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Rehabilitation
for ACL injuries
Alternative exercises
Rehabilitation after surgery
When can I return to my sport or activity?
How
long will the effects of the injury last?
Read more about ACL injuries
Rehabilitation
As an athlete, your number one concern is getting back to full strength
as soon as possible so that you can return to training and competition.
That is why appropriate rehabilitation is extremely important. Rehabilitation
for an ACL injury, a common knee injury in football
and basketball, often includes the
following:
- reduce activity
during the acute phase
- ice injury multiple
times per day
- compression of
the injured knee with a secure wrap or ACE bandage
- elevation of the
injured knee above heart level
- use anti-inflammatory
medications such as ibuprofen to reduce inflammation and speed up recovery
The objectives of
rehabilitation from an ACL injury are to increase hip and knee flexibility,
establish pain-free range of motion, and strengthen the thigh muscles.
In the case of severe injury, you should completely avoid activity that
causes knee pain. In these cases, you can maintain cardiovascular fitness
by swimming or cycling unless otherwise prescribed by your doctor. Rehabilitation
of an ACL injury is different when the knee injury requires surgery (or
reconstruction). In these cases, your doctor will prescribe physical therapy.
In some of the following
rehabilitation exercises, both legs are to be exercised, which is intended
to prevent the uninjured leg from developing anterior knee pain. (The
uninjured leg is forced to assume some of the workload of the injured
one and so is prone to injury.) It's best to perform these exercises three
times a day. It is important that you gradually work up to this amount.
- Front thigh muscle
sets
Sit with legs extended and fully contract the muscles of the front thighs.
Hold contractions for 10 seconds. Repeat 10 times.
- Straight-leg raises
Lie with one leg extended and the other bent at the knee. Lift the entire
leg from the hip so that the heel is about 5 inches above the floor
or ground. Hold this position for 5 to 10 seconds and then slowly lower
the leg. Repeat 10 times for each leg.
- Backward leg raises
Lie on stomach with legs straight. Lift one leg as high as possible
and hold for 5 to 10 seconds. Repeat 10 to 20 times for each leg.
- Half-knee bends
Stand with feet at about shoulder width apart or as the injury improves,
try to stand with feet together. Slowly lower the body weight by bending
the knees. Do not perform a full squat but rather stop at about half
of the full-squat position and then fully extend the knees. If there
is pain before achieving the half-squat position, stop downward travel
at that point. Repeat 10 to 20 times.
Once ACL pain has
been minimized, you may swim, cycle, walk,
stair climb, weight train, or jog, as pain allows. These activities will
help you to gradually return to full training. Also remember to continue
these stretching, strengthening, and range-of-motion exercises in order
to reduce the risk of injury recurrence.
Alternative
exercises
During the period when normal training should be avoided, alternative
exercises may be used. These activities should not require any actions
that create or intensify pain at the site of injury. They include:
Rehabilitation
after surgery
An athlete who wishes to return to sports that involve jumping, cutting,
and pivoting may need surgery to repair the ligament. This stabilizes
the knee, preserves the cartilage, and enables a return to sports at the
same level as prior to the surgery. After surgery, exercise and rehabilitative
therapy are required to strengthen the muscles and restore mobility. With
this procedure, most athletes can return to their chosen sport at the
same level.
- Keep in mind that
if your ACL injury requires surgery, the soft tissue needs time to heal
before exercise can begin. While in the hospital, patients start partial
weight bearing with exercises to re-establish knee joint mobility and
normal gait. In these cases, you would be required to wear a brace and
use crutches for the first six weeks.
- A physical therapy
program usually begins with range-of-motion and resistive exercises,
then incorporates power, aerobic and muscular endurance, flexibility,
and coordination drills.
- Finally, patients
develop speed and agility through sport-specific exercise routines.
A typical patient may begin to ride a bike at three months, start running
at five to seven months, and return to competitive sports after eight
to 12 months. Full recovery may take up to two years.
- The ultimate goal
of ACL reconstructive surgery is to provide dynamic stability while
maintaining full range of motion, so that athletes can return to competitive
or recreational sports. Progress is assessed by the patient's perception
of how stable the knee feels and by comparing the strength and stability
of the injured and uninjured knees.
When can I return
to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity
as soon as is safely possible. If you return too soon, you may worsen
your injury, which could lead to permanent damage. Everyone recovers from
injury at a different rate. Your return to activity is determined by how
soon your ACL injury recovers, not by how many days or weeks it has been
since your injury occurred. It also depends on how serious the injury
is. Instances where reconstructive surgery is required will obviously
create a longer recovery period than patients with a strain or anterior
knee pain.
A good rule is to
allow pain to dictate when you're ready to return to activity. You should
return in moderation, and back off if you feel any pain.
The ultimate goal
of ACL reconstructive surgery is to provide dynamic stability while maintaining
full range of motion, so that athletes can return to competitive or recreational
sports. Progress is assessed by the patient's perception of how stable
the knee feels and by comparing the strength and stability of the injured
and uninjured knees.
You may safely return
to your sport or activity when, starting from the top of the list and
progressing to the end, each of the following is true:
- You have full range
of motion in the injured knee compared to the uninjured knee.
- You have full strength
of the injured knee compared to the uninjured knee.
- You can jog straight
ahead without pain or limping.
- You can sprint
straight ahead without pain or limping.
- You can perform
45-degree cuts, first at half-speed, then at full-speed.
- You can perform
20-yard figures-of-eight, first at half-speed, then at full-speed.
- You can perform
90-degree cuts, first at half-speed, then at full-speed.
- You can perform
10-yard figures-of-eight, first at half-speed, then at full-speed.
- You can jump on
both legs without pain and you can jump on the injured leg without pain.
How long will the
effects of the injury last?
With proper rehabilitation, a first occurrence of pain that is diagnosed
and treated in its early stages with rest, ice, elevation, and compression
usually lasts two weeks. If the injury has recurred several times, full
recovery may take as long as six weeks.
If poor biomechanics
are the underlying problem, returning to your sport may take longer. Some
athletes with anterior knee pain caused by poor biomechanics of the foot,
knee, or hip, find immediate relief from pain once fitted with appropriate
and effective orthotic devices or patella tracking braces.
Frequent episodes
of ACL injuries may result in a ligament tear. Such a complication may
require surgical treatment, and full recovery under such circumstances
can take up to two years, depending on the severity.
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