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The Effects and Treatment of Anterior Cruciate Ligament Injuries: A Case Study

A Case Study Presented to the

Faculty of the Physical Education Department

School of Education

Ateneo de Zamboanga University

In Partial Fulfillment of the

Requirements In PATHFIT 2 FITNESS

EXERCISES

By:

Abam, Cherish Pinky S.

Patega, Jade K.

Cuenca, Gene Clarence S.

Ramos, Mary Joy S.

Follero, Kevin Jay E.

Rojas, Adegaile Kaye M.

Gonzales, Francesca Rae M.

Royo, Valent Lou B.

Ateneo de Zamboanga University

March 2020
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TABLE OF CONTENTS

Title Page 1

Table of Contents 2

Abstract 3

Chapter I – Introduction 4

Chapter II – Review of Related Literature 6

Chapter III – Significance of the Study 25

Chapter IV – Results and Discussions

Section 1 – The Injury

27

Section 2 – Therapy, Treatment, and Rehabilitation 31

Section 3 – The Exercise Form 34

Chapter V – Conclusion

Summary of Findings 41

Individual Concluding Statements 42

Summary of Statements 49

Bibliography 50
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ABSTRACT

This case study reviews the anterior cruciate ligament (ACL) injury. This particular knee

injury is very common among athletes, especially those who play in contact sports. Since the

sports injuries usually heal and improve with exercise, there is no clear option of what exercise

fits this particular injury the most. Some athletes may be instructed to follow exercise forms that

are unhelpful, or even worse, harmful to healing the injury they have.

Through studies on the anatomy of the injury and matching it with different exercise

forms, this study aims to find, assemble, and defend an exercise form or regimen that best suits

the precautions, movements, and goals needed in treating and rehabilitating an ACL tear.

Through this study, it was found out that a special exercise regimen is really necessary for

efficient healing of such an injury. A generalized existing exercise form may prove to give

unnecessary movements or risks for the injury.

This study is made with the intention of ensuring that athletes who suffer this kind of

injury will be able to immediately receive the proper rehabilitation regimen without having to go

through a dangerous trial and error phase of checking what form suits the injury best.
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CHAPTER 1 – INTRODUCTION

An anterior cruciate ligament (ACL) injury is very common to athletes. Any sport that

requires jumping and running, which is almost every sport, can give an athlete an ACL injury.

Turning too fast, landing awkwardly, and even being directly hit in the knee by equipment or

other players can result in the tearing of this ligament. Because of how common it is, a lot of

different treatments, both surgery-based and exercise-based, have come up to address the injury.

Unfortunately, the effectiveness of these treatments may vary, largely depending on the gravity

of the injury, and also on the nature of the accident that caused the injury. On top of this,

complications may arise from the injury that could be exacerbated by some of these treatments.

The variety of treatments available for an ACL injury means that a specific routine must

be made to maximize the healing process of the injury, as well as to remove the confusion that

may arise from having too many choices. This study aims to find that specific routine, compare it

with other available exercise forms for effectiveness in healing the injury, and find credible

evidence that proves the effectiveness of the routine.

The anterior cruciate ligament is a ligament found in between the femur and tibia, behind

the patella. The anterior cruciate ligament is named this way because it is the front cruciate

ligament of two cruciate ligaments, and cruciate means that has a cross formation. This

ligament’s purpose is to limit the mobility of the knee joint. By doing so, it inhibits any

excessive movement the knee might make. Because of this, the anterior cruciate ligament take

the brunt of a sudden turn or an awkward fall, and if too much force was involved, will result in

the tearing of the ligament, which is what is called an ACL injury. This injury may heal on its

own, but takes too much time and might heal into an unstable position for the knee.
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This study showcases a specific routine that is not a common existing exercise form. This

study focuses on this routine because unlike existing exercise forms, the benefits of a specific

routine like this is hard to prove. This is why this study was conducted on this routine; to prove

that each exercise in this routine specifically caters to the area that need to be maintained after

sustaining an ACL injury, and to show evidence from credible sources that the exercises, both

individually and as a whole, are effective in helping an ACL injury heal properly.
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CHAPTER II – REVIEW OF RELATED LITERATURE

ACL ANATOMY AND INJURY

The knee is a structure which involves three bones – the patella, tibia and femur. There

are 4 major ligaments found in the knee structure which aids in providing stability and strength.

