The Infamous Injury: New Research on ACL Rehab

Torn ACLs get a lot of airtime on ESPN because of the injury’s devastating effects on an athlete’s ability to get back in the game quickly.

 

The ACL or Anterior Cruciate Ligament is one of the four major ligaments in the knee. The ACL is located deep in the knee and can lead to debilitating injury because it is a crucial stabilizer for rotation and forward movement of the knee.1 Non-contact tears are the most common form of ACL injuries, especially in sports such as skiing, soccer, football, basketball, wrestling, and gymnastics. 2 If surgery is required, intensive rehabilitation during physical therapy is performed and athletic activity can usually be resumed three to six months after ACL reconstruction. 3

 

One recent victim of a show-stopping ACL injury was 2010 Olympic gold medalist Lindsey Vonn. (Warning: This video is almost painful to watch.)

 

 

In February of this year Lindsey tore her ACL at the Alpine World Championships in Austria. Determined to compete in the 2014 Olympics, rehabilitation has been her top priority since the accident. Seven months later, she is finally training again.

 

 

Recent research findings with regard to ACL rehabilitation:

  • Introduce closed kinetic chain as early as possible. Closed what?! It’s when your foot stays in contact with the ground when performing a leg exercise. An example would be a mini-squat versus an exercise where your leg leaves the ground. The key is to keep the motion very limited, slow, and controlled. 4
  • Choose a provider that uses specific testing and criteria for safe return to sport. 5 A group of tests known as “battery tests” or single leg hops has been recommended to determine how safe it is to resume athletic activity.
  • Prevention and strength training is key, especially for females. Women are 10X more likely to injure their ACLs, especially in a non-contact way. 6
  • Sportsmetrics has gained a lot of popularity for its prevention of ACL injuries. 7  Sportsmetrics is a six-week evidence-based prevention program performed in the off-season. Sportsmetrics is the only research-based prevention program to support reduction in ACL injury.

 

For more information on Sportsmetrics, email me at asynakowski@sptny.com, or visit www.sportsmetrics.org.

 

For more information on the ACL visit: www.sptny.com/blog/?p=869

 

References:
1 Knee Injury, Soft Tissue at emedicine
2 Dr Langran “Alpine Ski Injuries”, skiinjury.com, December 5, 2010
3 http://www.ehelathmd.com/librray/acltears
4 Escamilla RF. Toran DM. Wilk KE. Paulos L. Andrews JR.  Anterior Cruciate Ligament Strain and Tensile Forces for Weight-Bearing and Non-Weight-Bearing Exercises: A Guide to Exercise Selection. JOSPT 42(3); 2012 (208-220)
5 Gustavsson A, Neeter C, Karlsson J, et al. A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal Of The ESSKA. August 2006;14(8):778-788.
6 Noyes FR, Westin SDB.  Anterior Cruciate Ligament Injury Prevention Training in Female Athletes: A Systematic Review of Injury Reduction and Results of Athlete Performance Tests.  Sports Health.4(1): 36-4
7 http://sportsmetrics.org/

 

 

PT Success Story: From Knee Pain to Mountain Climbing in Four Weeks

Most of our patients come to us with a strong desire to feel better. Of course they also hope to do that in the shortest possible time frame! Being fully committed to the process and having a well-defined goal in mind typically helps expedite rehabilitation. The following story is a great example of our commitment to clinical care and patient goals.

 

Enmanual came to Sports PT with knee pain (pain was about a 5 on a scale of 1-10). When he shared with me his ambitious goal of climbing 11+ miles up Mt. Whitney in less than four weeks I was cautious, but also excited to do what I could to help make that goal a reality. Enmanual seemed to be fully committed to doing whatever it would take to alleviate his knee pain.

 

Upon evaluating Enmanual we discovered a lot of myofascial restriction due to compensation coming from a weakened core and hips. First we eliminated the fascial restriction through instrument-assisted soft tissue mobilization, joint mobilization, and kinesiology taping. Then we gave him corrective exercises to build strength and maintain his progress.

 

He made incredible progress in only four week’s time and ultimately was able to climb up Mt. Whitney as planned without any pain! Stories like this are what make me love being a therapist. Pain that can be avoided should never prevent people from living their lives.

 

 

Click here for more information on the role the hips and core play in knee pain.

 

 

 

Straighten Up!: Three Tips for Better Posture While Sitting

Standing Postures

Good posture plays an important role in preventing stress on your back, maintaining muscle flexibility, and avoiding future aches and pains. Correct posture is sitting or standing up tall so your head is in line with your trunk. Poor posture is sitting or standing with a slouch and rounded shoulders, thereby positioning your neck and head forward compared to your trunk.

 

Some individuals have poor posture due to spinal conditions like scoliosis, kyphosis and osteoporosis (which can be addressed by your physician or physical therapist). However, the majority of us have poor posture due to weak or tight muscles and moving incorrectly. The good news is that exercise and body awareness CAN help!

 

People with chronic low back pain often have slouched posture due to weak and/or tight back muscles. A slouched posture can cause the low back muscles to be active for longer than normal, contributing to pain. Sitting has been shown to increase your spinal disc pressure by 145%, and sitting with poor (slouched) posture can increase that pressure up to 180%, contributing to low back pain.(p459)1

 

Poor posture can cause abnormal stress on your spine and can strain the muscles that help stabilize the head. (p459)1 Eighty-five percent of people with temporomandibular joint (TMJ) pain, or jaw pain, have forward head posture. (p258)1 This position of your neck may contribute to strain on the supporting muscles, and in some cases, headaches. (p258)1

 

Three tips to help keep your seated posture healthy:

 

Bad Posture

#1: If you use computers on a daily basis, place your computer screen at eye level to help improve your neck posture.

 

#2: Sit on the edge of your chair and squeeze your shoulder blades together with your elbows bent at 90 degrees (as if you are pinching an egg between your shoulder blades). Squeeze for five seconds and repeat a few times every hour.

 

#3: When sitting, squeeze your buttock muscles together for about five to seven seconds. Repeat this action a few times every hour to help activate your core while sitting at a desk.

 

Physical therapy can also improve your posture. A physical therapist will evaluate which muscles need to be stretched and which ones need to be strengthened as part of your regular exercise regimen. Your physical therapist can help correct joint restrictions, stretch out your tight muscles and establish a strengthening program individualized for you. They may also recommend use of a lumbar roll, or a small towel roll placed at your low back in your car, at your desk, or in your favorite chair. This will help to support your low back and assist in sitting with good posture.

 

Have chronic neck pain? Read on to find out how physical therapy might help you.

 

References:
1) Placzek J and Boyce D. Orthopaedic Physical Therapy Secrets. 2nd Ed, 2006