Anterior Cruciate Ligament (ACL) Injuries & Effective Treatment Through Physiotherapy

Anterior Cruciate Ligament (ACL) Injuries & Effective Treatment Through Physiotherapy


The anterior cruciate ligament is a diagonal ligament running through the knee’s middle, preventing the tibia (shinbone) from sliding out before the femur (thighbone) whilst providing the knee with complete rotational stability. ACL injury occurs when there is a tear or a sprain in the anterior cruciate ligament of the knee. There may be a Grade 1 (mildly damaged ligament but stable joint) or Grade 2 (partial tear, which is rare) or Grade 3 sprain (complete or near complete tear).


ACL injuries mostly occur during sports activities that require sudden slowdowns and direction changes, pivoting on a firmly planted foot, incorrect jump landings, sudden stop while running, and knee collision. They are the most common knee injuries among athletes in very high demanding sports such as football, basket-ball, etc., and even in sports such as cricket, badminton, etc.

As per various studies, female athletes are more prone to ACL injuries. This is due to contrasts in physical conditioning, muscular strength, and neuromuscular control, between male and female athletes. Further reasons may include contrasts in pelvis and leg alignment, increasingly loosened in ligaments, and the consequences of oestrogen on the ligament region.


Symptoms include hearing or feeling a “popping” noise in the knee, severe pain and swelling, loss of motion, tenderness, instability and inability to continue any activity.


Diagnosis is mostly done through a physical exam, which is usually enough. The most common physical test is the Laxman Test. Other physical tests include pivot shift test, jerk test and anterior drawer test. If it’s unable to be diagnosed through physical tests, there may be a need to diagnose through X-rays, MRIs and ultrasounds.

Effective Treatment Through Physiotherapy

Physiotherapy, with its therapeutic nature, provides effective treatment in case of ACL Injuries, be it mildly damaged, partial tear, or a near complete tear. In most cases where a few weeks of rehabilitation therapy through physiotherapy is adopted, it is possible to avoid intrusive treatment procedures. This is because physiotherapy is capable of reducing these ACL injuries, provided there is stability in the knee. At the same time, physiotherapy also reduces risks of ACL injuries developing into knee osteoarthritis. Treatment of ACL injuries through physiotherapy are more effective in elderly patients, those with less levels of activity, and those who play sports with less stress on knees.

Normally, the physiotherapist provides an assessment of the injury with instructions and feedbacks. The rehabilitation therapy consists of machine based treatment followed  by an exercise protocol for biomechanical correction procedures to bring back motion and flexibility in the knee, and reduce the pain and inflammation. The exercise protocol is made by the physiotherapist based on the medical presentation of the condition. The exercises include – hamstring strengthening exercises to ensure general balance in the knee; exercise that strengthen the hips, pelvis and lower abdomen; training exercises to ensure proper jumping and landing; and training to improve sudden direction changes and pivoting. We at Eva Physiocare are developing rehabilitation therapy programme including diet therapy and an integrated wellness programme for ACL injury patients.

Anterior Cruciate Ligament (ACL) Injuries Surgery & Physiotherapy In Pre Post Rehab

Anterior Cruciate Ligament (ACL) Injuries Surgery & Physiotherapy In Pre Post Rehab


Generally, a completely torn anterior cruciate ligament essentially requires surgical procedures for treatment. Surgeries are also usually recommended in cases where the patient is an athlete and wants to continue his / her high demanding sport, there is injury in more than one ligament, the patient is young and very active, and there is loss of stability in the knee due to the injury. However, pre and post-surgery rehabilitation therapy becomes pertinent. This is mainly because ACL injuries have a risk factor developing into knee osteoarthritis and a rehabilitation therapy programme negates that risk.

Pre-Surgery Rehabilitation Therapy

The significance of exercises in the pre-surgery period lie in the fact that they help in reducing the pain and inflammation after an ACL injury. Additionally, the exercises help regain motion and strength in the knee after the surgery, while negating the risks of knee osteoarthritis. It also helps prepare the patient mentally for the surgery.
Exercises generally include bridging, glute sets, hamstring curls, heel raises, heel slides, quad sets, shallow standing knee bends, straight-leg raise to the front, and straight-leg raise to the outside. These exercises are done under the thorough guidance of the physiotherapist, in a progressive manner, so that no stress is caused due to the exercises. Additionally, RICE (rest, ice, compression, elevation) and electrotherapy help reduce inflammation and pain, whilst ensuring one’s regain of motion range and joint flexibility.

Post-Surgery Rehabilitation Therapy

After the surgery / the ACL reconstruction, the rehabilitation therapy needs to be resumed as it is critical for full recovery. At this stage, several comprehensive steps, including a wide range of exercises are used to attain full flexibility and motion in the knee while avoiding knee osteoarthritis. Exercises include open-kinetic-chain knee-extension, open-kinetic-chain knee-flexion, and closed-kinetic-chain knee exercises.
The therapy and exercises are easy at the beginning, aimed at removing blood clots and gradually are increased in intensity aimed at restoring knee strength and stability. Weight bearing exercises are added depending upon the patient. The final phase of the therapy increases stress on the knees to a bearable extent. This therapy may take 5-6 months to help the patient be free of any pain and regain complete motion range. Generally, after 12 months of rigorous post-surgery rehabilitation, athletes can return to their heavy demanding sport.


Generally, the orthopaedic surgeon of the patient works with or in coordination with the physiotherapist. An ACL injury treatment that includes surgery is a very long procedure. The treatment starts at the very beginning, right after the injury. It starts with rehabilitation, moves into surgery, and then again ends with rehabilitation. It is a very comprehensive treatment procedure and enables the complete and effective cure of the ACL injury while negating any risk factor at the same time. We at Eva Physiocare are developing rehabilitation therapy programme both before and after surgery, where we coordinate with the orthopaedic surgeon of the patient, including diet therapy and an integrated wellness programme for ACL injury patients and focus on their complete care and cure.