Anterior Cruciate Ligament Injury (ACL) is a common ailment in the sports world, both for athletes in the big league and those at the backyard volleyball pit. Typically, the injury occurs when the foot is planted but the knee twists, causing damage to the ACL. Treatment and recovery take many forms, but your physical therapist can be a strong advocate for your success.

Early Intervention

The most common symptoms of a torn ACL are a loud popping sensation or sound in the knee, severe pain and inability to continue the activity, rapid swelling, loss of range of motion, and a feeling of instability when bearing weight. It’s important to seek medical attention if you experience these symptoms. With the ACL out of commission, the job of tackling weight and mobility transfers to the meniscus. If the meniscus tears, the risk of a long-term impact such as osteoarthritis increases significantly. With all of this in mind, it’s critical to get an accurate diagnosis and to stay off of your injured knee as much as possible to avoid further damage. The exam is basic and mostly non-invasive unless the doctor feels it’s necessary to insert a camera for a better look, a process called arthroscopy. You may also be sent in for x-rays or an MRI as needed to determine whether you should undergo surgery for the repair.

Treatment

The initial treatment for tears not requiring immediate surgery consists of rest, cold applications, and compression in the form of a knee wrap or brace. Many ACL tears heal with the proper care. If rest, ice, and compression don’t do the trick your doctor may recommend surgery. Whether you have surgery or not, you can rely on your physical therapist’s guidance throughout the process. 

What to Expect from Physical Therapy

Without surgery physical therapy will target increased muscle strength, agility, and balance. Your therapist will also help you identify movements that can defer pressure from your knee so you can increase activity without further injury. Since each person’s response to an ACL injury is unique, your physical therapy plan will be customized for your situation. 

If you undergo surgery, the recovery process will be somewhat different. In fact, your therapy will likely begin before you have the surgery in order to strengthen surrounding muscle groups, decrease swelling, and improve your range of motion. 

Following surgery, the goals of therapy are to improve knee health and prevent subsequent injury. With this in mind, you will likely wear a brace for the first month or two to keep the knee from hyperextending. You will also rely on crutches initially, slowly working with your therapist to increase the amount of weight you can bear on your leg. Along with protecting the area, your therapist will help with pain control, improving your gait, and reduction of swelling. Over time, they help you increase strength, range of motion, balance, and flexibility. As you improve your therapist will support you towards personal goals such as getting back to an activity like swimming, climbing the hill to the mailbox, or even returning to contact sports such as football.

Whether a result of aging, sedentary lifestyle, surgery, or injury, muscle weakness can contribute to other physiological issues and contribute to an increased risk of falls. According to the Center for Disease Control, one out of five falls causes a serious injury such as broken bones or a head injury. In fact, over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture. Many factors contribute to a higher likelihood of injury resulting from a fall. Vitamin D deficiency, vision problems, and improper footwear are just a few. But a major cause of falls is lower body and core weakness, which is where physical therapy can help significantly. Even if you’re currently feeling stable, the proper strengthening can improve your general health and safety.

Why is Physical Therapy Better Than the Gym?

The internet, magazines, and information at the doctor’s office are loaded with strength-training advice. However, each person has strengths and weaknesses that a physical therapist can help identify and target. For example, perhaps you didn’t know tightness in your calves is resulting in back pain or that a weak core is contributing to neck pain. Maybe large muscle groups are doing the work of smaller muscles or vice versa. Perhaps you are out of alignment or have one leg shorter than the other, resulting in issues with stability. With a basic exam, your PT can identify these opportunities for improved strength and mobility that will likely not improve by working out at the gym alone.

Strengthening

The strength of large and small muscle groups, especially stomach and other core muscles are at the ‘core’ of supporting your entire skeletal system. Ensuring your muscular system is strong and functioning properly will allow you to strengthen muscles you may not even have known were being ignored at the gym.

