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ACL Injuries Physiotherapy: Symptoms & Treatment

This article discusses the role of physiotherapy in treating ACL and knee ligament injuries, focusing on the importance of rehabilitation and strength building exercises to help restore full range of motion, reduce pain and improve overall knee joint stability.

As with all injuries, this information is simply a guide. It is always best to check in with a Physiotherapist or Athletic Therapist to have a personalized assessment and hear recommendations for what you and your body may need.

The knee is a complex joint balancing stability and mobility. Physiotherapy is essential to recovering from ACL and knee ligament injuries, allowing individuals to restore strength and mobility.

Knee ligament injuries can vary in severity depending on the type of injury and associated trauma involved. Commonly seen among athletes, ACL tears are often accompanied by damage to other structures within the knee joint. These may include meniscus tears, cartilage damage, and irritation of adjacent tissues such as tendons and muscles. In some cases, a direct blow may cause an acute rupture of the ACL or other significant ligaments in the knee joint.

Physiotherapy plays an important role in helping individuals affected by ACL or other knee ligament injuries to regain strength and movement so they can return to normal activities safely. Physiotherapists specialize in treating orthopedic conditions with personalized programs that involve stretching, strengthening exercises, manual therapy techniques, and education about proper biomechanics when performing daily activities. An individualized approach that considers all healing aspects helps optimize outcomes while minimizing long-term effects on mobility.

What is the ACL?

The Anterior Cruciate Ligament (ACL) is a critical knee ligament located within the knee joint. It is responsible for providing stability to the knee and helps to prevent excessive rotation or forward movement of the tibia relative to the femur. ACL injuries can occur due to direct contact, such as a fall or collision, or non-contact mechanisms, such as landing on an extended knee after jumping. ACL injuries are among the most common ligament injuries affecting the knee joint, ranging from mild strains to complete tears.

ACL Injuries

What is an ACL Injury?

Anterior cruciate ligament (ACL) injuries are among the most common knee ligament injuries. The ACL can be injured through sudden or forceful movements, such as during sports activities or due to direct contact with another person or object. Symptoms of an ACL injury typically include a 'popping' sound at the time of injury, swelling in the knee joint, and pain that worsens with weight-bearing activities. In some cases, instability may also be present.

Physical therapy is often recommended for ACL and other knee ligament injuries to help strengthen surrounding muscles and improve the range of motion. Treatment may involve manual therapy techniques such as soft tissue massage, joint mobilization, and specific stretching and strengthening exercises to restore normal function. Surgery may be required for more severe injuries, with significant damage to the ligament fibers.

ACL Injuries

Knee ligament injuries are among the most severe and debilitating conditions in an athlete's career. The four major knee ligaments – the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) – are all vulnerable to injury from a traumatic event or overuse. ACL tears are the most common type of knee injury, followed by MCL and LCL sprains and PCL strains.

Injuries to the ACL typically require surgery for proper healing. At the same time, a sprain of any other knee ligament can usually be treated with rest, ice, compression, elevation, physical therapy, and possibly bracing. Surgery is usually only needed if there is extensive ligament damage or if symptoms persist despite conservative treatments. Physiotherapy plays an important role in rehabilitating athletes who suffer from knee ligament injuries as it helps to strengthen weakened muscles around the joint and restore range of motion. Additionally, exercises may be prescribed to improve balance which will help protect the affected area from future injury.

How Can Physiotherapy or Athletic Therapy Help with ACL Injuries

Physiotherapy is important to the ACL and knee ligament injury treatment program. Physiotherapists provide assessment, education, advice and individualized treatment plans to assist the injured person in regaining strength and range of motion.

ACL injuries are typically treated with rest, bracing, and physiotherapy. The key goals of physiotherapy include:

  • Restoring normal joint motion.
  • Improving muscle flexibility and strength.
  • Reducing pain and swelling.
  • Rebuilding proprioception (the body's ability to sense position).
  • Preventing joint stiffness.
  • Restoring normal gait.

Pain Relief and Inflammation Control

Initially, we highly recommend making friends with ice and spending as much time as possible with your knee elevated and/or compressed. You can use ice for up to 15 minutes as often as every hour. You can pressurize the area for all waking hours and have it elevated any amount as much as possible. You will also want to rest from most activity, but try to keep moving and stretching as tolerated. 

