Professional Documents
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Research Paper
Austin Swedish
Mr. Koshman
11-20-17
Role of a Physiotherapist During an ACL Injury 2
Research Paper
The physiotherapist has one of the most important roles in the rehabilitation process. A properly
guided rehabilitation program is required to minimize the effects of an injury such as swelling
and loss of motion as well as acquiring the necessary strength and stability of the joint. The best
way to treat an ACL injury is to prevent one from happening in the first place. The research will
Rehabilitation of an ACL injury should be patient specific. Though the program will be the same
for everyone, but the progression of the program may be very different between patients. For
example if a patient has a lot of inflammation and swelling then that needs to be dealt with
first before exercises. As well as the program the physiotherapist may use modalities such as ice,
laser, IFC, ultrasound and massage to help with pain, swelling and inflammation. Patient
education is also very important, the physiotherapist will inform the patient about precautions,
Injuries happen, but a physiotherapist can minimize the occurrence of these injuries by doing a
full biomechanical assessment looking at body and foot alinement, muscle imbalances,
movement patterns and training techniques. For example foot alinement is very
important because if the foot isn't in proper alinement then the knees are also in a bad position
making them more prone to injury. The same goes for someone who has a muscle imbalance in
their hip, the hip may not be strong enough to hold the leg in proper position. Improper training
is also a big cause of injuries. For example, a basketball or volleyball player has to learn how to
properly jump and land. This program can train the muscles to develop a muscle memory that
Role of a Physiotherapist During an ACL Injury 3
will help their hamstrings contract at the right time when they land, helping with knee bend. It
will also train the abductor muscles to keep the legs wide apart when they land.
The knee is a hinge joint, made up of two separate joints. The tibiofemoral and
the patellofemoral joints. The joints are held together by ligaments with cartilage in-between
the bones acting as a shock absorber. The tibiofemoral joint is the joint that is affected with an
ACL injury. The ACL ligament attaches to the femur at one end and the tibia at the other. It
keeps the tibia from moving forward on the femur. The hamstring muscles and quadriceps
Most ACL injuries occur in sports involving pivoting, hyper deceleration and jumping. The
typical ACL injury occurs with the knee externally rotated and in 10 to 30 degrees of flection
when the knee is forced inwards and then internally rotates. Another way is when the knee is
hyperextended, ether from being hit from the front or from rapid deceleration.
From doing this project I hope to gain enough knowledge to prevent any further injuries to
myself, but also have a good understanding into physiotherapy and whether its the right job
for me.
Physiotherapists are primary health care professionals with a significant role in health
promotion and treatment of injury and disease. They combine their in-depth knowledge of the
body and how it works with specialized hands-on clinical skills to assess, diagnose and treat
practicing physiotherapists must be registered in Canada. They must have an entry level
education and practice standards, and have successfully passed a standardized physiotherapy
Role of a Physiotherapist During an ACL Injury 4
competence examination. Eleven million Canadians over the age of 12 years old are affected by
return to healthy living, including return to work and recreational activities ( Canadian
Physiotherapy Association, 2012). Physiotherapists assess and treat patients in order to reduce
and eliminate pain and swelling, and address muscle weaknesses, imbalances, loss of stability
and limited functional abilities. One in ten Canadians with a musculoskeletal condition consults
Soft tissue and manual therapy techniques; including massage, spinal and peripheral joint
proprioception and stability. The rehabilitation process is an ongoing process with specific
changes to the program based on their progression, healing times, tolerance to exercises and any
previous injuries.
The ACL rehabilitation program is separated into 6 phases and should be closely monitored by a
Before Surgery
RICE and electrotherapy can be applied during several weeks ahead of the surgery in order to
reduce swelling and pain, to attempt full range of motion and to decrease joint effusion. This will
help the patient to regain better motion and strength after the surgery. The patient must be
Before proceeding with surgery, the acutely injured knee should be in a quiescent state with little
or no swelling, have a full range of motion, and the patient should have a normal or near normal
Role of a Physiotherapist During an ACL Injury 6
gait pattern.
It is important to prepare the knee for the surgery. These are the guidelines:
Use a knee immobilizer and crutches until you regain good muscular control of the leg.
Extended use of the knee immobilizer should be limited to avoid quadriceps atrophy.
Icing and anti-inflammatory medications are used to help control pain and swelling.
