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Anterior Cruciate Ligament Injuries and Physical Therapy

The anterior cruciate ligament (ACL) is an important structure in your knee. It helps to prevent forward slippage of your shin bone under your thigh bone. Injury to your ACL causes a feeling of instability in your knee and may prevent you from participating in high-level activities and athletics.

If you have knee pain after suffering an injury, your physical therapist can help determine if your ACL is potentially damaged.

Components of the initial evaluation after an ACL tear may include:

  • History

  • Functional mobility assessment

  • Analysis of gait

  • Palpation

  • Range of motion

  • Strength

  • Swelling

  • Balance and proprioception assessment

  • Special tests

Physical Therapy Treatment after ACL Tear

Components of a physical therapy treatment plan after an ACL tear include

  • Pain control: Your physical therapist can use various treatment techniques to help decrease your knee pain. Ice packs may be used to decrease swelling, and occasionally TENS may be used on your knee to decrease the pain that you are feeling.

  • Gait training: If you are walking with an assistive device like crutches, your physical therapist can teach you how to use them properly. He or she can also help your progress from walking with crutches to walking normally with no assistive device.

  • Swelling management: The R.I.C.E. principle is one of the best ways to decrease swelling in your knee. This involves rest, ice, compression, and elevation of your knee.

  • Improving quadriceps contraction: After an ACL tear, your quadriceps muscle on the top of your thigh virtually shuts off and stops working properly. One of the main goals of physical therapy after a knee injury is to regain normal quadriceps control. Your physical therapist may use a form of electrical stimulation called NMES or Russian Stimulation to help accomplish this task. Quadriceps strengthening exercises, like straight leg raises, will also be prescribed.

  • Strengthening exercises: In addition to performing exercises to strengthen your quadriceps, other strengthening exercises for your hamstrings and hip muscles may be necessary during your ACL rehab.

  • Range of motion exercises: After an ACL tear, pain and swelling in your knee may limit your knee range of motion. Knee ROM exercises like the prone hang can be done to help improve and normalize your knee mobility.

  • Balance exercises: After a knee injury, you may notice you are having difficulty maintaining appropriate balance on your injured leg. Balance exercises using a wobble board or a BAPS board may be necessary to regain normal proprioception, or body awareness, after your injury.

  • Plyometrics: If you are planning on returning to high-level sports, then your physical therapy plan of care should include plyometric training. Learning to properly jump and land can help you regain the confidence needed to return to athletics.

One of the most important components of your ACL rehab program is to learn how to prevent future problems with your knee. Be sure to work with your physical therapist to determine the variables that may have contributed to your injury, and devise an exercise strategy to prevent another ACL injury.

What if My Knee Pain Continues?

If you have torn your ACL and have attended physical therapy to restore normal mobility and function but still continue with the feeling of instability, you may need to consider surgery to repair your ACL. You should speak with your healthcare provider to help you decide on the best course of treatment for your ACL and to determine if a surgical repair is a good option for you. In general, if you wish to return to high-intensity sports that require running, stopping and starting, or jumping, you may wish to consider an ACL repair. If you do have knee surgery, you may benefit from physical therapy before and after an ACL repair to help you return to normal activity and function.

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