Manual Therapy to Help with Swelling and Re-gaining Range of Motion

Physiotherapy or Athletic Therapy treatment is likely to include hands-on range of motion work, flushing massage for swelling and help with activating the muscles that have de-activated as a result of the injury.

Exercise Program Instruction

A thorough exercise program will also be imperative. It is important to restore lost range of motion, strength and stability as quickly as possible.

Recommendations for Follow Up

Your therapist will be able to help make recommendations on whether seeking medical attention is warranted at the time and what you can do to help speed up recovery. When you have a complete tear of the ACL, it is generally suggested that you have a consult with a surgeon. Your options will usually involve either rehabilitating it through strength or surgery.

Strengthening and Return to Life or Sport

Either way, it will be incredibly important to be as strong and stable as possible around your knee, including strengthening your legs, hips and core along with practicing good pivoting, jumping and landing technique in later stages of recovery. Your Physiotherapist or Athletic Therapist can help you strengthen to return to pre-injury levels and/or to prepare for surgery. The better condition you are in going into surgery, the better condition you will be coming out. If you have a partial tear or sprain, your rehabilitation will not involve surgery, making the exercise program even more important. 

What are the Best Exercises for ACL Injuries?

Hamstring Strengthening

Hamstring Strength

Attach an elastic to a secure object and to your ankle of the involved leg.
Lie on your stomach with your knee straight.
Bend your knee through the available range without lifting your hips.
Return to the starting position and repeat.

Upper Calf (Gastrocnemius) Strengthening

Heel Raises - Gastrocnemius/Calf Strength

Stand upright and raise your heels up.
Lower yourself and repeat.
Can hold on for balance if needed.
Focus on bringing your heels towards each other at the top of the movement.

Terminal Knee Extension (Popliteus Strengthening)

Terminal Knee Extension

Stand back to a wall with a rolled towel behind the affected knee.
Extend the knee by pushing the back of the knee against the towel.
Hold for the required time.

Range of Motion into Knee Bending and Straightening

Knee Range of Motion

Lie on your back, place a towel around your ankle and hold it firmly with your hands.
Bend your knee as far as you can and then pull on the towel with your hands to increase the flexion.
Maintain the position and relax.

Knee Range of Motion

Sit (or lay down) with your involved leg straight out in front of you.
Place the heel on a small, rolled up towel with the knee unsupported.
Add 15 seconds, up to 5 minutes as tolerated. Start at 30 seconds.

How can you Prevent ACL Injuries?

ACL injuries typically occur as a result of fast paced sport or life movements that force the tiba, or shin bone forward on the femur, or thigh bone at such a high level of force that not much can prevent them from happening. The most important factors in prevention of ACL injuries, or any injury, is being strong, balanced and moving well. A cross training workout regime with an expert in muscle balance and movement mechanics, such as a Kinesiologist, outside of the sport you play is likely the best method to prevent injury. Working regularly for body maintenance with a Physiotherapist, Athletic Therapist or Massage Therapist is also effective.

ACL Injury Prevention

What is the Quickest Way to Heal from ACL Injuries?

ACL injuries can be either minor or major, but in either case, their healing time is somewhat fixed by the physiological soft tissue healing time. A minor sprain will take about 4-6 weeks to heal and recover, whereas ACL surgery is a minimum 6 month recovery time and it is better if the return to sport is delayed even beyond that.

However, physiological healing time is only part of the battle. Other extremely important factors are how quickly swelling can be controlled, range of motion can be restored and strength and stability can be built. All of these factors are functional and completely controlled by how much work the person puts into their recovery in terms of self treatment at home, home exercises and Physiotherapy or Athletic Therapy sessions in the clinic. The more effort you put into these things, the faster your recovery will be. In an ideal case, it would the physiological healing time that is your limiting factor and not your range of motion, strength, stability or physical readiness to return to life or sport.

Contact Us For Help

Inertia Physio+ offers Kanata and Stittsville exceptional Physiotherapy, Athletic Therapy and Registered Massage Therapy with private treatment rooms, one on one care, a maximum of two patients per hour and treatment focused on the evidence based practices of manual and exercise therapy.   Don’t suffer any longer.  If you have pain or injury, our Kanata and Stittsville Physiotherapy, Athletic Therapy and Registered Massage Therapy team is here to help you get back to life pain free life and activities.  Please reach out to us at (613) 672-2200 or for an appointment today!  You are also welcome to book online. We also offer direct billing on Physiotherapy and Massage Therapy services whenever your plan allows.


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