The ligaments are also responsible in linking the femur to the tibia and helps prevent certain tear

and sprain that can happen in the knee. These ligaments are the anterior cruciate ligament,

posterior cruciate ligament, medial collateral ligament and lateral collateral ligament. The

cruciate ligaments are located on the inside of the knee joint. The anterior cruciate ligament and

posterior cruciate ligament form an X on the inside of the knee. However, the collateral

ligaments which are the medial collateral ligament and lateral collateral ligament are located on

the sides of the knee. They prevent excessive sideways motion of the knee. But in the context of

this study, the researchers are only going to study the anterior cruciate ligament.

The Anterior Cruciate Ligament, otherwise known as the ACL is a dense connective

tissue that is found in the knee. It links the femur to the tibia. It is significant in a way that it

helps stabilize the knee by preventing further anterior movements of the tibia. It also avoids

hyperextension of the knee. Its origin can be found in the posterior medial part of the lateral

femoral condyle. Meanwhile, its insertion is at the anterior medial part of the tibia. One should

keep in mind that its orientation is inferiorly, anteriorly and medially. When it comes to its blood

supply, it is vascularized by the branches of the middle geniculate artery. The tibial nerve,

specifically the posterior articular nerve, is responsible for its innervation. The anterior cruciate

ligament or ACL is a quadruped stifle joint found in the knees of humans, between the femur and

the tibia. The ACL actually consists of two ligaments that are in a crossed, hence the name

“cruciate.” (Friedberg, 2020)

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The aforementioned ligament is commonly ruptured by athletes and people who

experienced trauma alike. But most patients are individuals who play football, soccer and

basketball. Over usage of the ligament can lead to a sprain or tear. Most patients will hear a pop

upon experiencing an ACL injury. Symptoms include extreme pain, swelling and instability of

the knee joint. Suggested treatments include bed rest and consultation with your orthopedic

physician or physical therapist to regain your knee stability and strength. But in worst and sever

case scenarios, a surgery is necessary already. (Mayo Clinic Staff, 2019)

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CAUSES, RISK FACTORS, COMPLICATIONS

Ligaments are strong bands that connect one bone to another. ACL is one of two

ligaments that intersect the middle of the knee. This ligament connects the femur to the tibia and

helps stabilize the knee joint. ACL injuries often occur during exercise and physical exercise,

which can strain your knees:

• Sudden delay and change of direction

• Pivoting with your foot firmly planted

• Awkward landings from a jump

• Sudden stops

• Blows that hit the knee directly

When the ligament is damaged, there is usually a partial or full tear of the tissue. Slight

injuries can strain the ligaments but leave it intact.

Several factors increase the risk of ACL injury, including:

• Being female - this may be due to differences in anatomical structure, muscle strength

and hormonal effects.

• Playing certain sports such as football, soccer, basketball, gymnastics and alpine skiing

• Poor conditioning

• Wearing inappropriate or unfitting footwear

• Improperly maintained sports equipment, such as ski fixtures

• Playing on artificial grass

People with ACL injury have an increased risk of knee osteoarthritis. Arthritis can occur

even if you have a ligament regeneration surgery. There are many factors that can affect the risk
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of arthritis, such as the severity of the original injury, the presence of knee-related injuries, or the

level of activity after treatment. (Mayo Clinic Staff, 2019)

The anterior cruciate ligament can be injured in several ways:

• Changing direction quickly

• Stopping suddenly

• Slowing down while running

• Landing awkwardly from jumping

• Direct contact or collision, such as a football shovel

Many studies have shown that the incidence of ACL injury in female athletes is

higher in some sports than in male athletes. It has been thought that this is due to changes in

physical conditions, muscle strength and neuromuscular control. Other factors include changes in

the alignment of the pelvis and lower limbs, increased ligament looseness, and the effect of

estrogen on ligament characteristics.

