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Anterior Cruciate Ligament Rehab: How Do I Get Back To My Best?

25
Sep, 2016
By Jamie Webb
Anterior Cruciate Ligament Rehab: How Do I Get Back To My Best?
  • Physiotherapy-Alternative
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There can be fewer tougher challenges in physiotherapy than returning a victim of an anterior cruciate ligament reconstruction to full fitness. Of course at Brighton Sports Therapy we love a challenge and aim to get people back even better than before the injury. New insight into rehabilitation enables us to restore your body to full function faster. Read on if you want to find out how…

The Anatomy

anterior-cruciate-ligamentThe anterior cruciate ligament is one of only 4 true ligaments in the body. By this I mean one that goes solely from bone to bone and is not enveloped in layers of fascia and muscle. For any traditional anatomists this is quite a controversial statement. But when you take a step back and consider this statement without any preconceptions it makes perfect sense.

If runs from the back part (posterior) of the articular surface of the femur to the front (anterior) articular surface of the tibia. It prevents the tibia sliding forwards on the femur and resists excessive rotation of the knee joint.

The Injury

Those unlucky enough to have had this injury will know all too well how it comes about. There are two classic ways to damage this ligament. Option 1 is rotational. For those old enough think Paul Gascoigne in the 1991 FA Cup Final. In this movement you are quite likely to also damage the medial collateral ligament (MCL) and / or the medial meniscus (cartilage). The 3 together are known as “the unhappy triad.”

Option 2 is over extending your knee. This can be coupled with articular (joint surface) issues due to extra force that goes through the knee as the ligament is damaged and the joint goes beyond it’s normal range.

Who’s Most Likely?

Some people are just more at risk from anterior cruciate ligaments injuries. Two of the more curious pre-disposing factors are gender and race. Women have a 3 times higher incidence of ACL rupture than men. As mentioned in this article here. Race also is a factor in the likelihood of injury. As this article here shows white European origin ladies playing basketball were 6 times more likely to rupture their cruciate ligament than non-white players.

As to why this would be the physiotherapy world is not all together sure. There are lots of theories. For ladies we talk about Q-angle. This is the angle of the femur relative to the pelvis. From experience however I would extend this to a more functional view. If your knee moves inwards relative to your hip as you do functional exercises such as a squat or lunge then you are more at risk. Happily of course we have lots of party tricks to help you with this if you have such a movement pattern.

To Operate Or Not To Operate, That Is The Question

To Operate On ACLIf your leg isn’t quite connected the way it used to be this might seem a peculiar question. Surely going the way so many people do and having a reconstruction is the way forward. Surely this will give you more stability?

But the jury is still out. You really need to consider what you will be using the knee for. The human body is incredibly adaptable and some people are even born without cruciate ligaments and don’t even know. If you rupture your ACL your hamstrings will compensate and adapt to perform the roll of the ACL. This really is quite clever.

This is not without it’s problems though. I’ve yet to find a piece of research for this one yet but I find in these cases the hamstrings seems to develop over use conditions. Which makes sense, as they quite simply have more work to do. This can be quite easily managed with massage in most cases.

I’ve just spent half an hour trying to find research recommending an operation or not. But it’s not that straight forward. The research is conflicting. If you look here versus here. Some research suggests if you have reconstructive surgery then your knee will be functionally more stable with reduced risk of meniscal problems. It then goes onto to state that you will be slightly more at risk of osteo-arthritis. But other research claims it makes no difference!

Of course even if you do get a bit more “wear and tear” leading to osteo-arthritis it needn’t be symptomatic as we discuss in our previous post Does Arthritis Really Exist? As an addendum to this post yet another case in the clinic this week of someone turning up being told they need an immediate hip replacement and walking out pain free.

To clear up the confusion if you’re contemplating having an operation or not I would suggest if you are involved in sports with high impact and lots of cutting, weaving and rotation then having the operation is a no brainer. If you are more into single planar sports e.g. running or you are relatively inactive then you may wish to consider not having the operation. Your surgeon will consider the pros and cons in detail with you.

Accelerated Return To Sport

Return to full competitive sport is getting quicker and quicker. Back in Gazza’s day the injury was considered career threatening. And if you did make it back were you ever the same player again. These days players are back in 8-9 months with no obvious affect on performance.

So why the shift. Firstly, improved quality of surgery has a massive impact on recovery times. This coupled with vastly improved physiotherapy. Simply because more is understood about the condition and the operation. The buzz word in physiotherapy is accelerated protocol. This is to avoid bracing post operation, reduce pain and inflammation as quickly as possible, regain full range of motion and re-establish full strength and neuromuscular control of the knee complex.

Neuromuscular might sound a bit fancy dangled but all it means is to get the muscles and nerves working in harmony again to give maximum stability around the knee. This is where our combined muscle activation and sports massage treatments come into their element. Immediately improving these neural pathways to your knee so it feels more stable and less painful.

Risk Of Re-Injury And New Injury

knee-injurySo if you’ve chosen operative or not what is your prognosis? With surgery there is the risk of the graft failing. This is increasingly rare but can happen. Of course if you don’t reconstruct there is nothing to re-injure! But you may get complications as a result of your altered movement patterns. Equally you may get away with it and be just fine.

Interestingly I read a piece of research (sorry don’t have the reference!) which analysed injuries after returning to professional football post ACL reconstruction. Within 6 weeks of return the players have an 80% chance of picking up some kind of additional soft tissue injury.

What does this mean? To me this suggests that there are imbalances that have not been fully addressed in their rehabilitation. This is where we find muscles activation invaluable in that we can predict, with reasonable accuracy, which muscles are working to their full capacity. We can then tailor our treatment and rehab to address these imbalances before they cause a problem.

