A Guide to Combating ACL Injury with Exercises and Other Treatments

Being able to perform simple leg movements, walking and running around, and participating in sports are some of the simple joys in life for many of us. On a more intense level, these turn out to be passions and professions for the athletes. However, an ACL injury can suddenly rob you of such joys and pleasures in life.

An ACL injury is caused by a sudden impact on the knee. The knee joint is the largest joint of our body and is responsible for simple leg movements like walking, standing up, and sitting. Depending on the severity, an ACL injury tear may lead to swelling and pain in the knee, and may severely impair your ability to walk, stand up, or run.

What Is an ACL Injury?

An ACL injury is an impact injury on the ligaments of the knee that causes a tear or injury to a knee ligament. The ligament that is impacted in an ACL injury is called the Anterior Cruciate Ligament (ACL) hence the abbreviation in naming the injury.

In fact, the ACL is one of the four knee ligaments that hold the kneecap in place and proper position with respect to the thigh bone above and the shinbone below. The ACL controls the forward range of movement of the shinbone. Along with other knee ligaments, the ACL helps in the proper functioning of the knee hinge joint and is responsible for basic movements of the legs like walking and running. These functions are severely impacted after an ACL injury.

ACL Injury Causes

An ACL injury tear can happen in different ways. 

• The most common ACL injury causes are sudden rotating movement of the knee, as in abrupt cutting manoeuvres in high-impact sports like football, soccer, basketball, skiing, and tennis to name a few. 
• ACL injuries also occur frequently among children and adolescents while playing rough. It can happen if the knee rotates abruptly while running or jumping and landing in a way that twists the knee. 
• Women athletes are at a higher risk of ACL injury tear, especially at a younger age due to various physiological and movement-related factors during high-impact sports involving running. 
• Other ACL injury causes may include sudden traumas to the knee during work injuries and automobile accidents. During these injuries, the knee ligaments are stretched too far and too abruptly to cause tears, thereby causing ACL injury symptoms like severe knee pain and limited range of leg movements. 

ACL Injury Symptoms

The Mayo clinic shows the symptoms of ACL injury tear are felt differently at different stages of injury and the healing journey. The following are some common ACL injury symptoms:

• At the time of an ACL injury, the person can hear a ‘pop’ sound and feel something snapping in the knee. 
• Swelling of the knee is accompanied by moderate to severe pain and tenderness in the joint which can last for up to several hours. 
• Even after several hours of the injury, the person may stumble or fall while walking due to instability in the knee.
• Over time, instability in the knee affects overall walking posture.
• Patients cannot bear body weight as it strains the knee and causes pain. 

Not all ACL injuries are the same. Based on the severity, an ACL injury tear is classified as: 

• Grade 1: The ACL is sprained or overly stretched but it has not sustained a tear
• Grade 2: The ACL ligament has sustained a partial tear at one or more points along the ligament
• Grade 3: The ACL is completely torn or snapped in half along the length of the ligament

An ACL injury can be diagnosed through physical examination like the Lachman Test or Pivot Shift Test. It may also be clinically diagnosed with MRI tests and X-ray tests to determine the extent of ACL injury and associated fractures in the leg bones.

ACL Injury Treatment

The ACL injury recovery time can vary from 8 to 12 months depending on factors like the severity of the injury, treatment involving surgery, and being an athlete. All these factors may increase the time it takes to recover from an ACL injury.

RICE Treatment

As soon as an ACL injury occurs, it must be treated with ‘RICE’ treatment- Rest, Ice, Compression (of the knee), and Elevation (of the lower extremity of the affected leg). Patients must be supported while walking or standing with the help of crutches, wheelchairs, etc.

The ACL injury symptoms should never be ignored. If left untreated, over time the mildest of ACL injuries may severely limit movement and stop one from returning to playing sports by increasing the risk of joint replacement, osteoarthritis, damage to knee cartilage, and knee instability.

Physiotherapy

Physiotherapy, as a part of a comprehensive post-surgery rehabilitation program, can drastically reduce ACL injury recovery time. It is effective in grade 1 and grade 2 ACL injury treatment. For athletes, exercises are a great way to prevent ACL injury by strengthening and balancing muscles and ligaments and improving postures during high-impact sports.

One of the best ways to holistically prevent and treat an ACL injury tear is to seek medical care from experienced orthopaedic doctors at FlexifyMe. Book a demo session that is completely free of charge and take the first healing steps on your ACL injury treatment journey.

Supervised physiotherapy, involving exercises targeting the full range of motion of legs and an ongoing assessment of progression in healing, is proven to be effective ACL injury treatment.

ACL Reconstructive Surgery

In severe cases of ACL injury tear, ACL reconstructive surgery might be the only option as the ligaments are not able to heal themselves. Physiotherapy and certain yoga exercises under the guidance of experienced orthopaedic doctors help to heal faster post-ACL surgery.

