Physical Therapy: ACL Tears

1. Josh Valentino Physical Therapy: ACL Tears Clients with ACL Injuries

2. What is an ACL? • ACL stands for Anterior Cruciate Ligament • Is one of four ligaments in the knee • Located on the anterior part of knee (front of the knee)

3. How to Tear your ACL • This ligament can easily be injured or torn and cause major damage to your knee • Suddenly stop running, foot pivots and knee gets pushed in with valgus force (knee pushed inward) • Twisting of the knee • Hyperextension of the knee • Forward movement of the tibia on the femur

4. Completely Rips Apart Knee Twist Inward

5. Signs & Symptoms • Popping Sound • Swelling & Bruising • Very painful • Unable to Bend Knee

6. 3 Classes • Class 1 Tear: a small number of fibres are torn resulting in some pain but allowing full function • Class 2 Tear: a significant number of fibres are torn with moderate loss of function • Class 3 Tear: all fibres are torn resulting in knee instability and major loss of function. Surgery is often required

7. Extremely Painful

8. Real Life Situation Derrick Rose ACL Knee Injury 4/28/2012 NBA Playoffs Game 1 http://www.youtube.com/watch?v=jo1UlzDeY-o Bulls 1

9. What to do? • RICE: -Rest -ICE -Compression -Elevation • See Doctor • Surgery might be necessary

10. Recovering Without surgery(not recommended) • Physical therapy to strengthen muscles around knee to make up for weak ACL -Ex; hamstring, quadriceps, calf, hip, and ankle • Knee brace • Ice • May still feel unstable

11. Recovering with surgery • Crutches to walk • Knee brace • Ice/Heat pads • Physical Therapy • No sports or physical activities involving bad knee

12. Post Surgery • Months 3-4: Jogging Phase • Months 4-5: Agility Phase • Months 5-6: Return to Drills Phase • Months 6-7: Return to Practice Phase • Months 7-8: Return to Competition

13. Rehabilitation • 6-12 months • Should begin from the time of injury, not from the time of surgery. • 3 stages •  controlling pain and swelling in the knee • recovery of ROM and strength • finally a graduated return to full activity 

14. Rehab Exercises • Knee Bend to Straighten  -Bend and straighten knee as far as possible without increasing pain. Repeat 20 times  • Static Quadriceps Contraction - Tighten quadriceps by pushing your knee down into a towel. Put your fingers on your inner quads to feel the muscle tighten during contraction. Hold for 5 seconds and repeat 10 times • Static Hamstring Contraction  - Sitting down bend knee to about 45 degrees. Press heel into the floor tightening the hamstrings. Hold for 5 seconds and repeat 10 times

15. Static Hamstring Contraction Knee Bend to Straighten Static Quadriceps Contraction

16. After Math • After 6+ months of rehab your knee should be back to its regular range of motion • Wont be at 100% until 12-18 months • There should be no pain and you should be able to play sports and do activities again

17. Return to Sports? • The decision to return to sports is determined by how good a person’s progression is during therapy • Physical therapist should be the decision maker • Returning to activities too early may injure the knee again • Recommended 6+ months after surgery before returning back to sports

18. Before Rehab After Rehab My career is over :’( CAN’T STOP ME!

19. Long Term • After surgery it is crucial to let your knee heal and to not participate in activities involving your knee unless it is through rehabilitation. This is help with long term affects • Recent studies have shown that people who have ALC tears with surgery have ended up with reduced range of motion in their knee • Although it has kept it stable enough to continue to participate in active sports

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