In Australia alone, almost 200,000 ACL reconstructions were performed from 2000 to 2015. It is said that Australia has the highest incidence of ACL reconstructions in the world and is increasing every year. At Excel Physiotherapy and Wellness in Mascot, more and more patients with ACL tears visit the centre for treatment. Most of these patients are recreational sport players, who are also known as ‘weekend warriors’.
What is the ACL?
ACL is the acronym for anterior cruciate ligament, which is an important ligament located deep in the knee. It is composed mainly of collagen fibers, with a small proportion of elastic fibers, giving the ACL high tensile strength. The ACL provides passive rotational stability for the knee and prevents the shin from sliding out forward relative to the thigh.
How is the ACL injured?
Many injuries to the ACL occur when one initiates a sudden turn or “cut”, but the foot stays planted on the ground. An injury can also be caused by incorrect landing position after a jump, whether there is contact mid-air or not. According to physiotherapy patients, they felt their knee give way and they instantly felt pain. Some of these patients also shared that after they heard a click, their knee blew up with swelling within the first two hours.
Treatment options for ACL injuries
In Australia, most patients who have ACL tears undergo surgical reconstructions. However, there is current research that shows that surgical reconstructions may not be the best course of treatment and that non-operative interventions should be performed before surgical intervention is considered. The first high quality randomized controlled trial concluded that a strategy of rehabilitation after ACL reconstruction did not provide better results at a five-year follow up compared to a strategy of initial rehabilitation with the option of having ACL reconstruction later on.
The role of physiotherapy in ACL injury treatment
Whether one has undergone ACL surgery or not, physiotherapy is essential for recovery. Physiotherapy focuses on sport-specific exercise rehabilitation, range of motion deficits, strengthening the lower limb, improving neuromuscular agility, patient education, goal setting, and a progressive return to pain-free function and sport. The treatment and rehabilitation physios perform are tailor-fitted to one’s specific condition.
How long does physiotherapy treatment of ACL injury take?
Every patient’s injury is unique and physiotherapy treatments are created specifically for each patient, so the periods for treatment and recovery will differ. For a patient who has had an ACL reconstruction, it generally takes about 9 to 12 months for them to return to sports with rehabilitation. On the other hand, those who have not undergone surgery usually recover a lot sooner. As mentioned earlier, studies have shown that ACL reconstruction is not a pre-requisite for returning to sports. In fact, physio patients who have not undergone surgery are able to return to high level activities without symptom complaints or episodes of instability. Case in point, athletes at the elite level, such as golf legend Tiger Woods, NBA stars Dejuan Blair and Sean Elliott, NFL star player Philip Rivers, and Winter Olympics athlete Jessica Rich have all returned to their sports with torn ACLs.
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Lawrence Lin is a physiotherapist at Excel Physiotherapy and Wellness located in Mascot, New South Wales, Australia. He is experienced in treating work related and postural injuries, in particular, necks and backs. Lawrence has a strong interest in strengthening the ‘core’ and gluteal muscles which is vital for people who suffer from low back pain, unstable knees, and other lower limb injuries. He regularly attends professional development courses in the areas of Sports Injuries, Rehabilitation, and Orthopaedic Surgery.