When you hurt the anterior cruciate ligament, you hear a "pop" sound and feel

your knees fall off the ground. Other common symptoms include:

• Pain - The knees will swell within a day. If ignored, inflammation and pain can disappear

eventually without treatment. However, if you return to sports immediately, your knee

may become unstable and may further damage the cartilage (meniscus) of the knee.

• Limited range of motion

• Joint area tenderness

• Discomfort while walking

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At the first visit, your doctor will discuss your symptoms and medical history with

you. During the physical examination, your doctor will examine all structures of the knee injury

and compare them without to the intact knee. Most ligament injuries can be diagnosed by a

thorough physical examination of the knee. Other tests that may help the doctor confirm the

diagnosis include (OrthoInfo, 2014):

• X-ray - Although X-rays do not show damage to the anterior cruciate ligament, X-rays

can show whether the damage resulted in fractured bones.

• Magnetic resonance imaging (MRI) scans - This study created better images of soft

tissues, such as the anterior cruciate ligament. However, a torn ACL can usually be

diagnosed without MRI.

“Estrogen has a dramatic effect on musculoskeletal function. In these other

musculoskeletal tissues, estrogen improves muscle mass and strength, and increases the collagen

content of connective tissues. However, unlike bone and muscle where estrogen improves

function, in tendons and ligaments estrogen decreases stiffness, and this directly affects

performance and injury rates. High estrogen levels can decrease power and performance and

make women more prone for catastrophic ligament injury. The goal of the current work is to

review the research that forms the basis of our understanding how estrogen affects muscle,

tendon, and ligament and how hormonal manipulation can be used to optimize performance and

promote female participation in an active lifestyle at any age.” (Chidi-Ogbolu & Baar, 2019)
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PREVENTION

Proper training and exercise can help reduce the risk of ACL injuries. Sports medicine

doctors, physical therapists, sports coaches or other sports medicine experts can provide

assessments, instructions and feedback to help you reduce your risk. Procedures to reduce ACL

damage include:

• Strengthen leg muscles, especially the hamstrings, to ensure an overall balance of muscle

strength

• Exercise to strengthen the core, including hips, pelvis and lower abdomen.

• When training and exercising, emphasize the right techniques and knee position when

jumping

• Practicing pivot movements and cutting movements to improve skills

Strengthening the training of the legs, hips, and core muscles, as well as training to improve

jumping and landing techniques, will help reduce the increased risk of ACL injuries associated

with athletes.

Wear suitable sports shoes and pads to prevent injury. If you are skiing downhill, make sure

that the straps of the skis are properly adjusted by experienced professionals so that the skis will

loosen properly when dropped. (Mayo Clinic Staff, 2019)

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SYMPTOMS

Damage to the Anterior Cruciate Ligament is one of the most common, serious and

painful knee injuries as it is one of two cross-shaped ligaments connecting the thighbone to

shinbone and stabilizes the knee. This type of injury frequently occurs during active sports that

involve a lot of jumping and rapid starts and stops because an ACL injury develops when it

stretches beyond its capacity and tears.

More than 70% of ACL injuries occur without any contact or blow to the knee. ACL

injuries affect roughly 1 in 3,000 people in the United States. When a person has an ACL injury,

it is fairly common to have injuries in other parts of the knee, including the cartilage, tendons,

and bones. Along with significant pain, a key sign of an ACL injury is a “popping” sound, which

occurs at the moment that the ACL is torn or stressed. The symptoms of an ACL injury can be

difficulty or inability to extend the knee, discomfort when walking, soreness around the knee,

and a feeling that the knee may give out. (Dresden, 2019)

ACL injuries are also more common in females than in males, even among those who

play the same sport. On average, they are 2 to 8 times more at risk of ACL injuries. Teenagers

also are getting ACL injuries at an increased rate, probably because more kids are involved in

organized sports. The increase in ACL injuries is also due to more awareness and advanced

testing.
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Symptoms aside from the aforementioned includes: pain and swelling, you could

experience grinding feelings of your bones or kneecap, and not being able to put weight on your

leg. When you injure your ACL, it can be a partial or full tear. In a partial tear, only part of the

ligament is torn. A full or complete tear happens when the ligament is torn in two pieces.