 

Your physical therapist can provide strengthening exercises specific to your needs and target weak areas. Then your PT will monitor your progress, supporting you along the way and supplying incrementally more challenging, yet targeted, exercises as your strength and stability increases.

Mobility

In addition to strength, physical therapy increases flexibility, which in turn improves mobility. In short, when your body is more fluid you are better able to react to potential falls. Basic exercises will help lubricate sticky joints in order to maintain a stable stance even when turning or climbing a ladder.

Balance

Of course, balance is another key component to keeping you on your feet and protecting against falls. With the proper training, the increase in balance will create a strong and elastic foundation to help you land upright, cushion your fall without damage, or maintain a vertical stature even on uneven ground.

FearSometimes uncertainty is your own worst enemy. If fear of falling keeps you from participating in activities you love, physical therapy can give you the physical strength and the reassurance to overcome the anxiety holding you back. Approach your physical therapy with a goal in mind to help keep you motivated and allow your PT to work towards that goal with you. Whether it’s being able to bathe unaided or returning to the tennis court, your PT is knowledgeable about the steps required to get you from here to there. 

Although you may not associate your lower back pain with your calves, when something is off-kilter in one area, it easily affects more distant areas of the body. If you think about it, your abdominals and lower back muscles support the majority of your musculoskeletal network, literally from head to toe. Without a strong core, your hips and spine can easily get out of alignment. When your alignment is off, you’ll often feel it in your knees, ankles, shoulders, or neck. 

Your core is key to maintaining posture and keeping your body primed for movement. If you are recovering from an injury or have fallen out of shape from long hours working at a computer, here are a few ways you can easily incorporate some basic core exercises into your day, to achieve all the benefits core strengthening has to offer. 

Arm/Leg Reach

Start by getting into position on your hands and knees. Make sure you have proper padding for your knees on the floor. Ensure your shoulders are lined up above your hands and your knees are directly below your hips. While holding your stomach tight and keeping your back flat, carefully extend both your right arm and your left leg, using the opposite limbs for balance. Fully extend, creating a flat board the length of your body. Bring the extended arm and leg under your body until your elbow touches your knee, maintaining balance as you move. Then place your hand and knee back onto the ground position and switch, extending the left arm and right leg. Complete 10 reps on both sides.

Standing Knee Crunches

Everyone knows crunches represent the ubiquitous core exercise, but if the floor version is too hard on your back, neck, or shoulders, perform a standing version instead. Stand with your feet shoulder-width apart. With a tight core and relaxed shoulders, slowly raise one knee until it meets the opposite elbow. If the twisting motion required to lower your elbow is too much simply do the leg lift portion instead. Complete 10 reps. 

Elbow Plank

The plank is a basic move with a huge core-strengthening impact. A full plank is performed with straight arms, but a modified version is achieved on your elbows instead. Use the technique that is best for you based on the potential wrist, elbow, or shoulder ailments. Roll your toes under slightly, placing the weight on the bottom of your toes. Similarly, place your hands or elbows flat on the ground directly below your shoulders. Pull your stomach tight and do not allow any sag in your lower back. 

Your body should make a “plank” like a board. Hold for 10 seconds. Lower a knee to rest, then reset your position for another 10 seconds. As you become stronger, try to hold the proper position for 20 seconds, then 30 seconds, etc, working up to one minute. 

For an added boost, hold the plank position while pulling one knee beneath and across your body. Return it to the extended position and repeat with the opposite side. For a modified version, hold the plank on your elbows and knees until you build enough strength to move to your toes. 

Hip Lifts

Think of hip lifts as an opposite form of crunches where you raise your hips instead of your head and shoulders. To start, lay flat on your back with your arms straight down along the side of your body. Bend your knees with your feet flat on the floor. Using your feet and shoulders as an anchor, lift your hips until your body is flat from shoulders to knees. Lower and repeat, maintaining a tight core as you go. Stability is critical so focus on squeezing your glutes and abs as you lift and lower. 

