ACL, or the anterior cruciate ligament, injuries make up almost 50% of all knee injuries. A hard hit, overextension of the knee joint, or a quick pivot can cause the shin to move forward, stretching or tearing the ACL. In this type of injury, the knee becomes very unstable. If there is a complete tear, surgery may be required.
Following ACL injury or surgery, treatment often consists of initial rest, with icing. ACL reconstruction takes 6-9 months to heal fully. For a partial tear, recovery takes about 3 months.
As a manual therapist, there are various manual techniques and prescribed exercises that you can include in an ACL treatment plan to help your client return to full function. The main goals of manual therapy regarding an ACL injury include decreasing pain and inflammation, increasing range of motion, and returning your client to full function. Prescribed exercises aim to improve strength, further improve range of motion, and slowly return your client to weight-bearing activities. Before surgery, exercises and strengthening can also be highly beneficial for a smooth recovery post-surgery.
ACL injury rehab, specifically following surgery includes:
At this stage in the game, soft tissue techniques and joint mobilization techniques when appropriate can help reduce scar tissue build-up and aid in regaining knee mobility.
Stretches, including calf, hamstring, and quad stretching, may be prescribed based on pain levels. Half pendulums on the stationary bike, as long as they are pain-free, may be initiated. Isometric quadriceps exercises are also vital to regain some quad strength.
Weeks 2-4 should allow for weight bearing, possibly with support. It is crucial at this point to have knee extension at 120-degree knee flexion, as during this stage full range of motion is emphasized. A gradual decrease and eventual elimination of crutch use are significant for the return to proper gait. An electric muscle stimulation system placed on the quadriceps muscle can help provide a feedback loop for regaining quad strength. Squats, lunges and other weight-bearing leg strengthening exercises can, also, be explored and completed during this phase.
Week 2-6 goals include returning the knee to full range of motion, and incorporation of step up, squatting, and single leg stance exercises.
Core and glute exercises are added, and resistance may be added to existing exercises. Full range of motion on the stationary bike should be attained. Bilateral muscular balance is the goal at this stage.
At week 12, a gradual return to sports is allowed. Inform your client to avoid a return to any contact sports for at least 6 months post-op.
Follow these general guidelines to get your client back to the activities they know and love! In a clinic setting and as a manual therapist, ACL injuries are not uncommon. Be prepared ahead of time. iBody Academy offers a wide variety of manual therapy courses, such as joint mobilization, that may aid in expanding your knowledge regarding proper techniques to apply for ACL injuries. Check them out at the online course section of our website!