Usually ACL tears happen in the middle of the ligament. Sometimes the ligament is pulled

completely off the thigh bone. (Familydoctor.org, 2018)

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MEDICAL DIAGNOSIS

For an Anterior Cruciate Ligament (ACL) injury be identified, various tests can be done.

There are manual tests and tests via technology. There are three common tests that can be

performed. These tests are the following: pivot-shift test, anterior drawer test, and lachman test.

“These tests evaluate joint integrity and any degree of separation by applying stress in certain

directions and assessing the endpoints. Intact ligaments produce an abrupt, firm end-feel,

whereas sprained or torn ligaments have soft, indistinct endpoints” (Clinical Advisor, n.d.).

The pivot-shift test involves stabilizing the leg in near full extension. To do the test, the

client must be in supine position. Stand beside the client’s affected leg then with your hand near

the toe must hold it and rotate it internally. The examiner will then flex the knee while

maintaining the internal rotation. A positive test will cause the tibia to jerk.

The anterior drawer test is another test that will help the medical examiner identifies ACL

tear or injury. This test is done by laying the patient in supine position while the affected knee

flexed in a 90-degree angle like the position of dorsal recumbent. The examiner will then place

both of his hand on the proximal tibia and pull on it. A positive result will cause the tibia to

move at least 6 millimeters anteriorly or a soft and mushy end feel will be experienced.

The Lachman test will again test for anterior cruciate ligament rupture. This is done by

positioning the client in a supine posture with knee flexed 20 to 30-degrees. The examiner should

grasp the femur or the thigh bone with the non-dominant hand to prevent movement of the thigh

then hold the proximal tibia and translate or move the tibia anteriorly. A positive result will give

a soft or mushy feel or the anterior translation of the tibia is at least 3 millimeters greater than the

unaffected leg. (Clinical Advisor, 2020)

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When ACL injury is inspected and will be further confirmed, a medical imaging will be

used specifically the MRI or magnetic resonance imaging. According to National Institute of

Biomedical Imaging and Bioengineering NIH (n.d.), MRI is a non-invasive imaging technology

that produces three dimensional detailed anatomical images. It is often used for disease

detection, diagnosis, and treatment monitoring. It is based on sophisticated technology that

excites and detects the change in the direction of the rotational axis of protons found in the water

that makes up living tissues. MRI scanners are particularly well suited to image the non-bony

parts or soft tissues of the body. They differ from computed tomography (CT), in that they do not

use the damaging ionizing radiation of x-rays. This technology will enable the physicians to view

the structure of the knee and indicate if there is an injury. (National Institute of Biomedical Imaging

and Bioengineering, n.d.)

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TREATMENT

ACL injuries should be treated right away. First aid will be used to reduce the swelling

and pain of the injury. The RICE method is followed in first aid. Rest, Ice, Compression, and

Elevation is what RICE means. Rest the knee to avoid further injury. As much as possible, the

leg with the injured knee should not be moved at all. Apply Ice on the injury. Use an elastic

bandage to Compress the knee. Lastly, put the client in a supine position and Elevate the knee

above heart level.

After initial first aid, over-the-counter pain medications can be taken. Seek professional

help immediately. A physician might suggest surgery, depending on the severity of the injury. If

the injury is not too sever, the physician might refer the client to a physical therapist for

rehabilitation, which consists of exercises that will help in the proper healing of the knee and

ensure that the client can still use their knee after it heals. (Healthwise Staff, 2018)

In the treatment of ACL injuries, there are mainly three goals:

• Stabilize the enough so that the client can still somewhat continue in their daily

activities

• Eventually make the knee strong enough so that the client can be able to do

activities they used to do before the injury

• Ensure that the possibility for injuries like these occurring again will be

minimized

There are two classifications of treatment for ACL injuries, non-surgical and surgical.

