Non-Operative Exercises and Treatment for ACL Tears

If you have torn your anterior cruciate ligament (ACL), then you are probably well aware that it’s the largest joint in your body, as well as the most complex. You probably also realize by now, that an ACL tear can be excruciatingly painful and debilitating.

The ACL is quite vulnerable to injury, due to how often is it used and abused. The knees bear nearly your entire body weight any time you are not sitting or lying down. The simple act of standing will place a lot of stress and strain on the knee area. However, when motion is added to the stress, any misstep is a risk for significant injury, such as a tear. For example, landing after going airborne, increases force on the joint and ligaments by about 4 times.

Ligaments in the knee are the tissues connecting the femur and tibia, which is a lot of responsibility. The ACL provides strength and stability to the knee, and when it’s injured, you lose most of it. And, it quite often requires surgery to repair it.

However, that is not always the case. Physical therapy is a viable option when trying to avoid surgery. This is where the rehabilitation of the knee joint could include non-operative exercises to rebuild, add range of motion, and strengthen the surrounding structures.

How does the ACL Tear?

In order to know what to expect in therapy, it might be beneficial to know why an ACL typically tears. An ACL tear is when the ligaments are overstretched and strained while the knee is moving. If the strain is too much, a tear can occur.

When the knee suddenly stops and twists as a result, or there is a blow or blunt force to the front, it could result in a tear or significant injury to the ACL. Common movements that could result in a tear include hyperextension and pivoting.

Hyperextension of the knee is when the knee is unnaturally straightened more than 10° beyond its natural fully extended position. Pivoting injuries are when the knee has an excessive inwardly movement, which turns the lower part of the leg unnaturally.

These are the 2 most common ways to tear an ACL. But, what treatments can you expect when trying to avoid surgery?

Treatment for an ACL Tear

To increase the chances of avoiding surgery, start treatment early and continue with it faithfully. A physician and physical therapist will help guide you in what the proper treatment will be for your individual needs. However, they will most likely consist of stages in treatment, such as the initial time period right after injury, and the stages afterward.

Immediate therapy will include the R.I.C.E. method of therapy. This consists of the following:

• Rest – Resting the knee for a certain length of time right after the injury will be beneficial, until the swelling and pain starts to subside.
• Ice – Icing the injury for a while following the injury will help in reducing the swelling, and should be done as soon as possible.
• Compression – Wrapping an elastic bandage around the injury will also aid in decreasing the swelling. Make sure it’s not too loose or too tight. It should be snug, but not causing increased pain, tingling, or numbness.
• Elevation – Elevating the leg above heart level will also help in reducing the swelling in the knee. However, support the back on the knee as you elevate the leg.

After the R.I.C.E. therapy, the next 6 weeks might include mobility exercises. The goal of this type of exercise is to help restore the natural movement in the knee, all while improving strength, balance, and coordination. One example would be thigh contractions, both while sitting and standing.

Other examples would be calf raises and squats, but not with additional weight. Your own body weight should be enough resistance during this stage. Calf raises are when you are standing straight, and raise the heels off the ground by going up on your toes, and lower back down slowly and carefully.

Squats are performed by standing with your legs shoulder width apart, and bending the knees while making the motion as if you were going to sit down, and slowly standing back up. It’s imperative that you keep your knees behind your toes at all times during this exercise.

After the first 6 weeks, your physical therapist will probably have you add weight as your knee permits, as well as adding lunges and more squats to your routine. At some point, your knee will be strong enough to add more exercises such as stair climbing and even running. But, wait until you are cleared by either your physical therapist or physician to add that much stress to your knee.

Years ago, surgery was the primary option. But, unless it is a severe tear, if you follow your therapist’s instructions and build the strength back gradually, you might be able to avoid it completely.