Physical rehabilitation for ACL injuries

Treatment Overview

Your doctor or physiotherapist will design a physical rehabilitation (rehab) program for you that takes into consideration your normal level of activity, physical fitness, and extent of your anterior cruciate ligament (ACL) injury.

A rehab program should include:

• Flexibility exercises.
• Strengthening exercises.
• Endurance activities.
• Coordination and agility training (for competitive athletes).

The function of muscles in the injured leg should be as strong as in the uninjured leg before you return to normal activities.

The program usually includes treatment with a physiotherapist at a therapy centre and home treatment in your home or at a gym or health club. Generally, as you see less of your therapist, you do more on your own.

What To Expect After Treatment

How quickly you recover from your ACL injury depends on how severe the injury was, how extensive the surgery was, and how consistent you are in following the program. The rehab program usually lasts up to 1 year. People who are dedicated to their program recover faster and have fewer knee problems in the future than those that do not complete their program.

Why It Is Done

Rehabilitation is needed after most ACL injuries, whether or not you choose to have surgery. Rehab programs strengthen the knee and its surrounding muscles, leading to better knee stability, and may also return normal range of motion and flexibility to your knee.

How Well It Works

How well a rehab program works depends on whether you undergo rehab only or surgery plus a rehab program and how consistent you are in following the program.

It is important for you and your health professional to establish what to expect from your rehab program. This depends on your age, the extent of your injury, whether other knee injuries are present, and your overall health.

• In rehab only, some people are able to regain enough stability in their knee to continue their normal activities and are able to avoid surgery. Other people have poor results, never regain knee stability, and either decide to have surgery or quit their activities or sports.
• If rehab is done without surgery, there is a greater chance that the ACL may be injured again.
• Athletes who have surgery and then complete rehab are more likely to return to competitive sports than those who do rehab alone.
• A review of research found there was not enough evidence to determine how effective a therapist-led rehabilitation program after surgery is for an ACL injury.¹

Risks

Rehabilitation programs should be well supervised to ensure that the exercises are appropriate and the progression is right for you. The risks of a rehab program include progressing too quickly through the program, which may weaken the reconstructed ligament, and starting sports training too soon. If you do not complete your rehab program, you risk having an unstable knee and reinjuring your knee in the future.

What To Think About

Physical rehabilitation for an ACL injury is extensive. Some people consider it like having a second job. Talk to your health professional about questions you have on the length or intensity of the program.

If you faithfully participate in a rehab program, you may be able to avoid or delay knee surgery by strengthening the muscles in the front (quadriceps) and back of the thigh (hamstrings) that support the knee. If surgery is eventually needed, you will be much better prepared for surgery and rehabilitation after surgery.

Not all physical rehabilitation programs are the same.

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Author:	Douglas Dana Robin Parks, MS	Last Updated: September 8, 2006
Medical Review:	William M. Green, MD - Emergency Medicine Adam Husney, MD - Family Medicine David Bardana, MD, FRCSC - Orthopedic Surgery/Sports Medicine Kathie Hummel-Berry, PT, PhD - Physical Therapy Patrick J. McMahon, MD - Orthopedics
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