The Anterior Cruciate Ligament (ACL) is one of the major stabilizing ligaments in the knee.  Its role is to prevent the forward motion of the shin bone (tibia) in relation to the thigh bone (femur).  It is essential for the control or the knee in pivoting movements.  Pivoting movements are required in many sports, especially soccer, basketball, and skiing.

 Whether a patient chooses surgical repair or conservative management of their ACL injury, an extensive rehabilitation program is required.  The decision to opt for surgery is based on the patient’s level of functional instability, their age, profession, level of activity, and the presence of associated injuries. 

 Rehabilitation programs for surgically managed repairs are largely dependent upon the technique used.  Exact time frames for rehabilitation milestones will vary but the overall goals will be the same:

• Maximize range of motion as early as possible in order to prevent excessive scar tissue formation
• Strengthen the muscles surrounding the knee to support and protect the ligaments and the joint
• Maintain flexibility of the muscles to reduce tension on the joint

 The average time for rehabilitation after ACL reconstruction to return to sport is around 6-9 months (2).  A sound rehabilitation program should always include specific drills and exercises designed to return the patient/athlete to their desired functional goals.  Core stability, proprioceptive and balance exercises are commonly used in ACL rehabilitation programs as well.

 All Access Physical Therapy provides expert care during all phases of ACL rehabilitation – from pre-hab to post operative management.  Our goal is always to return our patients to their highest level of functioning.  We are able to address prevention of ACL injuries through our many sports conditioning classes offered at the Fitness Academy.  For more information about ACL injury prevention or ACL rehabilitation, please contact All Access Physical Therapy at (508) 845-3500. 

 One of our primary concerns when treating our athletic clientele is further injury prevention.  We are very conscious of what we do within our treatment program that will help our athletic clients decrease their risk for other common yet traumatic injuries.  A common athletic injury that we frequently rehabilitate and work to prevent is an anterior cruciate ligament (ACL) tear. 

The ACL prevents the anterior (forward) movement of the tibia (shin bone) in respect to the femur (thigh bone) during walking, running, recreational and sports related activities.  ACL injuries occur as a result of both contact and non-contact  situations where the increase in force of movement is too much for the ligament to hold.  These movements place increased stress on the knee joint, typically with forces in the rotational and horizontal planes in respect to the knee, which causes the ACL to tear.

Research has shown that athletic women suffer this type of injury an average of 3 times more that men competing in the same sports.  It has been suggested that women are more likely to ACL tears due to the changes in hip and knee alignment they go through during adolescence.  As a result, women are more susceptible to the rotational and horizontal forces mentioned above during sports participation.  These forces are highest during cutting movements, quick direction changes, and when landing from a jump. 

A recent study by Imwalle et al., published in the Journal of Strength and Conditioning Research looked at the possible link between cutting movements and non-contact ACL injuries using a subject sample of high school female soccer players.  The study compared rotational forces placed on the hop and knee during 45 degree and 90 degree cutting movements.  The researchers found that hip and knee internal rotation were increased more during the 90 degree cut versus the 45 degree cut.  As a result, the subjects' knee abduction increased during a 90 degree cut putting the subjects at greater risk for an ACL injury.  The researchers concluded that targeted neuromuscular strength training to the trunk and hips may improve the athletes' ability to control knee and hip internal rotation during cutting movements, and therefore decrease their risk for ACL injury.

Our rehabilitation programs and strength and conditioning plans fall in line with this research. Our programs focus on core strength with targeted training for the low back, gluteus maximus, gluteus minimus, and abdominals.  Targeting these muscle groups improves the participants' ability to control hip and knee internal rotation during cutting movements.  Our therapists look at our clients' form during agility and plyometric (jumping) activities that put greater stress on the knees and correct that form as needed. 

Our Physical Therapists and Fitness Staff are experts at working with athletes during all stages of ACL injuries, from prevention to post operative rehabilitation.  Contact us if you have questions about how All Access can help you rehabilitate or prevent an ACL injury. 

 Reference: Relationship Between Hip and Knee Kinematics in Athletic Women During Cutting Maneuvers: A Possible Link to Non Contact Anterior Cruciate Ligament Injury and Prevention.  Lauren E. Imwalle, Gergory D. Meyer, Kevin R. Ford, and Timothy E. Hewett: Cincinnati Children's Hospital Research Foundation Sports Medicine Biodynamics Center and Human Performance Laboratory, The University of Cincinnati College of Medicine, Cincinnati, OH, and Graduate Program in Athletic Training, Rocky Mountain University of Health Professions, Provo, Utah.  Journal of Strength and Conditioning Research: Volume 23, Number 8, November 2009, pgs 2223-2230. 

The urge to “fatten up” and “hibernate” in winter is strong, even for us humans. However, you are better off staying in shape than struggling to catch up come spring. Winter exercise benefits more than just your physical fitness: it is also a powerful antidote for the winter blues.

Options for winter workouts vary by your interests and your location. People who live in warmer, sunnier climates have the outdoor advantage over those of us in the Northeast who have to live with the cold temperatures and snow. But being outdoors in the winter can be exhilarating. Look at Rocky Balboa…all he needed was 2-3 feet of snow covered wasteland, a pile of wood to cut and throw around, a cold barn to workout in, a “Paulie” weighted sled, a few trees to chop down, and a snow covered mountain to climb (watch this if you need a visual: http://www.youtube.com/watch?v=W8xHjC27YvM&NR=1). If it worked for him, it can work for you. And look at how much fun he had!!!