ACL Rehab: Is It About Your Knee or Your Body? You Decide!

[Guest Prosoft Admin]

by Mike Napierala, PT, SCS, CSCS, FAFS

We’ve been talking about protocols recently, the blessings and curses. 

In terms of ACL Reconstructions, this could not be more important to understand.  From athletes, to parents and coaches, from athletic trainers to surgeons, and yes even to physical therapists, the first thing often thought of when those three dreaded letters  ACL is heard is thoughts of the KNEE.  Who wouldn’t think of a knee first, right?  I mean, the ACL’s home is in the knee, right? You better start there at least. 

But for far too many lay people and professionals the thinking doesn’t just START at the knee, it all too often STOPS at the knee. 

The decisions made about how to stress the tissues at the knee are absolutely critical.  What ranges of motion to move into.  How fast or slow to take it.  When to begin walking on that leg.  How much weight is right to put into it?  When can I begin strengthening the Quads and Hamstrings that cross that knee?  Etc., etc., etc.!

That ACL graft inside needs high regard and respect to heal properly.  Too little stress and tissues aren’t stimulated enough to strengthen and mature.  Too much stress and gradual failure and stretching out can occur. 

But stop for just a moment and think about what does that ACL attach to?  From above, it starts on the femur or thigh bone, and below it inserts onto the tibia or lower leg bone.  The knee, right?  ABSOLUTELY CORRECT!

Now we can move on to what knee exercises and stresses are good right? 

NO WAY!  STOP! 

Go back for a moment and think about what you just said in your answers.  The ACL attaches to the femur and tibia.  Well, look a little further up and remember that who is the hip?  It’s the pelvis and...FEMUR!  That’s right, whatever happens at your hip, because it’s the femur, absolutely DIRECTLY influences your knee and your ACL!

Look on down a little further and what do you see?  The ankle, and who is the ankle, you ask?  It’s your top foot bone (talus sits on top of the calcaneus like a rider on a horse) and your lower leg, which is your tibia and fibula (small, thin bone along outside of leg). That’s right, the TIBIA. Remember, whatever happens at your ankle DIRECTLY influences your knee and your ACL.

WHY BOTHER GOING THROUGH THIS LITTLE BIOMECHANICS 101 REMINDER? Well, so many parents and coaches and athletes out there, and unfortunately even some professionals, think too narrowly about the ACL.  Like a microscope the attention is exclusively or at least too frequently on the KNEE ITSELF and less appreciating of the incredible influence that the same hip and foot-ankle have on that ACL. 

When you think of how connected our body is it’s not a far jump to even take that to another level and consider the impact that the opposite hip or ankle or even how the trunk and arms can influence an ACL’s stresses.

At PEAK PERFORMANCE we approach ACL rehab a little differently.  Yes, we focus on and understand what needs to happen and what needs to be controlled or avoided at that knee itself.  Critical.  Can’t be missed.  First concern. AGREED.  But, because of our functional biomechanics background we ALWAYS make sure to go up and down the chain of that athlete’s body to work at identifying how well those connected segments are working. 

A few of the common issues we’ve found in our ACL Reconstruction patients include that same foot overpronating too quickly or excessively, having a hip that is built in a way that makes it turn inward (called anteversion), and even a loss of ankle bending on the opposite leg (during a squat type motion, referred to as dorsiflexion and often related to an old but unresolved ankle sprain injury.

Each of these issues can cause that knee to be driven into a twisting and inward collapsing motion that puts the ACL under duress.  And it’s absolutely something that the knee’s own Quads and Hamstrings CANNOT HANDLE ADEQUATELY. 

Getting ACL Reconstruction young athletes back on the court or field isn’t typically a problem.  Most go back and play who want to.  Our question for parents, coaches, and athletes and yes, even doctors, is have any potentially contributing areas been DISCOVERED and ADDRESSED so that risks of having that same mechanism of twisting collapse of the knee can be controlled at least some, or have we hung our rehab and recovery hat on whether they’ve gotten back the ability to kick with their Quads and pull back with their Hamstrings at the knee itself.

YOU DECIDE! It’s your knee, your son or daughter’s, or your athlete’s knee! 

For us at PEAK PERFORMANCE, we’ve already looked in that microscope, seen what we need to, and then moved that aside and gotten out the telescope and begun searching the galaxy of the body for shortcomings that need to be addressed.  Give us a call at 218-0240 if you have questions or need help with your ACL Reconstruction rehab or any other injury that you’d like to have a functional biomechanics approach taken.