Non-surgical treatment involves rehabilitation programs that will help eliminate pain, stabilize

the joint, and prevent further damage. However, this treatment can only be applied to small ACL

tears, and even then, lifestyle changes will be necessary to avoid future ACL injuries.
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Surgical treatments are considered only when either the tear is big or complete, or if

rehabilitation does not work. The ACL does not heal on its own because it lacks a blood supply,

so if rehabilitation does not work, surgery will usually be necessary to stabilize the knee. There

are three types of ACL reconstruction surgery that is commonly used. (University of Michigan,

2020)

• The patella tendon-bond autograft surgery involves removing one-third of the patella

tendon along with a piece of bone at the attachment sites at the kneecap and tibia

• The hamstring autograft surgery involves taking two tendons from the hamstring muscles

and wrapping them together to form a new ACL

• The quadriceps tendon graft surgery is usually used for pediatric ACL injuries.

If the above three does not work, a partial or full knee replacement surgery may be necessary.

After an ACL surgery, exercise is important to regain neuromuscular control of the

quadriceps, strengthen the hip and maintain knee and ankle range of motion on the affected leg.

These select exercises are to be done one to four weeks after the surgery has been done. (CHOC

Children's, 2020)
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• Long Sitting Towel Calf-Stretch

• Supine Hamstring Stretch

• Quad Sets

• Ankle Pumps

• Heel Slides

• Prone Hip Extension

Your doctor may ask you to lie on your back and bend your hips and knees at an

angle. He will then place his hands on different parts of the leg and gently move it. If any

of your bones move abnormally, it may say that your ACL is damaged. The doctor might

request an X-ray. X-rays do not show soft tissues like ACL, but your doctor may need it

to rule out bone fractures. Furthermore, Magnetic Resonance (MRI) or Ultrasound tests

can show both soft tissue and bone. If your ACL is damaged, it should appear in the

image. In an operation, arthroscopy, literally meaning "looking into the joint" can be

done. During the exam, the plastic surgeon makes a small incision in your skin. He

inserts a pencil-sized tool into the joint, which included a lighting system and a lens

(arthroscope). The camera projects images of the joints onto the TV screen. Your doctor

can see the type of injury you have sustained and repair or correct it if necessary.

(Wheeler, 2018)

Treatments include first aid, drugs, kneepads, physical therapy, and surgery.

• First aid - If your injuries are minor, you may just need to put ice on your knees, lift your

legs, and keep your feet resting for a while. You can reduce swelling by wrapping a small

band of ace around your knee. Crutches can help reduce the load on your knees.
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• Drugs - Anti-inflammatory drugs can help reduce swelling and pain. Your doctor may

recommend over-the-counter medications or prescribe stronger medications. If you have

severe pain, your doctor may give you a steroid injection in the knee.

• Kneepads - Some people with ACL damage may wear a brace or kneepads on their knees

while running or exercising to provide additional support.

• Physical Therapy - It may take several days or a week for your knees to return to normal.

During your workout, you will exercise to strengthen the muscles around your knees and

help you return to having full range of motion. You can be sent home to exercise and do

it yourself.

• Surgery - If your ACL is severely torn, your knees are unstable when you walk, or you

are an athlete, your doctor may recommend this. The surgeon will remove the damaged

ACL and replace it with tissue to help new ligaments grow. After undergoing physical

therapy, people who have surgery can usually return to their normal activates within 12

months.
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EXERCISE FORMS

“Quadriceps strength deficits are observed clinically following anterior cruciate injury

and reconstruction and are often not overcome despite rehabilitation. Given that quadriceps

strength may be important for achieving symmetrical joint biomechanics and promoting long-

term joint health, determining the magnitude of strength deficits that lead to altered mechanics is

critical. Patients with low quadriceps strength displayed greater movement asymmetries at the

knee in the sagittal plane. Quadriceps strength was related to movement asymmetries and

functional performance. Rehabilitation following ACL reconstruction needs to focus on

maximizing quadriceps strength, which will lead to more symmetrical knee biomechanics.

“(Palmieri-Smith & Lepley, 2015) the excerpt above summarized states that quadriceps setting

exercise helps improve symmetry in knee movement by building up the strength of the

quadriceps.

