What Is Your ACL?
Your knee is a complex joint. It’s essentially a hinge that allows your legs to bend and straighten. It includes several bones as well as ligaments and muscles that provide stability.
Your ACL is the anterior cruciate ligament in your knee. It’s a dense band of connective tissue that joins your thigh bone (femur) to your shin (tibia). It’s the smallest of your knee’s four ligaments but definitely one of the most important.
The ACL’s job is to keep your leg stable. It keeps your thigh bone in the right place, stopping it moving forward when you’re standing, walking or running, and stops your knee rotating. If you didn’t have an ACL, your knee would wobble and move when you twist your body.
Not sure how to pronounce ‘cruciate’? If you’re a Harry Potter fan, then think of the Cruciatus Curse – ‘cruciate’ has a similar pronunciation. If you’re not into stories of teenage wizards, then ‘cruciate’ sounds like ‘kroo-she-ate’.
What Causes an ACL Injury?
That might be when you change direction suddenly during a soccer match, land after leaping to catch the basketball or come to a sudden stop. ACL injuries commonly happen during sports like skiing, soccer, football and basketball, which involve twisting, landing, stopping suddenly. Your ACL can also be injured by another player falling across your knee causing it to twist unexpectedly. That can happen during a football tackle.
What Are the Symptoms of an ACL Injury?
If you’ve torn your ACL, you might hear a popping sound, accompanied by your knee giving way or buckling. Then your knee may start to swell because there’s blood leaking into the joint. You probably won’t be able to move the knee easily.
ACL Injury Treatment
You may know the RICER protocol, which stands for Rest, Ice, Compression and Elevation. It’s been in use since the 1970s but there isn’t actually a great deal of evidence to support it.
Your body’s natural response to an injury is to send in its own emergency response team of white blood cells, healing chemicals and new cells needed to repair the damage. Inflammation is a by-product of this healing process. Some swelling may be caused by the waste products at the end of this process – elevating the limb will help your body’s lymphatic system to drain these away.
Ice is certainly a great painkiller. But it’s a bit like putting a roadblock in front of an ambulance. Ice limits the blood flow to the injured area. That limits swelling, which is why icing used to be recommended. But, that inflammation is your body’s natural response to an injury. Healing relies on inflammation.
So, what should you do instead of RICER? The new protocol is called METH:
- Movement: The right exercises help promote desired change
- Elevation: Elevating the injured area helps to drain excess fluid
- Traction: Pulling exercises help decrease pain and spasm and help fluids flow more easily
- Heat: This increases blood flow to the affected area, which facilitates healing (while elevation facilitates drainage).
You’ll need your physio’s guidance for the right kind of movement and traction. But heat and elevation are straightforward home remedies that you can implement in the immediate aftermath of an injury.
Diagnosis and Treatment
Your knee is a complex structure and there may be additional injuries alongside your ACL sprain or tear. You should always seek professional advice from a doctor or physiotherapist as soon as possible after an injury.
Your doctor or physiotherapist will ask how the injury happened and examine your knee to determine how severe it is. You may need an X-ray or other imaging so your doctor can see exactly what’s happened inside your knee.
Surgery has traditionally been the main treatment for a damaged ACL. During ACL reconstruction surgery, the torn piece of your ACL is removed and replaced with a piece of tendon from another part of your knee or from a donor. Surgery is also able to repair any tears to your meniscus, a cartilage pad inside your knee which is often damaged during an ACL tear.
Physiotherapy is used before and after knee surgery. Before surgery, the goal is to strengthen your knee and get it moving so that you’re more likely to regain full motion after surgery. Physical rehabilitation after surgery helps to strengthen your muscles, improve your flexibility and reduce the likelihood of re-injury.
Whether or not you need surgery depends on a few factors, including your age, activity levels and the extent of your injury. A recent study supports the idea that people with less severe ACL injuries, or non-sporty types who’ve reached middle age may do just as well with non-surgical interventions such as physiotherapy.
ACL Injury Prevention
Certain activities can help prevent an ACL injury. They include:
- Warming up, stretching and cooling down properly before exercise
- Gradually increasing the intensity of your exercise
- Giving your body time to recover between training sessions
- Doing a month of pre-season training before ski or sporting seasons
- ACL injury prevention exercises to improve your balance, power and agility
- Stopping your activity when you feel pain and immediately following the RICER protocol.
How Can The Brisbane Spine Clinic Help?
Here at The Brisbane Spine Clinic, we provide sports physiotherapy to many patients recovering from ACL injuries, as well as those keen to prevent an ACL injury by improving their strength and agility. Please make an appointment to see us today.