With the sporting season currently on hold, it is the perfect time to prepare your body for the impeding demands of a full season and rehabilitate any injuries that you might have. It is the time to work hard at your strength training, mobility work and motor control deficiencies. Today I will focus on the anterior cruciate ligament of the knee, otherwise known as the ACL. As a retired athlete I have torn my ACL too and I have learnt first hand that a full recovery does not involve any shortcuts. Marcus and I attended a conference on ACL rehabilitation by Mick Hughes in February this year to make sure we are up to date with the latest research and evidence based practice.

What is the ACL and how does it get injured?

The ACL is a ligament in the knee that resists excessive movement of your shin and thigh bone on top of one another, namely anterior translation and rotation. It provides a significant amount of stability and attaches from the anterior portion of your tibia (shin bone) to the posterior portion of your femur (thigh bone).

The ACL is most likely to sustain an injury from a non-contact movement. For example, landing from a jump in netball, or cutting and side stepping in a footy match.

We know that female soccer (football) has the highest rate of ACL injury, followed closely by basketbal and AFL. The reason these sports have higher risk relates to the movements required by each sport. For example, in both AFL and soccer there are a lot of hard cutting and change of direction movements. In AFL and basketball a lot of jumping and landing that athletes need to train for to condition their bodies to tolerate and become efficient at the movements.

Following on from the stats above, you can see that being female does increase your chance of sustaining an ACL injury, sorry ladies. This is because females physiologically have a wider pelvis (bigger angle towards the knee), your hormones (oestrogen) can influence how ‘loose’ the ACL is; and the size of the bone area where the ACL attaches into is smaller.

What does a typical ACL injury look like?

Typically, a “pop”, “crack” or “snap” is heard at the time of injury. Secondly, a sharp, sudden pain is felt with the athlete grabbing at their knee. Thankfully, the pain does not usually last long but the knee feels unstable followed by immediate balloon-like swelling within the first 10-20 minutes which tends to worsen over the following 24 hours.

* The most suspicous sign for coaches or side-line physiotherapists to look out for is if the player immediately grabs their knee.

In the short term walking is difficult and assistance in the form of crutches, a stick or someone to lean on, might be required. However, this is not always the case! Numerous players who’ve suffered an ACL injury only complained of a swollen knee. So it is always worth getting a full assessment done if your leg does not feel ‘quite right’, feels unstable or weak as there are different degrees of ligament injury.

What to expect during your physiotherapy assessment

Your physiotherapist will perform a number of clinical tests to reach a definitive diagnosis and establish an individualised treatment plan. He or she will test the integrity of all the ligaments, menisci and cartilage in your knee, assess any swelling inside your knee capsule (intracapsular swelling), look at your strength, stability and perform a few functional tests. If an ACL injury is suspected you will likely be referred for an MRI to confirm the diagnosis and assess the severity of your injury, and to see if any other structures in your knee have also been affected.

In the meantime, you will receive support in the form of bracing, taping and compression, crutches (if needed), reassurance and a few home exercises to improve your rehabilitation outcome.

Conservative management vs surgery

Not all ACL injuries are the same, therefore some have fantastic outcomes with rehabilitation, while others would benefit from early surgical intervention. The answer will be based on each individual’s injury, the extent of damage, initial management, level of sport etc.

How long until I can return to sport?

The general rule of thumb is to wait a minimum of nine months before returning to sport, provided you have done a full nine months worth of rehab to prepare you for it. The rehabilitation period differs for each individual and should be guided by a trained and qualified physiotherapist.

Your physiotherapist should put you through your paces with a variety of tests to ensure your body is ready for the demands of your sport. Testing the strength, stability, mobility, motor control and skills (co-ordination, reaction times, jumping, landing etc.) to pick up any deficiencies if present. In my own journey, I waited ten months before I went back to gridiron after being cleared by my physio’s specific and brutal discharge criteria.

Just waiting nine months and going right into a game isn’t going to cut it and will put you at risk of re-injury. This is because that for every one month you return to sport before the recommended nine your chance of re-injury is 51%!! If that doesn’t scare you into doing your exercises then I don’t know what will.

If you have injured your knee and aren’t sure what the next steps are, contact us at Reload Physio. We can guide you through a thorough individualised rehabilitation program to get you back to sport safely, at the highest level.

Can you be proactive to prevent an ACL injury?

The short answer is yes, you can.

Lets consider what movements are known to cause an ACL injury: non-contact landing and cutting. You are able to train your body to get used to these movements over a period of time to prepare for the unpredictable nature of sport.

There are many prevention programs out there that have been validated to reduce the risk of ACL injury, and are used by professional, and competitive athletes around the world. One of the most well known programs is the FIFA 11+ for soccer, which runs through a variety of different exercises that are performed during pre-season and in-season conditioning. It is still being validated for other sporting codes, such as netball.

If you think you or your team could benefit from a program such as FIFA 11+ please contact us at Reload Physio for more information.

Happy Monday everyone.

ACL Injuries