The Anterior Cruciate Ligament (ACL) is a crucial ligament within the knee and is important for knee stability. Located in the knee, the ligament starts from the posterior aspect of the femur and crosses over to connect to the anterior aspect of the tibia.What makes the ligament so important is the function of the ACL. During movement of the leg the ACL stabilises the tibia, preventing any forward movement (anterior translation) of the tibia.
Without an ACL the lower leg lacks the support necessary for most functional activities of the knee. Apart from the lack of stability due to an ACL injury, the inability for the ligament to repair makes this type of injury more significant. Areas of decrease vascularity and presence of cartilage tissue contribute to poor healing of ACL injuries.
An ACL injury can occur in many different ways, and though often associated with athletes and sport this injury can happen to anyone. Mechanisms for an ACL injury include suddenly changing direction or pivoting with your foot firmly planted on the ground. Twisting and hyperextending the knee will increase the susceptibility. Landing awkwardly or an impact like a motor vehicle accident can also cause an ACL injury.
While many immediately think surgery once they have sustained an ACL injury, conservative treatment can also be a viable option. Not unlike the post-surgery protocols of an ACL injury, conservative treatment has distinct phases.
- Firstly reducing pain and swelling associated with the acute injury. Also important early in the rehabilitation is obtaining a good gait pattern, more specifically a heel-toe pattern. The use of crutches can help to obtain this gait pattern and while also reducing pain and swelling
- Improving the strength of the leg is important and is implemented very early in the rehabilitation. No one muscle stands out as important to strength specifically, as all the muscles need to work well together to provide stability
- Proprioception is a key element in the recovery of an ACL injury. This refers to the spatial awareness of your knee, essentially your knee is aware where it is space at any time. Often an ACL injury occurs from a sudden change in direction or landing awkwardly, which can suggest a lack of spatial awareness prior to the injury
- A progression of the above elements is dynamic stability, functional exercises that require a level of proprioception and strength. Often these exercises are functional, replicating movements that we normally encounter during our daily lives
- A fitness program, usually starting with walking or a stationary bike, begins as soon as possible. As you progress through our rehabilitation, your fitness program will also. This will include progressing to running and a return to a specific sport. Specific exercises that replicate your sport will be implemented at this stage
The conservative rehabilitation of an ACL injury will vary among each individual and their post rehabilitation priorities, though one common aspect needed is commitment. Having a deficient ACL will require a lifelong commitment to maintain strength and stability, especially if you are aiming to live an active life. Not mention above is the surgical option for an ACL injury which physically replaces the damage ligament. Surgery is often a lengthy period after the injury, so conservative treatment is often necessary to relieve the symptoms. This is often known as ‘prehab’ and is associated with reducing post-operative complications associated with ACL surgeries.
For more information, or to book an appointment to have our physio team help you get back to fitness and health, talk to your friendly Gold Coast Physio today on (07) 5574 4303!