ACL Tear : Recovery
ACL tear or injury to the anterior cruciate ligament of the knee is one of the most common sports injuries - ACL injuries account for around 40% of all sports injuries. If you have injured your knee and have sprained your ACL, you may benefit from physiotherapy to help you improve your ROM and strength, decrease knee pain and swelling, and help you return to your previous level of function.
A more serious injury like an ACL tear may require knee ligament surgery followed by a physiotherapy knee rehab to restore full function of the knee.
How do you get an ACL tear?
You can tear your ACL if your lower leg extends forwards too much. It can also be torn if your knee and lower leg are twisted. This may happen due to a sudden impact, accident, improper landing of foot after a jump and a bad fall.
Did you know that in case of ACL injuries,
- Female athletes are at risk four to six times greater than their male counterparts [20–22]
- Competitive and recreational athletes between the ages of 15 and 25 are at the greatest risk
- Occupation and Age (thereafter relating to osteorthririts) also contribute to the risk
Which sports have a high incidence of ACL injuries?
Sports that require high dynamic loading of the knee and report a high incidence of knee injury include football, volleyball, handball, and basketball.
Injury to the ACL occurs during dynamic activities that primarily involve:
- pivoting (changing direction suddenly)
- during landing incorrectly after a jump
Related Reading : Tennis elbow treatment: Home Care & Physiotherapy
How does it feel to tear your ACL?
If the ACL is torn, your knee may become very unstable and lose its full range of movement. You may have felt or heard a "pop" in the knee, and the knee usually gives out from under. ACL tears cause significant knee swelling and pain.
This can make it difficult to perform certain movements, such as turning on the spot. Some sports may be impossible to play.
Can you walk with a torn ACL or MCL?
The inflammation and pain sets in with the injury. Trying to walk in this condition may worsen the injury. It is recommended to consult a sports physiotherapist so he or she can help you with techniques to alter the gait and you do not worsen the condition. Reliva physiotherapist will also help to alleviate pain and swelling.
Is surgery required for ACL injury?
The decision to have surgery to repair a torn ACL depends on:
- your age,
- activity level,
- degree of instability and
- associated injuries.
Some people are able to get back to full activities without surgery just by strengthening the surrounding muscles. Many people find that their activity level is decreased because of the torn ACL and desire reconstructive to allow them to return to full activities. In most instances, surgery is successful and will allow full return to activities of all levels. Reconstructing the torn ACL can also help prevent further damage to the knee from chronic injury.
What is the treatment for ACL injury?
Your doctor or physiotherapist is best placed to help you choose between the two treatment options for ACL tear:
- Recovering from ACL injury without Surgery:
- ACL Reconstruction Surgery:
ACL tears do not necessarily require ACL reconstruction surgery. You may decide not to have ACL surgery if your knee does not feel unstable and you do not have an active lifestyle.
If you have injured your knee and have sprained your ligament, you may benefit from physiotherapy to:
- decrease knee pain and swelling,
- help you improve your ROM and strength,
- help you return to your previous level of function.
In most cases, if you have a serious ACL injury you’ll require surgery. If you do have knee surgery, you may benefit from physiotherapy after an ACL repair to help you return to normal activity and function.
How does Physiotherapy help a torn ACL?
ReLiva physiotherapist will perform special tests for an initial evaluation and assessment to determine if you have damaged specific structures or ligaments in your knee and he or she will work with you to develop an appropriate treatment plan.
Mr. Shreyas Kudalkar underwent an ACL reconstruction surgery on the right knee and wanted to get fit. He chose ReLiva and gushes, “I couldn't have made a better choice. The way doctors have taken care and helped me get better is truly outstanding! I have recovered pretty quickly and wish everyone like me choses Reliva for a speedy recovery.”
Physiotherapy will benefit ACL injury in healing and recovery in following ways:
- Physiotherapy treatment for ACL Sprain or Knee Injury
- Physiotherapy for ACL tear that needs surgical repair
In case you have sprained your knee ligaments, the physiotherapist will focus your treatment to:
- Reduce pain and inflammation
- Normalise your joint range of motion
- Strengthen your knee
- Strengthen your lower limb
- Improve patellofemoral (kneecap) alignment
- Normalise your muscle lengths
If you have suffered an ACL tear, you will benefit from physiotherapy before as well as after the surgery.
a) Physiotherapy before ACL reconstruction surgery: [2-3 weeks]
Based on the initial assessment, Reliva physiotherapist will chart out your treatment plan. Your physiotherapy treatment pre-surgery will aim to:
- Reduce pain and inflammation.
- Strengthen your knee: esp Quadriceps and Hamstrings.
- Strengthen your lower limb: Calves, Hip and Pelvis muscles.
- Guide and alter your gait to avoid knee buckling
- Recommend and train you to use support and protective equipment like knee brace
Once the swelling settles down, you may have the surgery.
b) Physiotherapy after ACL reconstruction surgery:
ReLiva physiotherapist will work along with your surgeon to train you with appropriate gait technique, using brace as required.
You will thereafter see the physiotherapist, in most cases after 3 weeks of surgery, for a 4 staged knee rehab. (We detail the 4 stage knee rehab in the later part of this article) Your post-reconstruction rehab includes:
- Rehab to support healing of the graft
- Increasing your range of motion
- Building muscle tone
- Gaining good functional stability
- Repairing muscle strength
- Reaching the best possible functional level
- Decreasing the risk for re-injury
What to expect during the knee rehab after ACL reconstruction?