Side Hip Lift

To work the opposite muscles of your core lay on your side with one ankle stacked on top of the other. Put a pad beneath your elbow and ensure it is directly below your shoulder. Then lift your hips straight towards the ceiling and lower back to the ground, maintaining balance and control. Do five repetitions and then move to the other side. If this exercise is too challenging, try to lift and hold instead of moving up and down. 

While these exercises are introductory, it’s important to check with your doctor or physical therapist before beginning any exercise program to ensure the movements are safe for you.

Also know you don’t have to set aside a lot of time each day to begin your progress. Instead, make these exercises part of your everyday activities. Drop and hold a plank while your coffee reheats. Throwdown a few hip lifts during the last minute of the spin cycle on the washing machine. Perform some knee crunches while brushing your teeth. 

Most of all, remember to focus on form over repetitions. The goal is to strengthen and improve support so doing an exercise five times correctly is preferable to doing twice as many imprecisely. 

Whether you’re easing back into exercise or have maintained your conditioning throughout the COVID-19 pandemic, sports injuries are a common occurrence. From repetitive motion injuries to an acute injury during a recent workout, knowing when to go to the doctor can provide information, an action plan, and peace of mind while minimizing unnecessary visits. When deciding whether to make the trek to your doctor or physical therapist, there are many things to consider, such as whether you’ve experienced the injury before and if you have other health conditions.

Acute Pain

Whether at the gym or the garden, if you experience sudden and acute pain, take it seriously. You may even hear a pop or feel a muscle tear. When something is obviously wrong, seek help.

You Have an Underlying Condition

What may seem minor to one person can be serious in another if the injury is exacerbated by an underlying condition. For example, a diabetic could suffer from nerve damage called diabetic neuropathy that stifles the feeling of pain. Diabetics may also take longer to heal due to a lack of blood flow. In this case, even something like a sore or small cut on your foot should be looked at.

Pain Persists 

A significant number of sprains and strains will heal on their own with proper care at home. Use the R.I.C.E. method to rest, ice, compress (brace), and elevate. However, if the pain is consistent after a few weeks, it’s time to have a medical professional take a look. 

Swelling Doesn’t Improve

Swelling is a natural response to many types of injury. The body uses it to protect the area from further injury. Ice helps reduce swelling and as the injury heals, the swelling should reduce on its own too. If you’ve twisted an ankle or dropped a weight on your wrist and the swelling has not subsided within five days, give the doctor a ring.

Tingling, Numbness, or Burning Pain

If you’ve ever hit your “funny bone” you know what we’re talking about here. Patients describe the feeling differently, but a pins-and-needles-type sensation can indicate nerve damage and should be evaluated. Nerve pain can stem from an array of issues such as spinal disk misalignment that leads to a pinched nerve. Check-in with your providers if the symptom lasts more than a few days.

Can’t Apply Weight

When it comes to foot, ankle, leg, or knee pain, an inability to apply pressure is a concern. While it’s common to feel pain with a twisted ankle, if you can’t even put your foot on the floor, you may have something more serious going on. Use the R.I.C.E method once again.  If the pain doesn’t improve even slightly within a few hours, seek medical treatment.

You’ve Hit Your Head

Some injuries automatically cause more concern than others. Even if a bone is fractured, for example, it’s not cause for life-threatening alarm. If you hit your head during a contact sport or while pumping iron at the gym, however, it requires close monitoring. If you blackout, even for a moment, be sure to let your doctor know. Also seek immediate help if you become confused, disoriented, suffer a severe headache, have blurry vision, or become nauseous. 

Repetitive Motion Injuries

Aches and pains are a common part of an active lifestyle, especially as we age. However, not all ailments have to be a part of your everyday life. Symptoms consistent with tendonitis, shin splints, bursitis, fasciitis, tennis, and golf elbow can likely be lessened through proper medical care, including physical therapy. If you have recurring pain in the same area, or pain that regularly occurs when in use, but goes away during rest, don’t ignore it, get it checked out.