Quadriceps isometrics exercises, straight leg raises, and range of motion exercises should
A. Full extension is obtained by doing the following exercises: Passive knee extension,
B. Bending (Flexion) is obtained by doing the following exercises: Passive knee bend,
Once 100 degrees of flexion has been achieved you may begin to work on muscular
strength. Examples of exercises are: Stationary Bicycle, Swimming, Low impact exercise
machines such as an elliptical cross-trainer, leg press machine, leg curl machine, and
5. Mentally prepare
Patient must know what to expect of the surgery and understand the rehabilitation phases
after surgery.
Role of a Physiotherapist During an ACL Injury 7
Pre-op therapy should encourage strengthening of the quadriceps and hamstrings. Range of
motion exercises should be included if there is no pain involved. See below for examples of
appropriate exercises.
After Surgery
Week 1
Regular icing and elevation are used to reduce swelling. The goal is full extension
and 70 degrees of flexion by the end of the first week. The use of a knee brace
weeks. Other mobilization exercises in the first 4 weeks are passive extension of
the knee (no hyperextension) and passive and active mobilization towards flexion.
Strengthening exercises for the calf muscle, hamstring and quadriceps (vastus
Week 3-4
The patient must try to genuinely increase the stance phase in an attempt to walk
with one crutch. With good hamstring/quadriceps control, the use of crutches can
be reduced earlier.
Week 5
The use of the knee brace is progressively reduced. Passive mobilizations should
hamstrings and quadriceps (vastus medialis) can start in close chain exercises.
The exercises should be started on light intensity (50% of maximum force) and
from less responsible positions (bike, leg presses, step) to more congested starting
positions (ex.squad). The progress of the exercise depends on pain, swelling and
general strength is good. This includes balance exercises on boards and toll.
Week 10
isokinetic exercises.
Month 3
etc.
Role of a Physiotherapist During an ACL Injury 9
Month 4-5
Final goal is to maximize endurance and strength of the knee stabilizers, optimize
ACL injuries are becoming quite common these days, however many of them can be prevented.
A physiotherapist can teach proper alinement to help protect the knees, help develop body
awareness, improve strength and balance to help support the knees, and instruct on correct
jumping, landing, stops and movement patterns. A successful prevention injury program would
focus on:
Improving flexibility.
Balance.
Agility.
Recent research has allowed therapists and clinicians to easily identify and target weak muscle
areas (e.g., weak hips, which leads to knock-kneed landing positions) and identify ways to
improve strength and thus help prevent injury. In addition, other risk factors such as reduced
hamstring strength and increased joint range of motion can be further assessed by a physical
therapist or athletic trainer to improve performanceor rehabilitation efforts after an injury has
Role of a Physiotherapist During an ACL Injury 10
occurred. Current studies also demonstrate that specific types of training, such as jump routines
and learning to pivot properly, help athletes prevent ACL injuries. These types of exercises and
training programs are more beneficial if athletes start when they are young. It may be optimal to
integrate prevention programs during early adolescence, prior to when young athletes develop
certain habits that increase the risk of an ACL injury. (Ervin Meqikukiqi, 2015)
The knee joint is one of the largest and most complex joints in the body. It is constructed of four
bones and an extensive network of ligaments and muscles. The knee is made up of two separate
joints. The tibiofemoral joint and the patellofemoral joint. The joints are held together by four
ligaments. Each ligament has a particular function in helping to maintain optimal knee stability.
The ACL is important for resisting anterior translation (moving forward) of the tibia on the
femur. The ACL runs from the anterolateral aspect of the medial intercondylar tibial spine to the
posteromedial aspect of the lateral femoral condyle. It is believed that there are two bundles of
fibres that form the ACL. Which bundle of the ACL is injured depends on the position of the
knee when it is strained. The ACL is also an accessory ligament in resisting rotary medially and
laterally as well as values and varus forces. The tibiofemoral joint is the joint that is affected with
an ACL injury.
A physiotherapist plays the strongest role in rehabilitating a patients ACL injury because
everyone heals at a different rate and experiences different signs and symptoms after an ACL
injury. The physiotherapist must be able to assess where the person is in the healing process and
what the signs and symptoms mean and then apply the correct treatment. This treatment may
include modalities to help with pain and swelling or could be teaching the right exercises to the
patient for increasing quadricep strength. The rehabilitation program is pretty straight forward,
Role of a Physiotherapist During an ACL Injury 11
but the progression of the program is very specific for each person. With the help of a
physiotherapist, a person could safely progress through the program with fewer incidents of
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