FAQs

Post-ACL Reconstruction Rehabilitation

The Crucial Role of Active Rehabilitation in Post-ACL Reconstruction

Post-operative ACL rehabilitation plays a pivotal role in the recovery process following a torn ACL, yet it often receives insufficient emphasis. The diligence with which patients adhere to their physiotherapy rehab influences the long-term performance of their reconstructed knee. While some patients experience a full recovery and can resume their previous lifestyles, many individuals may endure persistent pain, stiffness, and limited joint motion for months or even years after ACL reconstruction surgery. To achieve the best possible outcome, entrusting your ACL reconstruction rehabilitation to a skilled physiotherapist becomes paramount.

Your Sport Matters

In sports, the risk of an ACL (anterior cruciate ligament) injury is higher in Level I sports compared to Level II sports. The classification of sports into different levels is not a standardised system. Generally, it refers to the level of contact, intensity, and risk of injury involved in the activity. We consider Level I sports to have a higher risk of ACL injuries due to the nature of their movement patterns and the amount of contact involved. On the other hand, Level II sports typically have less risk of ACL injuries.

Level I Sports

Level I sports with a higher risk of ACL injuries includes football, AFL, the rugby codes, netball, basketball, volleyball, tennis, snow skiing and American football.

Why is a Level I Sport More at Risk of ACL Injuries?

The reasons why Level I sports are more at risk for ACL injuries compared to Level II sports include:

1. Contact and collisions: Level I sports often involve direct physical contact with opponents, increasing the likelihood of collisions that can lead to ACL injuries.
2. Aggressive movements: Level I sports typically require more aggressive and abrupt actions, such as cutting, pivoting, and jumping, which can strain the ACL.
3. Higher intensity and skill level: Athletes in Level I sports are usually more skilled and perform at a higher intensity, increasing the likelihood of exposure to ACL injury risks.
4. Playing surface: Some Level I sports are often played on turf or artificial surfaces, which may contribute to ACL injury risk compared to natural grass found in many Level II sports.

It's important to note that while Level I sports have a higher risk of ACL injuries, physical activity carries some injury risk. Athletes should take appropriate precautions, such as proper warm-up, conditioning, and correct techniques, to reduce the risk of ACL injuries. Additionally, seeking medical attention and following rehabilitation guidelines if an ACL injury occurs can help ensure a safer return to sports activities.

What's the Timeline for Returning to Activities after ACL Reconstruction

For athletes, returning to their beloved sports after undergoing ACL reconstruction is of utmost importance. However, the timing and readiness for a return to sport (RTS) significantly impact re-injury risk.

A compelling 2018 study by Kate E. Webster and Julian A. Feller caught our attention. In their research, Webster and Feller aimed to determine the proportion of athletes who returned to Level I sports (activities involving jumping, hard pivoting, and cutting) within one year after ACL reconstruction. Additionally, they compared the return rates based on age and sex while also examining the association between RTS and commonly used outcome criteria.

The study involved 1440 athletes who met specific criteria, such as undergoing primary ACL reconstruction, possessing a normal contralateral knee, having no additional surgery within the first year after reconstruction, and participating in level I sports weekly before the injury. The researchers recorded the proportion of athletes who had resumed level I sports 12 months after surgery. Knee function, laxity, and self-reported outcomes were also assessed.

Your Age Matters

The findings revealed intriguing trends. Athletes aged 25 years and younger exhibited significantly higher rates of returning to level I sports, with 48% achieving this milestone within one year after ACL reconstruction. In contrast, older athletes aged 26-35 years had a return rate of 32%, while those aged 36 years and older had a return rate of 19%.

Your Gender Matters

When comparing return rates by sex, male athletes in the younger age brackets (≤25 years and 26-35 years) demonstrated significantly higher return rates than their female counterparts. However, after the age of 36, no sex-based differences in RTS were observed.

Your Symmetry Matters

The study also shed light on the significance of specific recovery indicators. Athletes, regardless of age, had twice the odds of RTS if they achieved limb symmetry index scores of 90 or higher and three times the odds of RTS if they attained International Knee Documentation Committee (IKDC) scores of 95 or higher.

Everything Matters!

