What is an ACL Injury?

A torn ACL is an injury or tear to the anterior cruciate ligament. The ACL is one of the four main stabilizing ligaments of the knee, the others being the Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL). The ACL attaches to the knee end of the Femur (thigh bone), at the back of the joint and passes down through the knee joint to the front of the flat upper surface of the Tibia (shin bone). It passes across the knee joint in a diagonal direction and with the PCL passing in the opposite direction, forms a cross shape, hence the name cruciate ligaments.

Anatomy of the Knee

The anterior cruciate ligament is located within the capsule of the knee and connects the femur (thigh bone) to the tibia (shin bone).

Pictured is a front-on view of the bones, tendons and ligaments that make up the right knee. In the middle of the picture there is a ligament called the "Anterior Cruciate Ligament." It is this ligament, most commonly referred to as the ACL, which is damaged in an ACL injury.

The role of the Anterior Cruciate Ligament is to prevent forward movement of the Tibia from underneath the femur. The Posterior Cruciate Ligament prevents movement of the Tibia in a backwards direction. Together these two ligaments are vitally important to the stability of the knee joint, especially in contact sports and those that involve fast changes in direction and twisting and pivoting movements.

The ACL is responsible for restraining excessive forward movement of the tibia and limiting rotational movement at the knee joint.¹

Symptoms of a Torn ACL

• There may be an audible pop or crack at the time of injury.
• A feeling of initial instability; may be masked later by extensive swelling.
• This injury is extremely painful, in particular immediately after sustaining the injury.
• Swelling of the knee, usually immediate and extensive, but can be minimal or delayed.
• Restricted movement, especially an inability to fully straighten the leg.
• Possible widespread mild tenderness.
• Positive signs in the anterior drawer test and Lachman's test.
• Tenderness at the medial side of the joint which may indicate cartilage injury.

Cause of an ACL Tear²

As with any sprain, an ACL injury is the result of excessive stretching or tearing of the ligament. The severity of the injury can range from a slight stretching to a complete rupture. An ACL injury most commonly results from:

• A sudden stop or change of direction.
• A twisting motion at the knee joint.
• A blow or sudden impact to the front of the knee.

Athlete's involved in sports that require a lot of running and change of direction and speed; (especially contact sports) are most susceptible to ACL injury. Sports that involve the highest risk are football, soccer, basketball, skiing, hockey and gymnastics.

Prevention / Treatment of an ACL Injury³

The following guidelines are for information purposes only. Seeking professional advice before beginning rehabilitation is recommended.

Although it is important to be able to treat ACL injury, prevention should be your first priority. So what are some of the things you can do to help prevent an ACL injury?

• Warm up properly
  A good warm up is essential in getting the body ready for any activity. A well structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity.
• Avoid activities that cause pain
  This is self-explanatory, but try to be aware of activities that cause pain or discomfort, and either avoid them or modify them.
• Rest and recovery
  Rest is very important in helping the soft tissues of the body recover from strenuous activity. Be sure to allow adequate recovery time between workouts or training sessions.
• Balancing exercises
  Any activity that challenges your ability to balance, and keep your balance, will help what is called, proprioception - your body's ability to know where its limbs are at any given time.
• Stretch and strengthen
  To prevent ACL injury, it is important that the muscles around the knee be in top condition. Be sure to work on the strength and flexibility of all the muscle groups in the leg.
• Footwear
  Be aware of the importance of good footwear. A good pair of shoes will help to keep your knees stable, provide adequate cushioning, and support your knees and lower leg during the running or walking motion.

Massage Therapy ⁴

Since the damaged ligament lies within the joint capsule deep inside the knee, it is unavailable for massage palpation. However, there are a number of beneficial secondary effects resulting from Medical Massage. It is quite common to see various levels of muscle spasm in the surrounding muscles of the knee joint. Massage treatment to these muscles will be helpful to normalize the biomechanical balance around the knee. The Medical Massage Specialists at Advanced Alternatives Massage Therapy have training and expertise in sports related injuries and can offer assistance in alleviating the pain associated with this condition.

Source:

1. http://www.sportsinjuryclinic.net/cybertherapist/front/knee/anteriorcruciate.htm
2. http://www.thestretchinghandbook.com/archives/acl-injuries.php
3. http://www.thestretchinghandbook.com/archives/acl-injuries.php
4. Orthopedic Massage / Whitney Lowe