by Alan Jordan
Whether you are a professional sportsman or an amateur who enjoys a Saturday-afternoon kick about, an anterior cruciate ligament (ACL) injury used to often spell the end of your sports participation. However, as long as there are no degenerative changes in the knee or associated damage to the collateral ligaments, your condition could be managed so you can continue playing.
This must be managed on a patient-by-patient basis though and many factors should be considered when developing a rehabilitation program after surgery for an ACL injury.
The type of graft, its strength and maturation has to be taken into account along with the effect of exercise on the graft. The role that certain muscles will play in limiting stress on the graft should also be considered along with proprioception – the body’s awareness of where the knee is.
The Aims of ACL Rehabilitation
- Manage pain and reduce swelling with rest, ice, compression and elevation.
- Increase the knee’s active stability.
- Helping the patient return to a desired level of sport training or lifestyle activities.
- Improve proprioception, so the patient can function effectively.
Exercises Used During Rehabilitation
Exercise will play a large part in helping the patient’s rehabilitation following surgery for an ACL injury. Both closed-chain exercises and open-chain exercises can be used.
Closed-chain exercises – where the foot is in contact with an object that cannot move, such as the floor – include squatting and they minimise the stress that is placed on the ACL.
Open-chain exercises – where the foot is in contact with a moving object, such as a ball – increase the forces through the knee. These are useful later in the rehabilitation process but should be avoided until your physiotherapist tells you you’re ready to begin.
How Long Does Rehabilitation Take?
Everyone is different, so your physiotherapist will help you meet the required landmarks at your own pace, but the following are standard time frames when you undergo rehabilitation.
During weeks one and two you will usually focus on motion and gaining full extension by walking and cycling.
In weeks three to six, closed-chain strengthening exercises will take place and you will continue to promote a full range of motion.
Throughout weeks seven to 12, you will begin sport-specific training by engaging in outdoor cycling, jogging etc. As time progresses, you should move onto light pivoting, lateral movements and shuttle runs.
From months four to seven, you should keep up the good work by doing constructed exercises and pylometric work can now begin.
If you would like more information about the rehabilitation of ACL injuries, you can read our full Broadgate Journal article now. You can also learn more about the author – sports scientist and physiotherapist Christopher Pettit – at https://www.broadgatespinecentre.co.uk/london-physiotherapy/.