So you’ve injured your ACL … What does this mean?
The ACL is a tough band of tissue that joins the thigh bone to the shin bone. This band of tissue runs diagonally from back to front, preventing forward movement of the shin, and in conjunction with other ligaments provide rotational stability to the knee.
There are different types of injury to the ACL, from a strain to a full tear. Depending on the severity of the injury and what your personal goals are, this will help determine what the next steps will be.
Whether surgery is indicated or not, evidence supports prehabilitation for better and quicker recovery. By actively engaging in this process the goals are as follows:
- Reduce pain and swelling
- Regain of movement in the affected knee and most importantly, restore full extension – in non-medical terms, getting the knee as straight as possible as fast as possible!
- Normalise gait - walk without a limp
- Regain full strength around the knee (but also the muscle groups above and below)
- Improve proprioception (positional awareness in space) and balance
Ultimately, it’s your knee and therefore your responsibility to dedicate time to rehabilitation. The very definition of rehabilitation is to “regain functions that have been lost as a result of injury.” However, in the early stages, pace yourself. Trying to progress too quickly can cause more pain, swelling and/or impact function. The principles of the following acronym of PEACE & LOVE should help.
- Protect: Crutches will allow you to walk without a limp and encourage weight-bearing through the affected leg. If other ligaments are involved, you may be provided with a brace.
- Elevation: The knee is going to swell, which is a normal part of the inflammatory process. Ideally for the first 24-48hrs post injury, try to keep the leg elevated. After this, try to avoid long periods of sitting as this will increase swelling in the knee and/or lower leg.
- Anti-Inflammatory medication: discuss this with your Surgeon, GP or Pharmacist.
- Compression: using an elasticated bandage or Tubigrip in the first instance will help to control the levels of swelling. This isn’t there for joint support long term.
- Education: That is what this leaflet is for.
- Loading: Discussed further in this leaflet.
- Optimism: Not all ACL injuries require surgery and those who don’t, usually return to pre-injury levels of function. There are always exceptions to this rule, which your Surgeon and Physiotherapist can discuss in more depth with you.
Vascularisation and exercise: Cardiovascular fitness and exercises are the cornerstone of prehabilitation, non-surgical management of ACL injuries and also post-operative rehabilitation following an ACL reconstruction.
Exercise Programme:
1. Range of movement programme: complete 3 sets of 10-15 repetitions daily as pain allows.
Straightening:
Bending:
2. Strengthening programme: this is designed to restore and maintain the strength of the main muscle groups of the lower limb which are the Quadriceps, Hamstrings, Gluteals and Calves. The aim is for the affected knee to have the same power of the non-affected knee: 3 sets of 8-12 repetitions or until light fatigue – 2 to 3 times per week. It is normal to experience some discomfort during exercises and some people experience delayed muscle soreness the day after. However, knee pain should not increase; if this is the case decrease the number of repetitions.
Quadriceps
Static Quads:
Inner Range Quads:
Straight Leg Raise:
Bodyweight Squats:
Hamstrings
Standing curls (with or without weight):
Hamstring Bridge:
Gluteals
Bridge:
Hip Abduction in Side Lying:
Calves
Heel Raises:
Soleus Biased Heel Raise:
3. Balance/proprioception: these exercises are designed to improve joint awareness in space following ACL injury and help to reduce re-injury risk. Aim to complete 3 sets of 15 seconds building up to 30 seconds. You can make the exercises below harder by closing your eyes.
Single leg balance:
Proprioceptive clock:
4. Aerobic exercise: Don’t neglect cardiovascular fitness. This is extremely important to maintain or build upon even after injury. Low impact CV exercise is safe and beneficial short, mid and long term!
Static bike, cross trainer and/or rowing machine build up to 30 minutes with no resistance to begin with. Gradually add resistance as time goes on.
Bike:
Cross Trainer:
Rowing Machine:
5. Plyometric exercise: These exercises aren’t to be completed until the strength and control of the knee is returning given the demand this places on the neuromuscular control required to perform safely. They are fundamental for the knee to be able to tolerate jumping, hoping and running: 3 sets of 8 repetitions 2-3 times per week.
Jumping:
Hopping:
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