In conclusion, the study showed that nearly half of the younger athletes (aged ≤25 years) returned to a level I sport within 12 months after ACL reconstruction. Younger athletes were more likely to meet criteria indicating satisfactory functional recovery and readiness for RTS. These findings underscore the importance of considering age when establishing thresholds for recovery indicators.

This research underscores the critical importance of meticulously assessing an athlete's readiness to return to sports after ACL reconstruction. By factoring in age, sex, and specific recovery indicators, healthcare professionals can provide tailored guidance and support to optimise the RTS process and reduce re-injury risk.

What to Do If You Have a Ruptured ACL?

If you experience a ruptured ACL, seeking guidance from a qualified physiotherapist is highly recommended. The success of your rehabilitation depends on various factors, such as your age, activity level, the extent of the injury, and the specific sporting demands you plan to resume.

Please consult your healthcare professional or physiotherapist for more information on ACL injuries, the need for surgery, posterolateral corner injuries, and knee ligament injuries. They can provide personalised advice and recommend the most suitable action for your situation.

More ACL Information

• ACL FAQs & Products

Reference: Webster, K. E., & Feller, J. A. (2019). Return to sport after anterior cruciate ligament reconstruction: Evaluation of age, sex, and readiness to return criteria. Orthopaedic Journal of Sports Medicine, 6(8), 2325967118788045. doi: 10.1177/2325967118788045

Exploring the Potential of ACL Braces as a Treatment Option

When addressing ACL injuries, one promising avenue of treatment that has gained attention is using ACL braces. These specialised braces are designed to provide support and stability to the knee joint, aiming to alleviate the effects of ACL insufficiency. Let's dig into the potential of ACL braces as a treatment option and understand how they might contribute to recovery.

The Role of ACL Braces

ACL (anterior cruciate ligament) injuries are notorious for impacting knee stability and overall joint function. Such injuries often necessitate medical intervention and comprehensive rehabilitation.

One of the strategies that has emerged in recent years is the utilisation of ACL braces. These braces are meticulously crafted to help counteract the instability caused by a torn or weakened ACL. By providing external support to the knee joint, ACL braces aim to minimise excessive movement and stress that can further compromise the injured ligament.

Benefits and Considerations

The potential benefits of using ACL braces are multifaceted. Firstly, they can protect the injured knee during activities that might otherwise exacerbate it. This protection is particularly valuable during the initial stages of rehabilitation when the injured ligament is vulnerable. Additionally, ACL braces can contribute to improved proprioception – the body's awareness of its position in space – aiding in restoring natural movement patterns.

However, it's important to note that while ACL braces offer advantages, they are not a standalone solution. And, they may even have some potential downside, such as a higher risk of DVTs.

ACL braces should be considered part of a comprehensive treatment approach, including physiotherapy, exercise regimens, and possibly surgical intervention. The decision to use an ACL brace should be made in consultation with a medical professional who can assess the individual's specific injury, overall health, and treatment goals.

Related article: ACL Cross Brace for Treatment

Who Might Benefit

ACL braces may be a particularly valuable treatment option for individuals who have experienced partial ACL tears or mild instability. Athletes, both amateur and professional, who wish to return to their sports after an ACL injury may find the added support of a brace beneficial during their recovery journey. Furthermore, those looking to avoid surgery or are not ideal candidates for surgical intervention might explore the potential of ACL braces as a conservative management approach.

Conclusion

In conclusion, ACL braces present a promising avenue for addressing ACL injuries and supporting rehabilitation. By offering external support and aiding in joint stability, these braces have the potential to contribute positively to an individual's recovery journey.

However, it's essential to recognise that ACL braces should be used with a comprehensive treatment plan tailored to the individual's unique circumstances. Consulting with your knee physiotherapist or surgeon is crucial to determine the suitability of ACL braces and to develop a holistic approach to healing and regaining optimal knee function.

When considering ACL braces or any other medical treatment, seeking personalised advice from a healthcare expert is paramount to making informed decisions that align with your specific needs and goals.

More ACL Information

• ACL FAQs & Products

When Can You Get Back to Sport?

Your safe return to sport hinges on decisions made by your sports physiotherapist, doctor, or surgeon. They'll factor in your tissue healing progress and how well you've advanced in your rehabilitation journey. Rushing back into sports prematurely can hamper healing, extend recovery time, and lead to prolonged pain.