What Do We Recommend?

Always start with the end in mind. What we mean by this is work backwards what you are trying to get back to. Whether that’s professional football or simply walking around pain free. Deconstruct the movements and then put them back together again into the full functional movements you were aiming for.

Get treatment as soon as you can. Of course we would say that. But the more you have people check everything is working as should be along the way the better your outcome. I would include physiotherapy, sports massage and strength and conditioning as absolute musts. Be disciplined in your mentality and also focus on what you can do, not what you can’t.

You will need to keep a positive mindset. You will have setbacks along the way. It’s not whether you have setbacks but it’s how you respond to them. Some days you will just push your knee too far. But that’s ok. With the right treatment and approach you can get things ‘tidied’ up and go again.

Don’t Fear, It’s Not The End Of Everything

When you’ve had such a severe injury then it is inevitably scary. You wouldn’t be human if you weren’t worried about whether you’ll ever be the same again. But our experience suggests there is little worry about. With the right mental approach and the correct treatment you’ll be back to your best sooner than you think. Whether that’s with our help or anyone else’s. Go out there and do it!

About Jamie Webb

Self confessed muscle geek updating out dated physiotherapy practices and misconceptions.

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  • I have experienced some pain in the back of my knee. I have been to see Jamie and have to compliment his professional knowledge. He has the great ability to explain complex issues. He gave me lots of advise on how to treat my pain with everyday movements. Apart from his expertise, I would like to point out that Jamie is a very approachable and friendly person. I would highly recommend him!

    CC
  • I picked up an IT band knee injury while training for the Brighton marathon this year that prevented me running any more than 5-10k without serious pain.  I'd all but given up hope of running the marathon after trying various things to fix it without success.  I started seeing Jamie less than 6 weeks before the marathon and after about 3-4 session I was able to run a lot further with much less pain.  By the day of the marathon, my knee felt almost completely better, and I ran the whole thing with no knee pain at all!  I don't claim to fully understand everything Jamie does, but it definitely works.  Amazing stuff & highly recommended!

    BK
  • I compete in a lot of endurance sports and high impact sports too. I have seen Jamie for a few years now and he is among the very best I have seen (and I've seen a few over the years!) Highly recommended.

    NL
  • Meeting Jamie for the first time was a very enjoyable experience, he explained a whole new way of the strains I had been putting on my body through Marathon running, tennis and bad posture, Within 30 mins he was working away and my body started to feel 10 years younger. A completely new and invigorating approach to back and muscles problems that I had battled with over the years. Jamie is extremely good at getting fast results and you back on track with your exercise routines and he even sets you homework I would have no hesitation of recommending BST to any one

    AB
  • Jamie knows what he’s doing, though don’t expect traditional physiotherapy. I visited with a calf tear recovery problem after a recommendation by a friend. I couldn’t run without damaging it over and over again. Jamie’s holistic approach had me running again within the month, and I’m still running, building up distance again. While he was at it he’s helped massively with problems with my ankle and shoulder, definitely seek him out if you’re having problems.

    SM
  • This guy knows his onions. After several Ironmans and too many marathons I was looking for someone to activate underused muscle groups and to help me feel less creaky overall. After sessions with BST I felt great and left with a whole new understanding of the human body. Jamie shared a lot of new and interesting insights and gave me a series of treatment that really worked.

    SC
  • As an ultrarunner I approached Jamie Webb with much trepidation, expecting the usual advice to stop running silly distances and I wouldn’t be complaining of injuries. Instead, I was met with complete acceptance of ‘what I do’ combined with consistent ‘work’ on the source of my injuries/complaints. I couldn’t recommend Brighton Sports Therapy highly enough. It has been a joy to finally run pain-free again. My running complaints have ranged from ankle injuries to IT-band trouble, lazy glutes, core and hip stresses and strains … ALL of which I can happily say are currently in the best condition they can be in. Will I stop running? No. But the holistic approach of Brighton Sports Therapy has allowed me to continue, improve and race pain-free. Thank you.

    AH
  • A few months ago as I began to have problems with my right knee, and on some occasions was unable to put weight on it when going up steps or uphill, I asked on Facebook if anyone knew of any good physiotherapists in my area, and I was recommended Jamie Webb. I went along and was assessed, with all aspects of my health taken into account, Jamie diagnosed a muscle imbalance, and immediately began working on releasing muscles in many parts of my body, but strangely (not to him) this had the effect of strengthening the muscles around my knee. I have since completed a 100k non stop walk, plus have trekked round Iceland with no further problems to my knee (or any other part of my poor body). I assure you that if Jamie is given a body suffering in any way from the traumas of sport, he will have you diagnosed, and be working on the problem within the first 30 minutes of your appointment, and you WILL leave after the 1st hour already aware of improvement.

    DP
  • I can honestly say that’s the best money I’ve ever spent! I’d been struggling with a football injury for months and Jamie made a massive improvement in the first session. I’m now able to go into tackles 100% knowing that my ankle will be fine. I no longer need any more treatment, that’s how good things are, but if I do get another injury I know exactly who I’ll be ringing!

    AP

Disclaimer: The testimonials above are the opinion of a few of our clients. Results to treatment cannot be guaranteed. We can guarantee we’ll be doing everything we can get you back to your best ASAP.

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© Brighton Sports Therapy – Brighton Sports Therapy is a trading name of JW Sports Therapy Limited. Company Number: 08422202, England and Wales, 5 The Offices, 10 Fleet Street, Brighton, BN1 4ZE | Website by Rather Fine Design

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