Physical Therapy Plays A Key Role In Reducing Frequency Of ACL Injuries

Physical Therapy Plays A Key Role In Reducing Frequency Of ACL Injuries Blog  ACL injuries

Anterior cruciate ligament or ACL injuries are one of the most common type of injuries among athletes. This injury occurs most often in non-contact sports such as gymnastics or skiing. It can also occur in sports that require extensive pivoting and twisting of the knee such as basketball and soccer. While it can be difficult to predict when this type of injury may sideline a player, recent studies have shown that physical therapy may be able to reduce the likelihood of ACL tears.

How Does It Happen?

ACL tears can be partial or complete tears of the ligament. The anterior cruciate ligament connects the bones of the leg above and below the knee, the shin and thigh bones. The following movements can cause this injury to occur:

•Making Sudden Stops
•Trauma To The Knee Itself
•Twisting The Knee

Risk Factors

Studies have shown that girls experience ACL tears more often than boys. In fact, girls are 6 times more likely to sustain this type of injury. Some factors that may affect this include:

•Hormonal Changes
•Difference In Knee Anatomy

Athletes are at an increased risk of ACL tears in the late high school years. Preventing this type of injury is especially important for those who are seeking college scholarships for sports. It is important to note, however, that anyone can sustain this type of injury. While sports are the most common culprit in ACL problems, many people suffer injury when they twist their knee during everyday life.

How Physical Therapy Can Help Before An Injury

Advances in physical therapy have made preventing ACL tears easier than ever before. Neuromuscular training is designed to improve muscle strength that makes injuries less common. In addition, this type of training program can help athletes learn how to jump, land and pivot in a way that makes injuries less likely to occur. Studies involving college athletes revealed that ACL tears decreased by as much as 40 percent among females who underwent a therapy program before ever sustaining an injury.

Therapy After An Injury

Once a knee injury has occurred, therapy can help lower pain levels and reduce the likelihood of future injuries. Although severe ACL tears often require surgery, less serious injuries may not. Therapists may use modalities such as heat and ultrasound to reduce pain and inflammation. Once the patient is more comfortable, exercises will be added as tolerated. Therapists focus on increasing core and trunk strength to prevent another injury once therapy is complete.

People who are facing an ACL repair, may participate in therapy treatments before surgery. This type of treatment is typically short-term and focuses on reducing the swelling and pain around the knee. Doctors have found that many people have less pain and shorter recovery times after an ACL repair when they see a therapist before the procedure is performed.

After surgery, doctors typically refer patients to therapy for several weeks. During these sessions, therapists work with patients to increase range-of-motion. Patients are prescribed a series of exercises to perform at home in between therapy visits. Modalities such as ES or electrical stimulation may be used to increase muscle strength as well.
Therapy is a valuable tool that can be used to reduce the frequency of ACL injuries before and after they occur. Therapists work with doctors to help their patients achieve the goals needed to maintain muscle strength that makes injuries far less likely to occur. Teaching proper body mechanics is another way therapists help patients prevent future injury to the knee during sports and moving forward.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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