Your physiotherapist's goal is to expedite the process using hands-on treatment methods, progressive exercises, and, notably, strength, functional, sport-specific, and agility drills that simulate your sport. On occasion, protective bracing or taping might facilitate an early return to sport.

As a general guideline, it's worth noting that most soft tissue and bone injuries typically require a minimum of six weeks for scar tissue to mature or bones to complete their healing process. Consequently, adopting a cautious approach becomes crucial. It's highly advisable to engage in a conversation with your sports physiotherapist, surgeon, or sports physician. This way, they can effectively liaise with your coach and ensure a well-informed decision regarding your return to sport.

More info:

Sports Physio

• Sports Physiotherapy
• Sports Physio Treatment
• Sports Injury? What to do? When?
• Acute Sports Injury Clinic
• Sports Physio FAQs
• Sports Insurance

Recovery & Sports Massage

• Sports Massage
• Sports Recovery Massage

Sporting Injuries

• Sports Related Conditions
• Sports Health
• Youth Sports Injuries

Why Has My Knee Suddenly Started Hurting?

Sudden onset of knee pain typically follows a clear instigating event and can be associated with injury to one or multiple structures in and around the knee. Bone, joint capsule, cartilage, ligaments, tendons and muscles can all be affected. For this reason, it is vital to ensure your condition is professionally assessed so that you can treat it appropriately. Several types of acute knee injuries are described below.

The anterior cruciate ligament is injured during a pivoting manoeuvre whilst the knee is bent, such as when changing direction whilst running. Pain, difficulty weight-bearing, an audible popping sensation and rapid onset of swelling are often experienced. It is also common for the meniscus to be injured in this manner.

Less prevalent conditions are fractures of the tibial plateau, the weight-bearing surface of your shin bone, and osteochondritis dissecans. Fractures of the tibial plateau require large forces, such as when falling whilst skiing or horse riding, and there is an inability to bear weight through the affected leg. Osteochondritis dissecans occur in adolescents and involve injury to the bone beneath the cartilage due to a lack of blood supply. This can be accompanied by pain, swelling and locking of the knee if a loose fragment of bone gets caught between the joint surfaces.

As you can see, knee injuries and their treatment vary considerably, so please consult your knee physiotherapist or doctor for their opinion on your knee pain.

How Do You Know If You Need A Doctor or Physio For A Knee Injury?

Knee pain or knee injuries can be a common occurrence whether you’re a seasoned athlete, weekend warrior or infrequently active.  If you’ve sustained a knee injury and need to see someone, you may be unsure where to start – a physiotherapist or the doctor?

Here are some points to consider when deciding who to see first.

When Should You Consult Your Doctor First?

Please consult your doctor if you have any broken skin or bone injuries. If you require wound care, your doctor is the expert. Likewise, if your normal bone alignment appears distorted from trauma or you have extreme and unrelenting pain, you should immediately go to a doctor or the emergency department. They will be able to assist you with prescribed pain relief and further investigation of your injury. You should also visit your doctor if you have any warmth, redness and swelling around your knee with pain unrelated to movement. These are potential infection symptoms that require urgent medical attention.

In non-urgent knee conditions, your doctor will assess your knee in the clinic. They will use their professional expertise to determine if you require some prescribed pain relief, referral to a physiotherapist, surgeon, imaging or another medical specialist. Some doctors have additional training in musculoskeletal and sports injuries, which is very beneficial in assessing and managing knee injuries.

Luckily most cases of knee pain respond to non-surgical and non-urgent care to restore normal knee function. Knee rehabilitation is where your highly skilled knee physiotherapist can assist you.

When Should You See Your Physiotherapist?

Your physiotherapist can assist you in diagnosing your knee injury and promptly commencing treatment. Physiotherapists are highly trained in the clinical diagnosis and management of knee injuries, sports and musculoskeletal injuries.

Your physiotherapist will also customise your rehabilitation to optimise your recovery and assist you in returning to full function as fast as possible. Throughout the rehabilitation, your physiotherapist will maintain clear communication with your GP, if you have one, and provide updates as you progress. If they feel that a second opinion, such as an Orthopaedic Surgeon assessment is warranted, they will direct your management accordingly.

