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Recovering from an ACL injury and preventing re-injury

acl injury rehab exercises

We recently covered the basics of an ACL injury — from why it happens to prevention techniques. This month, physical therapist Meredith Franczyk follows up with the nitty-gritty of healing, including what to expect in rehab and strength moves you can do to prevent re-injury.

An ACL — anterior cruciate ligament — is one of the four ligaments that helps stabilize the knee joint. Its function is to stop excessive forward movement of the lower leg (tibia) and inward rotation of the knee. An ACL injury or tear can be caused from direct impact onto the leg with the foot planted on the ground, quick movements or twisting the leg with movement/landing. This is why it is common among athletes such as soccer, volleyball and football players. It can also be caused from non-impact reasons such as suddenly stopping while running, quickly shifting your weight from one leg to the other or hyperextending the knee. While runners are not a high-risk group for ACL tears, the injury can still occur if the knee twists or hyperextends during running.

You will often (but not always) hear a pop after impact followed by swelling and pain while bending the knee. The knee can also give out with movement or just shifting your weight onto the injured leg. An ACL tear can usually be diagnosed by special tests, which include anterior drawer, Lachmans and pivot-shift ,and/or an MRI. If a tear is suspected you should follow up with a doctor. Depending on the activity level of the person and the severity of the tear, surgery may be necessary. For the non-active person, surgery is usually not performed and the person would follow up with rehabilitation.

ACL injury rehab: what to expect

ACL rehabilitation is initially more aggressive if surgery was not performed. If surgery was performed, physical therapy lasts about 3 months. Typically, for the first 1 to 2 weeks post-op, rehabilitation consists of passive knee range of motion, patellar mobilizations, and managing swelling and pain. Quadricep strengthening is emphasized early in treatment, but it is also important to start proprioceptive training after the second week.

After a few weeks, rehabilitation therapy focuses on closed chain (feet fixed on the ground) exercises such as squats to 90 degrees, lunging, and balance activities. You should avoid squatting past 90 degrees because that puts more stress on the ACL. In addition, you want to avoid “open chain” (feet not fixed on the floor) knee extension exercises — like straightening out the lower leg while in the seated position –as they can also cause re-injury.

Running usually resumes about 10 to 12 weeks post surgery with a training program.

Stick with it — or risk re-injury

In my experience and research, people significantly decrease their rehabilitation exercises post physical therapy even though they are advised to continue.
The Journal of Orthopedic and Sports Physical Therapy found through a meta-analysis that only 63 percent of ACL repairs continue on to their pre-injury level of function and that only 44 percent of these athletes go on to become competitive again. It also found the odds of re-injuring the same knee or the opposite knee can be as high as 49 percent. If the strength and neuromuscular control is not where it should be, there is a higher risk of re-injury to the knee. It is important to continue with single leg activities such as standing on unstable surfaces, cone stepping, and lunging drills well after physical therapy is finished. It is also important to set up a running program that gradually increases speed and distance.

Post-rehab strength training

Here are a few examples of exercises appropriate for ACL tears that have finished rehabilitation.

Squats with a band above the knee
Place the exercise band above the knees with the legs shoulder width apart and slowly squat down. Make sure to keep your knees forward and not allow the band to pull them inwards.

2 to 3 sets of 10

acl injury rehab squats
Step downs
Keep the injured leg on the step and slowly step down with the opposite leg to the floor, about 5 seconds. Try and take about 10 seconds to return to the start position to work the quadriceps muscle eccentrically.

2 to 3 sets of 10.

acl injury rehab step downs
Single leg heel raises
Lift up with your toes on the injured leg trying to maintain good balance and control of your leg. Engage your core and gluts, while you raise the heel up.

2 to 3 sets of 10-15.

acl injury rehab single leg

acl injury rehab plank

On your forearms and toes, making sure your core and gluts are engaged and keeping your buttock in the neutral position. Hold the position for at least 20 seconds, 5 reps.

Side planks:
acl injury rehab side plank

Lay on your side and lift your body up with your hand and feet one on top of the other. Make sure that you are engaging your gluts and core and not letting your hip drop down. Hold at least 10 seconds, 5 reps.

Running Injuries

Meredith Franczyk, PT, MPT

Meredith has over ten years of experience and is currently working in outpatient orthopedics at lakeshore physical therapy. Over this time, she has developed specialties in general orthopedics, manual therapy, and sports rehabilitation. Meredith has specific interests in sports related injuries. She takes a keen interest in new methods and advancements in physical therapy practice and has taken multiple continuing education courses to improve her skills and enhance her knowledge. If you have any questions or are looking for physical therapy please contact her at Lakeshore Physical Therapy.