Heel propping allows the knee to fall into hyperextension. This helps reset the knee to its

passive knee extension. Heel propping can be done by the client by using a towel to pull their

own foot upward while keeping their knee down, allowing the leg to hyperextend. Heel propping

helps the recovery of clients whether as part of a rehabilitation routine or a post-operation

exercise regimen. (Biggs, Jenkins, Urch, & Shelbourne, 2009)

Heel slides help one regain their range of motion by stretching the anterior thigh muscles.

Heel slides are just like raising and lowering one’s knees while standing up. The only difference

is in heel slides, the client is lying down in a supine position. Therefore, these exercises can be

done by clients who have just undergone surgery. (Healthwise Staff, 2018)
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“The main goal after knee surgery is to help you return to your normal activity and

function. After surgery, the muscles in your leg will likely be weak, and your physical therapist

will prescribe exercises to help you improve the strength in your hips, quadriceps, hamstrings,

and calf muscles. Straight leg raises are a great way to help improve the strength of your

quadriceps and muscles in your hips. A typical ACL rehabilitation protocol will likely include

performing straight leg raises on your back, your side, and your stomach to help target those

muscles that support your knee and help with normal walking.” (Sears, 2019) The excerpt above

summarized states that straight leg lifts help strengthen the quadriceps and hip muscles. Through

the strengthening of these muscles, it will boost the return of the ability of normal walking and

stability of the knee.

“Following a torn ACL, you may enter a rehabilitation program to reduce pain and

restore function to your knee. Using a stationary exercise bike after ACL reconstruction can

improve range of motion in the knee joint, according to Massachusetts General Hospital Sports

Medicine. Because you may be unable to put much weight on your affected knee, rehabilitation

works to regain some stability that might have been lost. Riding a bicycle improves circulation to

the lower extremities and also works the muscles both above and below the knee, which can

improve support for the joint.” (Brannagan, 2019)

“The hamstring curl is the king of exercises when training knee flexion. The lying,

kneeling and standing hamstring curls are the best machines to tackle this task. When using the

hamstring curl it is best to perform these unilaterally in the initial General Preparatory Phases of

training. This will allow for the correction of any imbalances from the left to right sides. Also it

is important to train all the three muscles that make up the hamstring group. This can be done by

changing the foot position.”

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“Pointing the toes out (duck feet) will hit primarily the biceps femoris. Having the toes

neutral will primarily recruit the semitendinosus. While turning the toes inwards (pigeon toed)

will cause the semimembranosus to be more highly recruited.” (Cosnett Training Systems, 2016)

“Simply stand up on your tip toes. Hold that pose for 10 seconds, then gently relax back

into a regular standing position. Repeat this exercise 10 times for a refreshing workout. Tiptoe

training will strengthen your feet, calves, and legs. It might even help with back pain by aligning

your body in a natural stance.” (Wilson, 2017)

“Although the literature suggests that decreased hip strength can lead to biomechanical

alterations that are associated with ACL injury risk, there is limited evidence to support hip

strengthening either for prevention of primary ACL injury or following ACL reconstruction

(ACLR) to prevent the same injury. In a hip-focused training program of healthy women aged

between 18 and 25 years, investigators saw significant improvements in landing kinematics after

the training, signifying a potential model for ACL prevention. Following four weeks of

plyometric and balance exercises with an emphasis on the hip, maximal isometric strength of the

hip abductors and hip extensors increased, and the participants utilized greater hip and knee

flexion and lower knee abduction (valgus) angles during landing. Although this study was

performed in a healthy population, and the effects of the program were not tracked for future

ACL tears, the results do suggest the potential for effectively reducing ACL injury risk.”

(Garrison, 2015)
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“Slowly slide your foot down the wall as far as possible, bending the knee. Hold for 3-5

seconds. Then push the foot gently into the wall and slide the foot back up until the knee is

straight. Repeat 10-20 times, 3-4 times daily. You can progress this exercise by hooking your

other foot over the top of your affected leg and gently pushing down, to further increase flexion”

(Wilson C. , 2018)

“Chair squats are a quality and safe way for those who are just starting out with strength

training. When used alone, they won’t burn enough calories for fat loss, but they do help build

strength and tone in your quadriceps, gluteus maximus and calves. Setting a chair behind you

alleviates the fear of losing control and falling backward that you may have when performing the

traditional squat. In addition, having a brief moment where your hips are in contact with the chair

lowers the difficulty of the squat. Chair squats are often used when first learning how to properly

squat. Beginners often do not push their hips back adequately, but having the chair behind you

promotes proper hip flexion.” (Nunley, 2020)

Step ups and step downs are both amazing exercises for prehab and rehab purposes alike.

