The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. Those who sustain an ACL tear will likely undergo surgery to repair the tear; however, some may avoid surgery by modifying their physical activity to relieve stress on the knee. When ACL surgery is an option, physiotherapy will take into account the healing time when we provide you with rehabilitation exercises. If you don’t have surgery, a physiotherapy rehabilitation program can improve your ACL function.
Key Components of an ACL Physiotherapy Rehabilitation Program:
Strength training addresses the muscles of the lower limb, the core, as well as left to right limb differences. It also addresses strength imbalances which help prevent re-injury of the ACL.
Multiple Exercise Interventions
- Locomotion: Tri-planar, direction change, acceleration & deceleration.
- Gross Fundamental Movement skills (see the “PLAY Tools” Inventory from the Canadian Sport for Life Models – Blog to come!): Locomotion, crawl, jump, throw, kick, strike, roll and dive.
- Exercises that require the joints to go through a full range of motion: Deep squat (single and double leg), pull-up, push-up
- Exercises that include a concentric as well as an eccentric component co-contraction of muscles around a joint: Lunges, squats, push-ups.
- Closed Kinetic Chain as well as in Open Kinetic Chain exercises: with a focus on activation from the core.
- Dissociation Exercises (Upper extremity from Lower extremity and Left from Right side): Roll, crawl, diagonal neural patterns.
Proximal muscle control
Proximal muscle control is about core strength and also control of the core. In a rehabilitation program, we would look at how the core reacts in key movement patterns like landing from a jump.
Proprioception is the sense of self-movement and body position. For instance, we look at landing from a jump and frontal plane movements of both the knees (inward) and of the trunk (side to side).
Neuromuscular training teaches your body better habits for knee stability. When you train how your knee moves, especially when you jump, land and pivot, you can maintain a more stable position of the knee joint. Neuromuscular training is considered in tri-planar motion. http://prairietherapy.ca/what-is-tri-planar-movement-and-why-do-we-use-it-in-rehabilitation/
Injuries to the ACL, are especially common in team sports like soccer, skiing, basketball, and volleyball. For example, in basketball, ball handling vs. defence has been shown to have a different incidence of injury rates, with the defence having a much higher incidence.
When looking at an ACL injury, we look at how the body responds to both muscular and cardiovascular fatigue. This includes the practice of sport-specific exercises when the body is tired. In Physiotherapy, we would use single leg balance exercises, jump & squat form/technique, deceleration training & direction changes.
How much and how long
Studies have shown variability in program duration and frequency, but in order to see a training effect, exercises need to have the components of progressive overload and not allow for accommodation. They cannot be stagnant and need to be progressive and challenging. Some programs have shown gains as quickly as six weeks when training 3 times per week for 90-120 minutes per session. Other programs have shown gains over an entire soccer season (4 months) when used as a warm-up (20min) prior to every training practice.
For more an evidence-based review of the literature on ACL rehabilitation programs please use the following link:
A physiotherapist will take into account multiple considerations when building a rehabilitation program for the patient with a deficient ACL. To learn more please contact us at Prairie Therapy and ask to book in with Zenia. http://prairietherapy.ca/physiotherapy-calgary-sw/