Sports Pitch

Behind The Scenes: ACL Journey – You are Not Alone!

Last updated: 5.39am, Monday 22nd March 2021 by

Knee injuries are a commonly seen in our clinic with them being either a long-standing issue, something that has gradually come on or something that has just happened recently (trip, fall or with sport). Unfortunately, I have experienced a knee injury and if I am honest I am probably a better Physiotherapist by going through the process myself.

I first injured my knee back in 2007 when I was playing football in New Zealand – at that time (I was a bit younger) but the diagnosis was an MCL (ligament at the side of your knee). I was frustratingly put in a brace for 6 weeks and gradually was rehabilitated back into playing again.

Everything had been going well, I managed to run 3 marathons and continued playing football without any issues that was until…. 2018 back in Glasgow playing football. I ran down the wing (something I don’t normally do – defence is my role). I went to turn, my stud got caught on the turf and I felt an instant pop and landed on the floor. A pop is a sound sometimes associated with an ACL rupture and the mechanism of the twisting motion is how you put the ACL under considerable strain. I had to hobble off and the next morning the knee was quite swollen. The knee doesn’t necessarily have to swell immediately – it can develop up to 24 hours afterwards depending on the associated damage within the joint. This swelling is a sign for ACL injury as the joint If I am honest I had a feeling I knew what I had done but was in slight denial.

Unfortunately, the diagnosis was an ACL rupture with lateral meniscal tear and injury to the back outside part of my knee. ACL injuries can be managed conservatively (non-surgical) and surgically. The decision is individual to every patient and their circumstances. My knee was surgically managed due to the instability and the other damage suffered within my knee joint.

ACL, anterior cruciate ligament (ACL)., glasgow ph ACL, anterior cruciate ligament (ACL)., glasgow ph

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Then the 9-12 month’s rehabilitation journey began – I knew it would be a long process and patience is key and importantly not rushing ahead. So I started with crutches for a couple of weeks and tried to get the swelling down and the knee moving. So I set myself weekly goals and worked hard in the pool and did my exercises prescribed to me.

ACL, anterior cruciate ligament (ACL)., glasgow ph

There are certain milestones to reach with your ACL rehabilitation –

  • Stitches out
  • Swelling Reduced
  • Range of motion slowly increasing
  • Off crutches
  • First time getting the knee on a bike
  • Able to do stairs properly!!
  • Progression of strength in the gym
  • Progression of balance exercises
  • Progression into jogging/running (straight line)
  • Jumping/ Hopping
  • Change of direction drills
  • Sports specific drills

The important aspect of each phase is that the knee doesn’t react to the progression you have added and that you have the strength for the knee to cope with the next stage. STRENGTH is key in your rehabilitation as you need to give the joint the best support and continue with some strengthening work even after you have returned to sport is key.

Common difficulties faced in Rehab

  • Swelling took a while to go – just keep with the compression, Ice and offload, movement is also good for swelling.
  • Overdoing the exercises
  • Trying to skip a step – gradual rehabilitation process so do not rush the knee if it isn’t ready.
  • Not moving it following surgery – really important to get the knee straight following surgery (unless advised otherwise by a surgeon) and getting it moving.

Everyone is also different and have you have to progress as your body allows. It is important to realise that the introduction of any new load has to coincide with how much strength you have to support your knee.

Balance and proprioception is a key factor in rehabilitation. After every operation, there can be issues with proprioception and if swelling is present this can have an additional factor. As it is a key stabiliser of the knee and is a key component in controlling the forward and twisting movement of the knee – it is so important to retrain the new graft slowly to do its new job and get the joint used to load again.

So you are walking well, back to straight-line running, strength is good in the gym. Are you ready to go back and play sport? The end-stage part of rehabilitation can sometimes be the most challenging because you are in a good place BUT you need to be sure that you gradually put the knee through sports specific movements and you have given the knee sufficient time for the graft to heal. This is why you give the knee ideally 9-12 months before going back into sport – give yourself time to get you a range of motion, strength, balance, loading (running, jumping, hopping), change of direction, cutting movements (all sports specific) and build it up gradually.

I know it can seem like a really long rehabilitation and your heart sinks when you get the diagnosis with a few tearful nights (I have been there). Speaking from experience there is a light at the end of the tunnel and we at Hampden Sports Clinic are here to help you progress through your rehabilitation – from start to finish. We have great facilities to enable us to follow the process through. We have the industry-renowned hydrotherapy pool, rehabilitation gym and an indoor warm-up area which will incorporate each stage of your journey.

ACL, anterior cruciate ligament (ACL)., glasgow ph

Knee diagram. Accessed 11.02.21,