Expert Interview - Physio on ACL Injuries
Top premiership physiotherapist Neal Reynolds talks to Sportsinjuryclinic.net about ACL injuries including early stage rehab, late stage, braces, surgery and more.
Neal Reynolds Physiotherapist
Videos include:
- Early stage rehab
- Late stage rehab
- Recovery times.
- Bracing & surgery.
Early stage treatment
ACL sprains are usually fairly obvious that they've done it. When they're coming off the pitch they will often tell you that something has popped. The first stage is to get the swelling down which will occur very fast with an ACL injury. It is important to test the knee early as it is easier to do so when there is little or no swelling. When Neal has an idea of what may be wrong, he will use a compression machine or bandage, as well as cold therapy to reduce the swelling and get into and out of the inflammatory stage as quickly as possible.
Late stage rehab
The hamstrings and quads become very important when it comes to an ACL injury. In the run-up to an operation it is important to get used to the exercises and to build the strength up as much as possible pre-op.
Once the surgery has been done, the rehab phase is anywhere between 6 to 9 months. Up until the stage when they can run, it's all about getting the knee moving fully, getting the muscles strengthened, following the guidelines from your surgeon or rehab therapist. Running is usually allowed between 12 and 16 weeks, depending on the surgeon. At this stage the rehab becomes more functional to build up fitness for the sport.
For CV fitness, this should be maintained throughout. At different stages of the rehab, you'll be able to do different things to try to maintain this. The last 3 months of rehab is more about getting the fitness back, as the graft will have taken by then, although may not have it's full tensile strength for a year or more.
Recovery
Recovery times for an ACL is a minimum of 6-7 months. Neal doesn't believe that you gain anything from coming back any earlier.
With young players, in their late teens, Neal would leave it even longer before returning to sport, maybe even 9 months.
The important thing is to get the muscle strength back, then generally this is when you can go back into training. There are some more accelerated programmes which get players back within 5 months, although from Neals' experience he would leave it that bit longer to ensure full strength, equal to the other limb.
Knee braces and surgery
It is important to pretect the knee to prevent ACL injuries. Neal does advocate bracing the knee to protect the ACL following an injury, as well as partial weight bearing on crutches until the knee settles down.
Surgery is rarely done immediately after injury. The knee tends to be left to calm down and for the swelling to disperse for around 3 weeks before reconstruction. By this time the player may be back to walking around absolutely normally without a brace.
There are lots of people out there who have had ACL injuries without having a reconstruction and they are fine. At high level sport generally you do have the operation due to the increased demands on the knee joint from cutting and turning movements.
