What is the ACL?
The ACL, or anterior cruciate ligament, is a key part of your knee joint. It connects your thigh bone to your shin bone and helps prevent your shin from moving too far forward or inward. Injuries to the ACL can cause the shin bone to push unnaturally forward, which can be seen in videos of ACL tears.
How Does an ACL Injury Usually Happen?
ACL injuries most commonly occur during sports activities without direct contact from others. They typically happen when you suddenly slow down or change direction, putting stress on the knee joint.
So, You’ve Torn your ACL, What’s Next?
Here at EmbdyHealth Physiotherapy, we follow the Melbourne ACL Rehabilitation Guide. This guide was designed by experts in the area of ACL injuries and is the number one way to get you from the beginning of your injury, all the way to the end.
The old way of rehabbing ACL injuries was time-based, everyone would return to running at 3 months, and everyone would return to sport at 9 months. However, as with a lot of things, everyone is different, while some people are ready to return to running after 3 months, many are not yet at this point, and some are actually ready to run before 3 months.
The use of the Melbourne ACL Rehabilitation Guide ensures that we go through set, distinct phases. This ensures that you are progressing only once you have reached all the criteria to be able to make it to the next phase. This results in the lowest risk of re-injury possible for you, the patient. Therefore, you can have the utmost confidence that once you progress you are as ready as you can be to move on to the next stage.
How Long Will it Take Before Returning to Sport?
I know that right now a return to sport can be daunting, you don’t want to have to go through this again. But that is the reason that we go through the 6 phases of the Melbourne ACL Rehabilitation guide. This guide gives you the greatest opportunity to return to sport in the safest way possible, while also ensuring that you are able to give the best performances you can give.
Rehab from an ACL injury is usually a 9-12 month process, however, there is a lot of research that shows that every month you wait after 9 months, all the way up to 12 months your risk of re-injury is heavily reduced. We are even seeing a lot of elite athletes now being held back to 12 months+.
Let’s Take a Look at How The Phases Progress
- Pre-Op Phase
The first phase is the pre-op phase. As the name suggests this phase begins immediately after you have torn your ACL, and before you have your surgery. This phase helps you recover from your injury and gets you ready for surgery.
Most important goals of phase 1:
- Reduce swelling
- Get full range of motion back in your knee
- Get the strength of your injured leg back to 90% when compared to your uninjured side
The latest research in the physiotherapy industry shows that waiting 3 months after your injury before you get surgery leads to the best outcomes. This is because it allows you to get your range of motion and strength levels as high as you can. Having good strength and range of motion allows you the best chance at improving as quickly as you can after surgery.
- Recovery From Surgery
The ‘Recovery from Surgery’ phase is quite similar to the pre-op phase above. The surgery is quite a traumatic thing for the knee to go through. In that respect it is quite similar to the injury itself, in that the structures around the knee become damaged, leading to inflammation and irritation of the joint and those structures.
The 3 most important goals of the ‘Recovery From Surgery’ phase are:
- Get the knee fully straight
- Reduce the swelling to only mild swelling
- Get the quadriceps (muscles at the front of the thigh) firing again
This phase usually takes a couple of weeks. As mentioned above, the times can vary a little bit. For some people the swelling is quite persistent and takes a little bit longer to reduce. In order to reach the goals above, you will be doing a lot of light range of motion exercises, quad activation exercises, and swelling reduction techniques. This includes things such as sliding your heel from straight, to your bum and back 10 times, squeezing a towel underneath your straight knee, wearing compression garments around your knee, icing, and elevating your knee above your heart. You will get used to these as you will do them a lot throughout the day.
- Strength and Neuromuscular Control
As the name suggests, this next phase focuses on increasing your strength and neuromuscular control. There are a few more components to this phase of your ACL rehabilitation in this phase, a few more hurdles to get through before you move onto the next phase.
The 3 most important goals in this phase of recovery are:
- Get your single leg balance close to the same as your uninjured leg
- Get most of your strength in your leg back
- Single leg squat with good technique and alignment
Other than the 3 most important goals of recovery in this phase of your ACL rehab, there are quite a few other goals for you to reach before you continue onto the next phase. This phase usually coincides with you seeing your physio a bit less as you are focusing on strength and balance gains which take a bit longer. Usually you have finished this phase by about the 3 month mark.
- Running, Agility, and Landings
At this stage of your ACL rehab, we get to start the fun stuff. This stage involves getting back into running, beginning with slow, straight jogs, progressing to landings from jumps and hops, and finally all the way to quick changes of direction and slowing down quickly from high speed sprinting. Once you have reached this phase you should have no swelling at all.
The 3 most important goals of this phase include:
- Attain excellent hopping performance (height, technique, endurance, and distance).
- Make your way through an agility program and modified sporting games.
- Regain full strength and balance.
This phase of your ACL rehab will slowly take you through your running drills while your physio ensures that you are ready each and every step of the way. The ‘Running, Agility, and Landings’ phase of your rehab generally finishes up around 9-12 months after your surgery. Again, some people will be quicker and some will be slower. By the end of this stage you are almost ready to return to sport. You won’t have to see your physio as much during this stage as you are given longer to progress through each stage of this phase.
- Return To Sport and Prevention of Re-injury
This next part consists of 2 phases which are morphed into 1. This phase will be very individualised and tailored to your specific needs. What you need to return to sport will be dependent on what sport you play, and the position you play in that sport.
This phase of your ACL rehab really aims to get you confident when returning to sport and making sure you have the greatest chance at returning to the best of your ability with the lowest chance of re-injury possible.
You and your physio should discuss how to implement a prevention of re-injury plan. This plan will often involve a group of warm up exercises for you to complete prior to games and training. There are many bits of research which show that completing these types of injury prevention programs work extremely well to reduce injury risk and can even improve performance.
There You Have It
You have now come to the end of your comprehensive guide on getting from the beginning of your ACL injury, progressing through ACL surgery, all the way to returning to sport and ensuring you don’t get another ACL injury. Your physio is going to be extremely important in your journey. While it may feel as though you have a long way to go, don’t worry, it will go quicker than you think. Good luck out there and stay healthy.
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