Role of Physiotherapy in ACL Rehabilitation Anterior cruciate ligament (ACL)
Domlur, Bengaluru Feb 9, 2017
Anterior cruciate ligament (ACL) is an important structure in providing stability to the knee joint. It plays major role in preventing excessive anterior tibial translation in various degrees of flexion. The ACL also prevents hyperextension of knee and limits excessive tibial rotation.
Physiotherapy is really important in ACL rehabilitation either post-operatively or without surgery. Physiotherapy helps the patient to regain his normal functional ability to the maximum possible by eradicating pain & swelling, improving joint flexibility & ROM (Range Of Motion), improving muscular strength, improving joint stability and achieving normal functional status.
Pre operative physiotherapy help in good ACL rehabilitation wherein our objective is to reduce the pain & swelling. To maintain and improve maximum ROM possible and to adequate strengthening and improve neuromuscular control.
Post operative or otherwise physiotherapy have major role to play till patient achieves his maximum functional ability. Post operatively initially, patient has pain & swelling. Managing that pain with RICE(Abbrev.for Rest icing compression elevation) method is chief priority. Ankle pumps also do help in this regard. Correct positioning also very important wherein knee brace helps.
Flexibility improvement & achieving full ROM are important aspect of ACL rehab. Rom exercises are to be done carefully and vigorously with the target of achieving at lest 70 degrees of knee flexion in first week itself.
Weight bearing to be started as early as possible. Although, weight bearing to be discussed with the respective surgeon to know the procedure followed and accordingly weight bearing to be planned. Initially, it my be started with mild toe touch & then progressed to partial and finally to full weight bearing. Weight bearing helps in improving the joint stability by improving the joint proprioception, stimulating the mechanoreceptors and helps bone strengthening & muscle toning.
Muscle strengthening of knee joint is to be started very early & initially started with quadriceps & hamstring isometrics. Muscle strengthening is essential for joint stability & serves integral part in GAIT training. Gluteus medius & vastus muscles with more focus on VMO (vastus medius obliques) are also given. Close chain exercises (CCE) in initial part of rehabilitation plays n important role since knee remain stable unlike in open chain exercises(OCE) and should be inculcated.OCE can be included when adequate stability and strength in knee joint is achieved.
GAIT training in physiotherapy helps the patient towards more functional mobility with improvement to near normal gait pattern. Initilly, it is done with walker support having knee brace put on & partial weight bearing on affected leg .Physiotherapist gradually improves gait progressing to stick walkingand finally waking without any support.
Functional training has great Role in physiotherapy in ACL rehab. Patient is encouraged to indulge in the activities concerned with daily life routines including his occupation environment. GAIT training on stairs; walk in and round the society with addition of challenges on path like making him walk in uneven surfaces etc.
Last but not the least, providing psychological support to the patient in every stage of rehabilitation by regular counseling in every session is very necessary. Psychological support or backing would lift the moral of the patient so that he qualifies with positive efforts in every phase of ACL rehabilitation.