Anterior Cruciate ligament (ACL) injuries are common for both male and females in the soccer world. Finding out you may have torn your ACL can scare you. Realize, its not an injury that will keep you out of the game forever. Being educated about your rehabilitation will not only help you return back to your sport but help prevent future knee injuries.
What’s an Anterior Cruciate Ligament Injury?
Your ACL is a ligament in your knee, its major role is to provide stability by preventing forward movement of the tibia (shin bone) in respect to the femur (thigh bone). It also prevents your knee from hyperextending (bending back too far) and from collapsing inwards (knee valgus) and outwards (knee varus).
As we know, soccer is a dynamic sport that requires you to constantly change directions while running full speed for 90+ minutes. When the stress is too much on the knee, an injury may occur. It’s no surprise your knee gets injured if your foot gets planted a certain way. Movements such as side-stepping, landing with a minimal bend in the knee, and accelerating or decelerating while changing directions may result in an injury. There are some ACL injuries that occur with direct contact, but many occur without contact.
Unsure if you injured your ACL…
First, your knee should be assessed by a qualified health care provider. During the assessment, you will be asked various questions and have tests performed to determine whether your ligament is intact. One particular test is called the Lachman. Your physical therapist (PT) will manually provide forward movement of your tibia (shinbone) in respect to your femur (thigh bone). Usually, if there is an excessive forward movement of your shinbone that may indicate an ACL injury. In that case, a follow up with your physician is recommended. An MRI may be ordered to confirm ligament damage and to rule out any other damage in the knee.
Not all may report of symptoms below, common complaints include:
Immediate swelling (within 12 hours)
Pain
Hearing a snap or “pop”
Inability to walk on leg (feeling as if knee will give way or buckle) or feeling as if knee wants to buckle while walking.
Will you need surgery to repair your torn ACL?
- Dependent on various factors: age, extent of ACL sprain, and level of athletic involvement…
- Severe sprain + inability to compensate well & plan to compete at a high- level again…
- Surgery likely your option
Good compensation + ability to modify activity level…
- Nonsurgical rehabilitation may be an option. These individuals are known as “Copers”. Your PT will complete a full screening to determine that you are a candidate for this route.
***Keep in mind those that elect this route will require at least 6 months of supervised PT, and may experience some instability in the knee ***
Is non-surgical the path you will take?
PT is absolutely necessary for you! Why?
A PT will help identify impairments that may be present and assist in creating an individualized program to address your needs. Remember, you won’t necessarily become a couch potato if you don’t elect for surgery. You may have to modify some of of your activities, but your PT can help you return to the activities you enjoy!
Your PT will focus on improving your joint mobility, improving strength (particularly your quadriceps), walking pattern, balance, endurance and agility training. The use of a protective brace for a ACL deficient knee will help prevent any instances of your leg giving way and to avoid any further damage to knee surfaces.
What if surgery is your best option? Well, did you know there are ways to get on the road to recovery before surgery?
Evidence has shown that a “calm” knee with no evidence of an acute inflammatory response is associated with fewer post surgical complications. Those that complete rehab before surgery have been reported to have improved knee ROM compared to those who completed surgery with a swollen and stiff knee. Your PT can help assist you with gaining full range of motion and decreasing swelling before surgery.
It is also reported a patient’s expectations of recovery is an indicating factor for the physical recovery (Sonesson et. al, 2017). Many individuals have high expectations before surgery or are unsure what the recovery truly entails. Your PT can help provide realistic expectations and help ease some fear you may have to ensure a smooth recovery.
Lastly: PROTECT, REST, ICE, COMPRESSION, ELEVATION (P.R.I.C.E.). You should be completing P.R.I.C.E throughout the day to minimize pain and swelling.
You’ve left the hospital and the rehab process begins….
While you’re probably groggy and in much pain, you’re one step closer to returning to your sport! ACL reconstruction time frame to return back to sports is anywhere from 6-12 months. Realize, that special considerations and time frame may differ for your rehab if there’s an injury to other knee structures. After surgery, your leg may be in a protective brace to prevent any additional strain on ACL. Your time frame for wearing the brace will vary, but it is commonly worn up to 4-5 months after surgery.
Your surgeon will give you rehab guidelines, but below is a general guideline.
https://cpb-us-w2.wpmucdn.com/sites.udel.edu/dist/c/3448/files/2017/07/ACL-2dg4gq2.pdf
*****Stay tuned for next part of the ACL series as we discuss rehab considerations for nonsurgical or surgical routes****
Was the information helpful? I want to hear about your ACL injury experience!
Arundale A., et. al. Exercise- Based Knee and Anterior Cruciate Ligament Injury Prevention. 2018. J Ortho Sports Phys Ther. 48:9. A1-A42.
Boyi, D., et al. Anterior cruciate ligament injuries in soccer: loading mechanisms, risk factors, and prevention programs. 2014. Journal of Sport and Health Science. 3: 299-306.
Everhart JS., Best TM., Flanigan DC. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. 2013. Knee Surg Sports Traumatol Arthrosc.
Malempati C. et al. Current Rehabilitation Concepts for Anterior Cruciate Ligament Surgery in Athletes. 2015. Orthopedics. 38: 11; 689-696.
Sonesson S. et al. Psychological factors are important to return to pre- injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. 2017. Knee Surg Trumatol Arthrosc. 25: 1375- 1384.
Ken
22 Feb 2019Thanks for highlighting different factors that must be taken into consideration. Good informational post