Physiotherapy following Anterior Cruciate Ligament (acl) injuries

At Physica Health, one of the most common injuries we see are ACL injuries. Some cases are partial tears, whilst others are complete and require surgery. Carl has completed a Sports Physiotherapy fellowship at University of Western Ontario, and has worked with a number of varsity athletes following ACL surgery, and has loved helping them in their recovery.

The ACL - anterior cruciate ligament, is the most important ligament in the knee. It connects the tibia to the femur, and is the most commonly injured ligament. The knee is made of 4 major ligaments, and the ACL prevents movement of the tibia forward on the femur. Most commonly, the ACL is torn as a result of a rotational force to the knee, also known as a non-contact twisting injury. Usually a pop is heard, and swelling is common post- injury. An X-ray cannot observe ligaments, so an MRI is warranted in most cases.

Surgery

A common question is: Do I need surgery? There has been some cases in professional sports where surgery has not been undertaken and the athlete has returned to full sport. However, if you want to return back to full sports, with twisting and pivoting motions, surgery is usually warranted.

There are different surgical techniques and you should speak to your surgeon about the technique he/she is using, and asking why. A hamstring graft is what is mostly used in Canada, whilst some surgeons prefer using a patellar tendon graft. Both have shown adequate success post surgical rehabilitation. If you are over 40, a graft from a cadaver is usually used, as this is found to be stronger. This graft is called an allograft.

Women tend to be quadriceps dominant, so sometimes the patellar tendon is preferred, since we do not want them to lose even more weakness in their hamstrings!

At Physica, we have seen a number of pre-operative and post-operative ACL patients. The clinic is situated near the Victoria High School (Vic High), and we take our athletes on the field in the later stages of recovery to make sure they are ready to play. This is where it gets exciting!

For recovery, we use protocols that were developed at Fowler Kennedy Sports Medicine Clinic at the University of Western Ontario. They have been tested on hundreds of varsity athletes with high success and Carl studied under Melanie Werstine, Sports Physiotherapist at the University of Western Ontario, who developed the rehabilitation protocols. Mobility in the beginning, with strength, leading into plyometrics, and return to sport is usually the plan for recovery.

In the beginning, the goal is full knee extension as this will help with quadriceps activation and eventually power. Here is a very important exercise we usually prescribe early on, known as quadriceps sets.

Here is an exercise that we do in the mid-stage of rehabilitation.

Here is an exercise in the later stages of rehab, working on plyometrics for return to sport.

So ultimately, RANGE, before STRENGTH, before PLYOMETRCS, before RETURN TO SPORT!