Have you ever heard a torn ACL “pop”?
Unfortunately, this all-to-common sound and the ensuing pain affects numerous athletes. Soccer, basketball and football players, downhill skiers and others have suffered this knee injury.
According to a study, which appeared in The American Journal of Sports Medicine reports, “It is estimated that anterior cruciate ligament (ACL) injuries affect more than 120,000 athletes in the United States each year, with many of these injuries occurring in young athletes between 15 and 25 years of age.”
In the past, a torn ACL tear often meant the end of an athlete’s career.
Today, advances in surgery and post surgery physical therapy help athletes return to their sport, often within a year.
The following case study shows how soccer athlete, Korbin McVean, tore his ACL, went through surgery, and finally, successful physical therapy through our Friendswood clinic.
The Torn ACL
Korbin says, ‘My injury occurred in January 2020 during a soccer game. As I was attempting to kick the ball an opposing player ran into me causing me to tear my ACL. I had to have reconstructive surgery of my ACL later that month.’
Physical Therapy Begins
Korbin says ‘On my first day of physical therapy, I was on crutches and in a full length leg brace that was in a locked position so that I could not bend my knee, my knee was painful and swollen, I had very little flexibility, and was unable to lift my leg on my own. My goal was to return to playing competitive soccer at a high level.
How Did The ACL Tear Affect Korbin?
Korbin says, “Physically, I was unable to lift my leg on my own. I needed help getting into/out of bed and the car. I also needed crutches in order to walk any distance. Overall, the pain in my knee was not that bad. I did have occasions in which it was hard to sleep due to not being able to find a comfortable position at first. I had very little flexibility in my knee, and the brace was really bulky making it very difficult to move.
Mentally, I was very nervous. After undergoing surgery, I was not sure if I was going to be able to return to 100% of my normal soccer activities. I was being told that I would, but with my knee being completely immobilized, sore, and swollen I had my doubts.”
Phase One: Developing an Athlete’s Physical Therapy Treatment Plan
During phase one (0-6 weeks) of his rehab, Korbin presented to physical therapy in a knee immobilizer. He faced difficulty contracting his quadriceps muscles on his own, loss of flexibility in his knee, pain, and swelling.
Our initial thoughts were to control the pain and swelling because they can contribute to the inability to contract the quadriceps.
Our next goal was to begin stretching exercises in order to restore range of motion in Korbin’s knee. Korbin presented with difficulty fully extending his left knee during the initial stages of his rehab.
We understood the importance of Korbin regaining his range of motion as quickly as possible in order to restore normal gait and running mechanics.
We used specific modalities and manual therapy to promote optimal healing from the surgery as well as to regain mobility of the patella (knee cap), a prerequisite to knee range of motion.
Phase Two: Gaining Strength Through Blood Flow Restriction
As we entered phase two (6-12 weeks), Korbin regained nearly all of range of motion in his knee. Our goal changed to begin strengthening in order to restore normal function of the knee and return to jogging. Korbin was able to wean from his crutches at this time. We introduced blood flow restriction along with strengthening exercises in order to maximize strength and hypertrophy gain.
Korbin responded well to blood flow restriction and restored muscle mass in his left knee. By the end of phase 2, Korbin regained about 90% of his strength and muscle girth when compared to his right. He progressed to jogging during this phase.
Phase Three: Return-to-Sport Training
In phase three (12-20 weeks), Korbin presented with full strength and range of motion in his left knee. Our goal of this phase meant continuing advanced strengthening and beginning return-to-sport training. We discontinued blood flow restriction during this phase as Korbin had reached maximum benefit.
He started jump training which consists of double and single-leg hopping.
The next goal was to progress to lateral movements such as lateral bounding, ski jumps, and resisted side stepping using the sports cord.
During the final weeks of therapy, Korbin progressed to agility training using ladder and soccer-specific drills using K-bands.
Finally, we introduced “unplanned” movement patterns by tossing Korbin a soccer ball at various angles and he would move to the ball, stop, and kick the ball back.
Measuring The Torn ACL Recovery
During phases one and two, we measured Korbin’s progress using range of motion and strength measurements. On day one of PT, Korbin started out with 14-35 degrees of range of motion in his left knee, inability to perform a straight leg raise, and a quad tone of 1+/5.
By the end of phase one, Korbin’s range of motion returned to -7 to 140 degrees, he could complete a straight leg raise without extensor lag, and quad tone was 5/5.
During phase three, Korbin demonstrated full range of motion and strength using conventional measurements.
At this point, we used:
- functional testing in order to measure progress in which all measurements were compared between the right and left extremity.
- a 1-minute repeated single leg squat test to measure strength/endurance of the left knee compared to the right. During this test, Korbin demonstrated the ability to complete 40 reps with each leg.
- a single leg one-rep max on the leg press. Korbin maxed out at 115 pounds equally on the right and left leg.
- measuring Korbin in a single-leg hop distance of 50 inches on each lower extremity.
Using these measurements, we determined Korbin’s strength, power, and endurance were nearly symmetrical in preparation for return to sport.
Post Physical Therapy
Since sports rehab with us, Korbin resumed all soccer activities. As a precaution, he continues wearing a sports brace during contact sports.
Korbin has returned to soccer-specific drills with his team. He does come to therapy once per week presently to “fine-tune” his coordination and motor function to decrease risk of re-injury.
Due to his progress, he no longer requires the “traditional” physical therapy exercises in order to strengthen his knee. He has progressed to drills that simulate certain situations that his knee may be placed in during soccer.