To make sure you get the most out of your ACL reconstruction, make sure you get comprehensive pre and post-surgery knee rehab from the sports physiotherapists at ReLiva Physiotherapy.
Stage 1 Knee Rehab [Week 1 to 3 of your recovery]
You'll be given exercises you can start in hospital after your surgery and continue when you get home. The exercises will include movements to bend, straighten and raise your leg.
You'll also be given crutches to help you move around. You may need to use them for about 2 weeks, but you should only put as much weight on your injured leg as you feel comfortable with.
For a few weeks, your knee is likely to be swollen and stiff, and you may need to take painkillers. You may be given a Cuff or advised Cryotherapy to help ease the pain and swelling.
Stage 2 Knee Rehab [Weeks 3 to 6 of your recovery]
Once the pain and swelling have settled, you may be advised to increase or change your exercises. Your physiotherapist will advise you about what exercises to do. The exercises will help you to:
- fully extend and bend your knee
- strengthen your leg muscles
- improve your balance
- begin to walk properly
You are likely to be able to walk without crutches at the end if this stage.
Stage 3 Knee Rehab [Weeks 6 to 24 of your recovery]
You should gradually be able to return to your normal level of activity between 6 weeks and 6 months after your knee operation.
Your physiotherapist will gradually progress your movements in sync with your healing. This is to allow enough time for the grafted tissue to anchor itself in place inside your knee.
Stage 4 Knee Rehab [After 6 months]
After 6 months, your rehab will focus on attaining your activity specific goal.
Some people, for instance a footballer may need little more time before feeling confident enough to play the sport again, and someone who is into martial arts may need longer to return to their previous level of performance.
How long does it take to recover from a torn ACL?
Depending on the severity of your ACL injury and your goals, your recovery time after surgery is usually six to twelve months with physiotherapy.
In case it is an ACL sprain, it may take eight to two to three months to regain your knee strength and range of motion with physiotherapy.
What should I do after ACL surgery?
If you have had an ACL tear and recently got operated, here is a list of Do’s and Don’ts:
DO’s after ACL Tear surgery:
- Give proper rest to the knee after surgery.
- Start a non-weight bearing walking for 3 weeks.
- You may do gentle knee bending exercises (under supervision of a physiotherapist) as pain eases out after surgery
- Start (under supervision) with partial or full weight bearing walking using crutches and knee brace after 4 weeks
- Gradually start regular activities at the end of 6 weeks
- Avoid any type of contact sports for atleast for 6 to 8 months after surgery, (this may vary depending upon the recovery of the ligament)
DON’T’s after ACL Tear surgery:
- Don’t put unnecessary stress on your knee.
- Do not ignore any new swelling or color changes that may appear on or around the operated region.
- Do not sit on the floor or squat unless prescribed by the physiotherapist.
- Don’t give up!
How to Prevent an ACL Injury?
If your work entails rigorous physical activity with jerks and sudden movements, it is advisable to take up a focused knee injury prevention program.
[ Anterior cruciate ligament injury is common in high velocity activities that involve twisting and pivoting such as sports participation in football, basketball, netball sports or a high velocity injury or fall.]
An exercise based knee program at ReLiva integrates strengthening with neuromuscular training, which studies suggest is the most effective for prevention of ACL injuries.
Three Components of Exercise in a Prevention Program
Plyometrics focusing on proper technique and body mechanics can help to reduce serious ligamentous injuries, specifically ACL injuries [65, 68].
- Neuromuscular Training
The objective of neuromuscular training is to improve the ability to generate optimal muscle firing patterns, increase dynamic joint stability, and to perform movement patterns and skills necessary during activities of daily living and sports activities.
- Strength Training
Strength training has been established as the most effective at decreasing ACL injury rates; however, strength training alone may not be efficacious for prevention.
Frequently asked questions related to ACL tear & recovery
Q1. What is the ACL?
Ans. The ACL, or the Anterior Cruciate Ligament, is one of four main ligaments around the knee that connect the femur (thigh bone) to the tibia (shin bone). The ACL prevents the tibia from sliding forward on the femur, and provides stability to the knee with twisting or pivoting activities, such as playing basketball and football.
Q2. How will a torn ACL affect the function of my knee?
Ans. With the initial injury, patients often fear or feel a pop with a sudden onset of pain and inability to return to sports. Sometimes it will be difficult to walk; often there is gradual swelling and stiffness in the knee. The torn ACL will allow the knee to buckle or give out pain with certain pivoting activities. Sometimes the problem can become so severe that even a simple activity like walking or working around the house will cause instability episodes.
Q3. How long should one keep his leg elevated after surgery?
Ans. Elevate leg. Keep your operated leg elevated at a minimum of a 45-degree angle. Prop your leg on cushions or pillows so your knee is at least 12 inches above your heart for the first three to five days after surgery. Keep your leg elevated if your knee swells or throbs when you are up and about on crutches.
Q4. How long does it take to be able to walk again post surgery?
Ans. This usually takes approximately 1 month from the time of surgery. Patient can use crutches during the period to avoid limping.
Q5. How long do you have to be on crutches after ACL surgery?
Ans. You may be able to begin putting your full weight on your repaired leg without crutches 2 to 3 weeks after surgery. If you had work on your knee in addition to ACL reconstruction, it may take 4 to 8 weeks to regain full use of your knee.
This article is based on the inputs from Dr Carol Johnson (PT). Dr Carol is a sports physiotherapist at ReLiva and is a Masters in Orthopaedics and Sports Rehabilitation.