 

Whether you’ve been in lockdown due to COVID-19 restrictions or have just slipped away from your regular exercise regimen due to lack of time or motivation, when you are ready to get back into the groove of working out be sure to ease back into the process. Avoid common injuries and achieve your goals by following a few tried and true practices. 

Start Slow

When your body has been inert, it’s sometimes difficult to gear back up. Doing too much too quickly can lead to pain, and more importantly, injury. Remember you aren’t at the same point physically that you were before falling off the exercise schedule. After all, you had gotten to that point gradually. The truth is, we lose our physical strength and flexibility a lot faster than we gain it. With that in mind, be gentle with yourself. If you used to hammer out an hour on the treadmill five days a week, start with 20 minutes three days a week. Begin with exercises at a lower level to reintroduce your muscles and joints to the movement. And remember that form is more important than intensity. Protect your body with proper form. 

Talk to Your Medical Professionals

Every “body”’s situation is different. Make sure you’re entering into the best exercise options for you with permission and advice from your medical professionals, especially if you’ve been diagnosed with a medical condition or are currently participating in physical therapy following a surgery or injury. The last thing you want is for your increase in activity to cause harm.

Types of Exercise

What you do and how you do it matter. While going for a run might seem like a good place for you to start, remember that a combination of activities, and starting slow, is the key to long-term success. Increasing cardiovascular endurance is one component, and an important one, that helps your heart, lungs, and muscles. However, equally important is resistance training as well as methods that increase flexibility. When getting back into the exercise groove, work those three components in reverse. Begin with a few days of gentle yoga or stretching. Then add in some resistance training exercises. Finally, start to incorporate cardio into the mix. Your body needs time to make the transition from couch to counting miles so stretch and strengthen before expecting too much from it.

Rest Days

Giving your body time to rest is just as important as the type and quantity of movement you participate in. Muscles need time to recover from strenuous activity. So make sure your routine includes a rest day every two to three days and don’t work the same muscle group within a 24 hour period.  

 

 

Warm-up and Cool Down

Once you find the motivation to workout you’re likely to want to put those shoes on and hit it hard, but it’s important to remember that the power bench presses and Crossfit exercises are not the only part of your workout. Start with a gradual warm-up to get your body primed for what’s ahead. At the end of your intense cardio or strength training, slowly lower your heart rate with a gradual reduction in the movement that includes deep stretches while the muscles are still warm. 

Drink Water

Water is essential to the human body, especially when working out or exposing yourself to extreme heat. Even mild dehydration can cause muscle cramps, fatigue, and a host of other symptoms so load up on water as you get back into moving. 

 

Pay Attention to Pain

Exercise should not cause acute pain. If you have sudden pain of any type, stop immediately. Try to walk it out, but stop again if the pain is intense. On your recovery days, it’s common to be stiff or sore, but if you experience pain that interferes with your daily activities, avoid exercises affecting that area and use R.I.C.E. (Rest, Ice, Compression, Elevation) practices to see if the pain subsides over a week or so. 

Find a Partner

Exercise is more fun with a partner. Plus having someone hold you accountable for getting to the gym or hitting the trail is a bonus too. If your partner has been in the workout game longer and is at a different fitness level, don’t try to keep up right away. Instead, set your own goals and meet your partner when you can. 

Set Goals

Speaking of goals, having an end result in mind will help you stay the course on those days you just don’t feel like putting in the effort. Tape a picture of yourself to the bathroom mirror or refrigerator. Keep a log of weight loss using a phone app or a written journal. Take note when you lift more, walk longer, or get to the top of the stairs without getting winded. Acknowledge your small successes as you work towards your larger goals. We believe in you and are always here to support you in achieving your fitness goals. If you have any questions or concerns, contact the team at Encore Physical Therapy.