What is the ACL?

The anterior cruciate ligament (ACL) is one the main stabilising components of your knee. It has a vital function in keeping the tibia (shinbone) moving in the right direction, and preventing painful rotations. It can handle around 500lbs of pressure before it starts to tear apart – but when it does, the damage is permanent and is unlikely to heal on it’s own.

What causes damage to it?

Typically, movements under force that aren’t typical.

So, instances where the foot remains planted on the floor, and the leg and body twist. The stress on the knee will often strain, tear or sever the ACL with fairly dramatic results.

Landing awkwardly and the bodyweight rolling in a different direction to where the foot is pointing is another common cause.

If your sport involves rapid, short-notice changes in direction (think football, rugby, tennis, basketball) then ACL injuries have a high probability. Sports that don’t involve swift direction changes – running, climbing etc – tend to far lower risk.

What happens when it tears/snaps?

Where the ACL is partly torn, the knee can/will still function after the initial swelling and bruising has settled down, but the degree to which the knee will return to it’s former abilities varies hugely. A knee that has a severed ACL almost always needs reconstructive surgery – especially if the person wants to return to playing sports.

The initial swelling can take weeks or months to dissipate, and can often result in blood pooling around the ankle and base of foot (as well as plenty of bruising around the actual knee). It’s unlikely someone with anything other than a very minor tweak will be able to painlessly weight-bear or bend the knee for some weeks.

ACL tears can be complicated by the nature of the incident – in twisting injuries, because of the force the ACL can exert on the tibia, spiral fractures of that bone are not uncommon and increase the recovery time and pain levels.

What can you do to prevent it?

Well, some injuries are common simply because you can’t completely eradicate the risk. If you play sports, you’re at risk every time you play. If you’re female, you’re at an even higher risk than males around the time of your period (usually the week before) as hormone changes at that time make the ligaments in your body slightly more “loose” than normal which means the knee has more movement – and more movement means a higher chance of turning or landing awkwardly.

That said, you can help yourself.

The knee is also supported, stability wise, by the hamstrings and their tendons. Strong hamstrings envelope the knee and give an element of lateral support that can minimise the damage caused by any incident – or in best cases, simply result in a minor hamstring strain rather than ACL damage.

Hamstrings can be trained in many ways – but they respond very well to strength training ranges (6 to 8 reps, anything from 3-6 sets) with targeted compound movements. Straight legged deadlifts, glute hamstring raises, weighted hip thrusts are all excellent movements that not only add performance benefits to most sports, but help to support the function of the ACL. Add in proper squatting form, traditional deadlifts and some weighted step-ups and you’re as close to injury-proofing yourself as you can get.

I’ve done my ACL. How do I get back to playing?

If you want to play at any decent level, or just play for fun but not have repeated flare-ups, you’re going to need surgery. In the UK, they tend to take one of your hamstring tendons (you’ve got 4, you can spare one!) and use that to replace the missing ACL. In the US, they tend to create a brand new tendon from donors. Of course, the first procedure is more painful and has a longer recuperation period due to the damage done to the hamstring to harvest the tendon.

Much of the rehab process is about getting that new tendon to be tight enough, but not too tight, to perform the correct function. Too tight, and the knee will have little flexibility, bending will be painful, and inflammation inevitable from time to time. Too loose, and you’re at risk of the same injury happening again.

The good news is that, once again, you can help yourself.

Getting into proper, structured training as soon as your surgeon/physio gives you the green light is essential. You need to teach your newly put-together knee how to act under load. You need to strengthen the supporting musculature which will have wasted away in the injury period. You’ll need to learn some basic proprioception – in short, telling your body where your feet are, because all the old reference points have been altered. The quicker you get back into safe, monitored, structured training, the quicker you can move out of the “re-injury” risk stage and get back towards playing a sport and focussing less on rehab and more on normality.

How can we help?

At RWF, we’ve rehabbed several clients with ACL injuries or varying levels – from strains, to partial tears, to fully severed and reconstructed ACLs. All of these rehabs have been successful and managed to get the client back to where they wanted to be.

It’s not a quick process. It’s not an easy one either, and it’s certainly painful at times. The commitment needed to fully rehab after surgery (or in my case, opting not to have surgery but instead work around and live with the damage) is high. It can’t be half-done and needs proper guidance to be done safely, at least in the early days.

If you’ve injured your ACL, come and speak to us. We can give some advice, without obligation to use us, and help to work with your physio or consultant to get you moving again. We have our own on-site physio that specialises in sports injuries – so you can rest assured your training is always getting an eye run over it by a team of experts.

Real World Fitness Personal Training   
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