If required, your physiotherapist may immobilise you or fit a knee brace to support and protect your knee during the acute stages of injury. Plus, they may refer you for imaging if your clinical presentation warrants additional diagnostic testing.

Your Decision

Whether you consult your doctor or physio first is entirely your decision. Either way, you don’t need a referral to see your doctor or a physiotherapist. But, if you require an appointment with a surgeon or diagnostic imaging, you will require a referral.

If you are unsure, please call us at PhysioWorks. One of our knee physiotherapists will assist your decision process based on your concerns.

More info:

• Common Knee Conditions
• Knee Pain Products

How To Avoid Repeat Back Strain

While it is easier to understand that lifting a heavy load in an awkward position can cause back pain, it's harder to comprehend how a simple movement can hurt your back. Yes, it can happen by merely leaning forwards to pick up your teacup or when bending to brush your teeth! We know that some people are vulnerable to repeated lower back sprains and strains.

The reason is poor local joint control. The main reason for this is inadequate or non-existent muscle activation of the deep core stability muscles. These muscles are small but next to the joint to control excessive slides and glides. The joint can slide too far and strain its supporting ligaments when they don't work correctly. Ouch! That hurts.

The good news is You can quickly correct poor core stability to prevent back pain. Don't hesitate to contact your physio for more information or have your core activation accurately assessed.

High-risk factors of back pain include:

• sudden forceful movement
• lifting a heavy object
• twisting the back
• coughing or sneezing
• prolonged sitting with poor posture

More info:

• Lower Back Pain
• What Is The Best Treatment for Lower Back Pain?
• Deep Core Stability
• Recurring Back Pain

Back Pain Info

• Common Causes of Back Pain
• Back Pain Products & FAQs

Back Injuries: A Physiotherapist's Guide

Back injuries, encompassing muscle strains, ligament sprains, bulging discs, bone injuries, and the impact of poor posture, are a prevalent health concern. This guide, written from a physiotherapist's viewpoint, offers insights into these injuries and practical advice for management and prevention.

Back Muscle Strains

Easing Muscle Strains with Physiotherapy

Muscle strains are often due to fatigue, excessive loads, or improper lifting techniques. Strengthening your back muscles is crucial for joint stabilisation and injury prevention. Physiotherapy plays a key role in recovery, offering tailored exercises to enhance muscle strength and flexibility.

For more detailed information, visit Back Muscle Pain.

Ligament Sprains

Recovering from Ligament Sprains

Ligaments, the fibrous bands that limit spinal movement, can tear when overstretched. Common causes include awkward lifting, sports, and accidents. Physiotherapy accelerates healing through targeted treatments, reducing pain and aiding a quicker return to normal activities.

For additional insights, explore Back Ligament Sprains.

Bulging Discs

Managing Bulging Discs Effectively

Intervertebral disc injuries, or bulging discs, occur when the disc's outer fibres weaken, pressing against spinal nerves. Symptoms can include pain, spasms, and numbness. Physiotherapy offers non-invasive solutions to alleviate symptoms and promote disc health.

Further reading available at Bulging Discs.

Bone Injuries

Addressing Bone Injuries and Osteoporosis

Spinal fractures can result from traumatic force or conditions like osteoporosis. Physiotherapy assists in pain management and rehabilitation, focusing on safe, bone-strengthening exercises.

Learn more at Osteoporosis.

Poor Posture

Correcting Poor Posture to Prevent Back Pain

Poor posture, whether sitting, standing, or lifting, can lead to significant back strain. Physiotherapists can guide you in adopting healthier posture habits, thereby reducing the risk of back pain.

Explore more at Poor Posture.

Conclusion

Embracing a Pain-Free Back

Back injuries, while common, are manageable and often preventable. Embracing physiotherapy, along with lifestyle changes, can significantly improve back health and quality of life.

What to Do?

Seeking Professional Advice

If you're experiencing back pain or injury, consulting a physiotherapist or doctor is a wise step. They can provide a comprehensive assessment, personalised treatment plan, and practical advice to aid your recovery journey.

Back Pain Info

• Common Causes of Back Pain
• Back Pain Products & FAQs