The Importance Of Physical Therapy
In Recovering From An ACL Injury

Patellofemoral pain

There are several key components that must work together to ensure a successful recovery after an ACL injury; which include the following:

  • Having a knowledgeable and motivated patient.
  • Being cared for by a surgeon experienced in this field.
  • Being cared for by a physical therapist who is aware of the unique needs of an ACL patient.

The importance of physical therapy

This is not a simple procedure and the success is hugely based on the surgeon’s attention to detail. Yet this is not the only thing needed for a successful recovery. A knowledgeable and motivated physical therapist is just as important. Physical therapy following the injury is incredibly important even before the surgery takes place.

There are roughly one hundred thousand ACL tears in the United States each year costing nearly two billion dollars. As this number is only increasing it isn’t clear whether the cause is from more people being involved in rigorous activities or if people are merely more prone to injury in their day to day lives.

Whatever the reason may be, this increase means that orthopedic surgeons will be busier than they ever have been doing reconstruction surgeries. Not to mention if an athlete is injured once, they are more likely to injure the same spot again… In fact, it has been reported that athletes who have sustained knee injuries are nearly ten times more likely to injure themselves in the same way again than athletes who have not received any injuries.

With this being said here are a few key things more people should understand when they are considering rehab choices following an ACL injury.

Prevention is Priceless

Research shows that a mere ten to fifteen minutes of warming up before rigorous activity can reduce ACL injury by up to 88%. A study in New Zealand revealed that through a mandatory injury prevention program soccer teams saved nearly $8 in recovery cost for every $1 spent in prevention.

Get a Jump Start on Physical Therapy | it Makes a Difference

In a 2013 study researchers found that patients who participated in rehab before surgery recovered nearly eight weeks faster than those who did not. In addition to a faster recovery, these patients also reported better relationships with their physical therapists and were better able to outline a recovery plan.

Three essential items included in pre surgery rehab are: symmetrical range of motion to the uninjured side, minimal or no swelling, and excellent control of the muscles in the quad.

It is a good idea to get patients started on doing exercises that they will continue to do after the surgery. This helps them know what to expect and helps the train the brain for what is coming next to help kickstart a recovery process after the surgery has taken place. Better understanding leads to better performance and thus better results.

Research which Surgeon is Right for you
and make the Best Decision!

Choose an experienced surgeon. Roughly eight out of ten orthopedic surgeons perform under ten ACL surgeries a year. Work with a surgeon who knows what he is doing and will perform the surgery in the most efficient way possible. Most importantly, you want a surgeon who listens to you and does what it is you want done. If you don’t know where to start, ask a physical therapist who deals with a lot of ACL patients; they will know who to recommend.

Research which Physical Therapist is Right for you and choose them!

Just as it is important to pick your surgeon, it is just as important to pick your therapist. Therapy will suffer from poor surgery, and the opposite is just as true. The combination of good surgery as well as good therapy will likely end in a good recovery as well. It’s your quality of life at stake; take the time to research who is good before you make a final decision.

Here are some things to watch for when choosing a physical therapist:

  • Does your therapist understand the sport you play? Take the time to find a therapist who has a knowledge of your sport. Therapy should be performance based and almost make you feel like you are training for your sport once you are out of the initial post surgery phase. If the therapy feels too easy, it probably is.
  • Does your therapist have a specific plan to get you back on track? Will they be able to track your progress and tell you when you are ready for the next phase? There are no standards when it comes to ACL recovery. Just as there is no universal injury, there is no universal cure. Progress, not time, should be the determining factor on whether or not you are ready to move on in your recovery phases. Your therapist should be observing how you perform physical activities, both in controlled environments as well as in the real world, and evaluating how you are performing in relation to your sport. If you are not performing up to standard, you are not ready.
  • Does your physical therapist take the time to help you mentally prepare as you readjust from the clinic to being back out on the field? Spending at least 20% of rehab time out on the field is an excellent starting point for recovering athletes for two reasons. Number one, the athlete will feel more in their element and feel normal again sooner; and number two, it puts the athlete back in the environment and allows them to fully experience their sport again, without having to try to mimic the feel of the sport in a clinical setting.
  • Does your therapist communicate with your surgeon? In spite of the common assumption that physical therapists talk to the surgeons, they often do not. The best surgeons and physical therapists communicate with each other in a strong and effective way that makes recovery smooth and easy for the patient. Do not make the mistake of assuming that just because they work in the same building they communicate. They run two individual professions and are often focused on their own line of work.

Don’t try to Rush your Recovery

Seven out of ten ACL injuries are non-contact injuries. This means that the cause of injury is likely from your own movement and not an external factor. Just as this does not happen overnight, recovery doesn’t, either. Just because a certain amount of time has passed or the doctor no longer considers you to be fragile doesn’t mean that you don’t have to still take things slow. Listen to your body and don’t push yourself too hard so you don’t end up right back where you started. Rehab is a slow process, not a quick fix. But if you take your time and recover properly, you will be an even better version of you when you reach the end.


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)


Complete tear of rectus femoris
with large hematoma (blood)


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

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