg raises
- Ankle pumps
- Knee extension isometrics
- Hip abductor
Even though you may be dedicated to your care plan, it is essential to keep going even if your muscle strength returns less quickly than you’d like. Strength builds in increments; the same is true for your newly rebuilt ACL.
Reactivating & Relearning Movement
Once your reconstructed ACL has regained its strength, which is likely six months into your rehabilitation plan, your prescribed exercises become more complex and sport-specific. As a result, you may begin including scaled-down versions of drills and skills you may do in your sport as a part of your plan.
For example, you may perform a shuttle run – running forward and then decelerating as you run backward. It may also include pivoting or cutting exercises, moving in a zig-zag pattern so that your body relearns the movements.
It is important to gradually return to these movements under a physical therapist’s supervision and to take your time with sport. Your PT will guide you through the exercises and ramp up the difficulty as you progress through your treatment. Also, if you are a student-athlete and fortunate to have an Athletic Trainer at your school, be sure to include them in your rehabilitation plan. They too can assist in your treatment and return to sport protocol.
Finishing Your PT Program
If you are diligent and consistent throughout your treatment, you should not only be able to return to your normal activities but also safeguard against future ACL injuries. Talk to one of our qualified physical therapists today at one of our 900+ locations to find the right care for you.