The American Orthopaedic Society for Sports Medicine estimates more than 150,000 athletes tear their anterior cruciate ligaments, or ACL, each year. It is one of four ligaments that stabilize the joint and is situated at the front of the knee. According to the AOSSM the tissue can tear when the knee is sharply jarred, usually when the legs are slowing the body down. Surgery is the most prescribed course of treatment for a tear, typically followed by a lengthy rehabilitation period.
Phases of Rehabilitation
ACLSolutions.com, a website written by three Utah orthopedic surgeons, describes a four-step rehabilitation process for ACL tears. This program is a shift from previous post-surgical exercise programs that favored the repaired tissue rather than test it. The website's authors write, "In the past, rehabilitation after an ACL injury was primarily concerned with protecting the new ligament and the surgical fixation. For that reason, full extension of the knee and active quadriceps exercises were avoided. Unfortunately, it has been discovered that this type of rehabilitation can cause problems with stiffness and may result in a limited range of motion."
Pre-Operative Period
A torn ACL does not prevent the knee from moving. It simply weakens the joint's stability. The doctors at ACLSolutions.com write that by babying the knee, you can actually do more harm to other muscles. The quadricep muscle sits on the top of the thigh and pulls your knee and leg straight when flexed. Once the knee is injured, it is important to keep working the knee to prevent atrophy or the loss of tone. A simple set of stretches, including knee extensions, heel slides and leg lifts, can maintain quadricep strength while protecting the injured ligament.
Post-Operation: First Phase
The first post-operative phase focuses on regaining range of motion in the knee, according to Australian orthopaedist Mervyn Cross. Writing for the "Encyclopedia of Sports Medicine and Science," Cross describes the process covers the first two weeks after the surgery and involves the knee being braced in an immobilizer until control of the joint is reestablished. Further stretching and exercise is aimed at decreasing pain and swelling. The doctors at ACLSolutions.com recommend the same battery of exercise as the pre-operative period.
Post-Operation: Second Phase
With greater control and range of motion established, rehabilitation focuses on placing weight on the knee, strengthening the muscles around the knee and regaining balance and gait, according to Dr. Cross. Your body's natural defense is to favor the injury. The four-week period includes balance exercises to reestablish strength in the injured leg, as well as reteaching the knee to walk and stride without limping. ACLSolutions.com reports that once normal range of motion is reestablished, workouts on an exercise bike or stair-stepping machine are possible.
Post-Operation: Final Phase
After six weeks balance and gait is reestablished, allowing you to refocus on strength training. ACLSolutions.com explains that leg presses and squats are good exercises, as these closed-chain lifts keep the foot flat and the leg stable, allowing the muscles to get stronger without further damage to the ligament.
Post-Operative Agility Training
The doctors at ACLSolutions.com say, "Most surgeons will wait until at least three months have passed before allowing their patients to return to agility training exercises." The timeframe of when to introduce sport-specific exercise is a tough one, but usually recommended around the twelfth week after surgery. Just because the workout includes facets of the sport, does not mean that the injured knee is ready to return to the field or court. Dr. Cross writes that elite athletes take between six to nine months to properly rehabilitate a torn ACL.
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