Exercises for ACL Injury Management

The exercises to treat ACL injury include a complete range of leg movements. These exercises target various leg and glute muscles like quadriceps, hamstrings, and hip muscles, as well as build core strength. 

Following are some of the common exercises prescribed for ACL injury treatment. However, one must consult their physiotherapist before trying these exercises.

Hamstring Curls: As the name mentions, this exercise targets and flexes the hamstring muscles. Done on the floor in a lying prone position, variations of this exercise can be done both at home and with equipment. To do the basic hamstring curls, follow the steps below:

1. Lie on the floor in your belly. Support your forehead on your folded arms resting on the ground. 
2. Stretch out the legs at shoulder width. 
3. Bend both legs at the knee till the lower legs are at 90-degree angles to the thighs. 
4. Hold this position for a few seconds.
5. Straighten the legs and return to the flat lying position.
6. You may repeat the steps for up to 5 repetitions during the initial stages of recovery.
7. If you feel comfortable, add light weights on your legs with ankle weights or hold dumbbells between your feet while doing hamstring curls.

Glute Bridge or Hip Bridge: This simple exercise is a compound exercise that targets the glutes, lower back, abs, and hamstrings at once. Here’s how to do a glute bridge.

1. Lie on the floor on a mat, if preferred. 
2. Rest your arms on your side, palms down. 
3. Bend your knees at 90 degrees and rest the soles of your feet firmly on the ground.
4. Engage your core muscles, and lift your hips making one straight line from your upper back to your knee. 
5. Breathe normally and keep your abs engaged.
6. Hold this position for 15-20 seconds.
7. Release the pose by lowering the hips on the ground.
8. If you are a beginner, repeat the steps 3-5 times. This may be increased as you progress in your healing.

Vrikshasana or Tree Pose: The Vrikshasana or Tree Pose yoga exercise works directly with your knees. It helps regain the balance that is lost when you sustain an ACL injury. Follow the steps to do this gentle yet effective yoga pose:

1. Stand on both legs and engage the core. 
2. Keeping your right leg firmly on the ground, step back just a little with your left leg resting on your toes. 
3. Bend the left leg at the knee and lift it. You may brace your knee with your arms for support.
4. Rest the sole of your left foot on the side of the thigh of your right leg. As a result, the left knee will move away from the body. 
5. Let go of the arm support from the left leg. You may either keep your arms on your hips or keep them in front of your chest folded in a prayer position. 
6. Keep your right leg straight and your body centred. Breathe normally.
7. Stay in this position for 5 to 10 seconds. 
8. Lower your left leg and come back to the standing position with both feet on the ground.
9. Repeat the steps by alternately raising your right leg. This would complete one set of this exercise.
10. Progressively increase the number of times of such sets. You may repeat the sets up to 10 times.

Moving High Lunge: Just like you would do a normal lunge, this exercise involves walking ahead while lunging at each step. This works the quads, hamstrings, and glutes while helping build good balance, all of which are necessary for a fast recovery from an ACL injury. Here’s how to do a moving high lunge:

1. Come to a standing position where you have some walking area ahead of you.
2. Keep your arms by your side and bend them at the elbow like you would do while running.
3. Engage your core and step ahead with your right leg. Remember to take a long step.
4. Go into the lunging position by bending both knees. 
5. You would know you are doing the lunge in the right way when the front leg is bent at a 90-degree angle at the knee. The back left leg may barely graze the ground.
6. All the while, keep your upper body straight and in line with your left thigh.
7. Get back up by leaning a little forward, while straightening your right leg put your entire weight on it. 
8. Curl and bend your left leg at the knee and close to your body.
9. Stand in on your right leg for 2 seconds. Keep your core engaged.
10. Straighten your left leg ahead of you and step forward with your left leg. 
11. Bend both legs at the knee and lunge, making sure the left forward leg bends at a 90-degree angle at the knee. The back right leg can be closer to the ground. 
12. Get back up again by straightening your left leg and putting your entire weight on it. Bend your right leg at the knee and closer to your body.
13. Likewise, walk ahead a few steps. You may repeat the steps up to 10 times, depending on your comfort level.

Conclusion

An ACL injury can bring your otherwise active and high-impact lifestyle to a sudden standstill. This injury affects the knee and is caused by abnormal stretching or tearing of knee ligaments during high-intensity sports and activities involving sudden rotating of the knees. Left untreated, this injury can cause problems with bones and ligaments around the knee and leads to restricted movement and trips and falls.

Effective ACL injury treatment includes supervised physiotherapy and guided exercises under experienced orthopaedic doctors. Physiotherapy is proven to be effective both as a non-operative treatment option, before surgery, as well as during post-operative rehabilitation. These exercises build strength and restore the tissues surrounding the knee for a gentle yet effective recovery.

ACL injury FAQs