But in order to truly maximize your gains in the gym or clinic, you need to perform them

correctly!! Yes, stepping up and down off an extremely tall box looks impressive and all, but can

you actually control it? Unless your goal is to get in some cardio, you need to really focus on

form and control in the step up and down. Don’t blaze through it; focus on an extremely slow

and controlled descent (eccentric control). Your knee should never collapse and be medial to the

ankle (unless doing a transverse step down which we’ll talk about later). You should feel the

burn in your glutes and quads as you try and stabilize your pelvis during the descent. Developing

eccentric control is crucial, especially for quadriceps or patellar tendinopathy prehab.

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Only use a box height that you can control. You should be able to control the descent

throughout the entire range of motion. Most of the time, you’ll find that you can control the

descent initially, but as the quad demand increases (as knee flexion angle increases), you’ll lose

the control of the descent. If you can’t control the end range of the descent, you’re using a box

that is too high! Finally, don’t cheat and push off with the opposite leg! The leg on the box

should be doing all the work, both raising (concentric) and lowering (eccentric). Don’t push off

the ground with that back leg! (The Prehab Guys, 2019)

“Exercises that focus on building up the muscles surrounding the knee are important for

keeping it strong enough to safely take on a person's body weight as well as the stopping and

starting motions that happen in sports. Stretching those muscles is equally important and aids in

the rehabilitation of the ACL as well as the potential prevention of future injury. These muscles

need to be pliable enough to allow the joint to move through a full range of motion and strong

enough to support them. Studies show that progressive exercise programs, including some of the

ACL stretches detailed below, are a key component to ACL injury recovery. Additionally,

people who utilize ACL stretching regimes see a significant improvement compared with those

that do not.” (Quinn, 2020)

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CHAPTER III – SIGNIFICANCE OF THE STUDY

This study revolves on the search for a routine that fits ACL injury treatment as much as

possible, and the gathering of credible evidence that proves its effectiveness in healing the injury.

This study will be can be used as a basis that the routine this study defend is actually better than

most, if not all, existing general forms of exercising. Unlike general exercise forms, the routine

this study defends has been carefully made, keeping in mind the progress of healing the injury

has and having adjusted exercises to fit the needs of the client in any of the stages of healing.

Other than this, the study presents proper evidence that proves the effectiveness of the proposed

routine. Instead of hoping for the best, physiotherapists and doctors already know in advance that

following this routine will guarantee effective healing for the client.

This study hopes to benefit the following:

• Athletes – This study hopes to benefit athletes who have sustained or will sustain an ACL

injury. The routine this study proposes is guaranteed to help them regain their strength

and full range of motion in a period of time that is neither too fast nor too slow. The

proposed routine will ensure that athletes will be fully ready when they go back to

playing their sport.

• Medical Professionals – This study hopes to benefit physiotherapists and surgeons who

help in the rehabilitation and surgery of the athletes who sustain ACL injuries. They can

follow the proposed routine and simply make the necessary minute changes to better suit

every client individually. Instead of having to come up with a different routine every time

a new client comes in for an ACL injury, they will simply have to use the proposed

routine of this study.

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• The general public – This study hopes to provide the public with a uniform routine that

guarantees healing and safety for injured athletes. The public will have a reliable routine

they can use if ever they have sustained ACL injuries. They will not have to guess

between existing exercise forms in which is the best for their needs.
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CHAPTER IV – DISCUSSIONS AND RESULTS

SECTION 1- THE INJURY

In the world of sports, one of the most common and infamous knee injuries is the ACL

tear or sprain. According to Friedberg (2020), in the United States alone, there are about 100,000

to 200,000 ACL ruptures per year. The lower limbs are considered to be very important to

players of different sports as it serves as the foundation of their career. Injuries in it could mean

the end of their future and career.

