Anterior Cruciate Ligament Injuries Physiotherapy Treatment

The Anterior Cruciate Ligament (ACL) is located squarely in the center of the knee, and any twisting or severe damage from either side, such as in a sports injury or a vehicle accident, can result in a partial or full rupture of the ACL. Anterior Cruciate Ligament Injuries which are partial do not require surgery and can be properly managed with rehabilitation. ACL rupture necessitates surgical treatment, but it also needs post-ACL reconstruction physiotherapy rehabilitation for healing and returns to ADLs and sports.

PHYSIOTHERAPY TREATMENT OF Anterior Cruciate Ligament Injuries INCLUDES:

PHASE 1 (1-2 weeks)-

• The goal of the initial phase of ACL damage therapy is to minimize pain and inflammation.
• In phase 1, limit knee movement to ankle, toes, and hip movement.
• Cryo-air, Ultrasound, and TENS, or also, Combo-therapy, are the therapeutic modalities employed in this phase.

PHASE 2 (2-4 weeks)-

• Firstly, Movement initiation is part of the subacute phase of ACL damage therapy.
• Then, an Active aided knee workout has begun.
• Towel/pillow pressing is an example of an isometric exercise.
• Mobilization of the patella.
• Also, CPM is the treatment modality employed in this period.
• Therapeutic taping, also known as Kinesio taping, is used to give stability and stimulate edema decrease.

PHASE 3 (4-6 weeks)-

• This is the chronic phase of ACL damage therapy, and pain and swelling are minimized till this point.
• Active exercises can be done.
• Full range of motion exercises to promote joint mobility. Such as ankle dorsiflexion/plantarflexion/circumduction and seated knee flexion/extension.
• Exercises in resistance.
• Quadriceps and hamstring strengthening workout Gluteus medius, for example, works in the side-lying position. Maximus exercise in the prone position, knee flexion in the prone position > advance to resistive training with an elastic band
• Physiotherapy that is functional.
• In addition, Weight transfers in standing (forward/backward, side to side) are examples of proprioception exercises for improving balance and control.
• Also, Neuromuscular Electric Stimulation, Extracorporeal Shockwave Therapy (ESWT), High-Intensity Class 4 Laser, and other therapeutic modalities can help.

PHYSIOTHERAPY REHABILITATION POST “ACL RECONSTRUCTION’ INCLUDES:

1st phase (o-8 weeks) of Post- ACL Reconstruction Physiotherapy rehabilitation started with-

Week 1 after ACL repair Cryotherapy will also help to relieve pain and swelling. TENS also aids in pain relief. Isometric exercises Mobilization of the patella. And Ankle pumps.

After ACL reconstruction weeks 2-

Mobility exercises like heel slides and knee extension with a towel kept under the knee. Standing with 50-70 percent body weight. Wall squats with 60 degrees of knee flexion only. Prone knee extension with ankle lifted on the pillow.

After ACL reconstruction weeks 3 to 4-

Static cycling. Standing knee extension against the resistive band, or ball behind the knee.  Squatting and leg press up to 60 degrees only. Gait training with the crutch. Isometric, concentric & eccentric exercise in the close chain.

After ACL reconstruction after week 4-

After the 4th-week Open chain knee extension exercises. Open-chain exercises like active leg raise and side-line abduction don’t strain the ACL and can be practiced from the first week.

Heel raises. Hip hinges. Proprioception, balance & coordination training.

Also, At the end of the first stage of Post- ACL Reconstruction Physiotherapy rehabilitation, the new range of motion should be 120 to 130 degrees of flexion and 0 degrees of extension. And the patient can walk without crutches and the gait should be symmetrical. This stage takes up to 6 to 8 weeks.

2nd phase of Post- ACL Reconstruction Physiotherapy rehabilitation includes-

• The goals of the Second phase Post- ACL Reconstruction Physiotherapy rehabilitation are that patients can perform sports-specific activities, and perform physically demanding work.
• Open chain knee extension in full ROM can perform from week 12, and also you can train with external resistance.
• Hydrotherapy.
• Iso-kinetic exercises such as forward, backward & lateral dynamic movement programs.
• Start jogging in around 10 to 12 weeks, or treadmill training.
• Lunges.
• Deep squats.
• Plyometric training.
• Endurance & strength training.
• Also, Agility training.
• And finally sports specific training and conditioning.