The term ACL is an acronym for Anterior Cruciate Ligament. Basically, ligaments are is

a flexible fibrous connective tissue which is responsible for connecting two bones together.

Ligaments are essential for holding different bone structures together. The ACL is located in the

knee between two bones which is the femur and tibia. It is also protected by another bone

anteriorly called patella which is known as a kneecap that is a circular-triangular and flat bone.

In addition, there are also other three primary ligaments in the knee that are: PCL or Posterior

Cruciate Ligament (cruciate ligament), MCL or Medial Collateral Ligament (collateral

ligament), and LCL or Lateral Collateral Ligament (collateral ligament).

ACL injuries are prevalent in sports that demands for lower extremities usage such as

basketball, football, soccer, and downhill skiing. These sports involve a lot of stress in different

bones and muscles in the lower limbs which makes the players vulnerable to lower extremities

injuries such as the ACL tear or sprain. When normal function of the anterior cruciate ligaments

is impaired, the person will likely experience loss of balance.

 28

It is important to note that injuries, specifically sprain, are graded on the severity scale.

There are three grades for sprain. Grade 1 involves only a small amount of stretching or fraying

of the ligament’s fibers. They person may experience mild swelling, pain, or bruising but is still

able to put weight on the affected leg. Grade II level means that the injured ligament is not

completely torn or is just partially torn. Unstableness and pain may be experienced when weight

is exerted. Grade III is the most severe sprain injury as it involves a complete tear of a ligament.

Ligaments may be separated from the bone and intense swelling and bruising will be felt and is

impossible to put weight on the affected leg as indicated by Roach et al. (2015).

According to OrthoInfo (2014), the causes of ACL injury are: changing direction rapidly,

stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct

contact or collision, such as a football tackle.

“Several studies have shown that female athletes have a higher incidence of ACL injury

than male athletes in certain sports. It has been proposed that this is due to differences in physical

conditioning, muscular strength, and neuromuscular control. Other suggested causes include

differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and

the effects of estrogen” (OrthoInfo, 2014).

Several symptoms are related with ACL injury. These symptoms include: a loud “pop” or

popping sensation in the knee, severe pain and inability to continue activity, rapid swelling, loss

of range of motion, and a feeling of instability or “giving way” with weight bearing (Mayo

Clinic, 2019).
 29

Diagnosis of ACL injuries can often be made by physically examining the injured knee to

the other. When the mentioned symptoms above are reported further manual tests such as pivot-

shift test, anterior drawer test, and Lachman test can be performed by the doctor. The pivot-shift

test requires the flexing of the knee and holding onto the ankle and slightly rotating the tibia

inwards (Physical Therapy Web, n.d.). In the anterior drawer test, it involves flexing the knees to

a 90-degree angle, sits on the person’s feet, and gently pulls the tibia towards him (Physical

Therapy Web, n.d.). “The Lachman test is performed by placing one hand on the person's thigh

and the other on the tibia and pulling the tibia forward” (Physiopedia, n.d.). If manual

examination appears to be positive for ACL injury, confirmatory test in a form of Magnetic

Resonance Imaging will be required. This method will provide images of ligaments and cartilage

around the knee (OrthoInfo, 2014).

Causes

ACL injuries often occur in activities related to sports that especially stress the knee.

Specific instances that could cause ACL injury include suddenly changing directions upon

planting foot, landing on one leg from a jump, a direct hit to the knee, sudden stop or slowing

down from running, and constant and repeated stress directed towards the knee (“Anterior

Cruciate Ligament (ACL) Injuries,” n.d.).

Risk Factors

Though anyone can acquire ACL injury, there are a number of factors that can increase

the risk of an ACL injury. Being female increases risk as females were found to have three times
 30

higher rates of ACL injury in comparison to males. The reasons behind these include differences

in muscle strength, conditioning, and control (Khadavi & Fredericson, 2019). Other suggested

reasons for the gap in risks between both sexes are the difference in pelvis and lower extremity

alignment, and effects of estrogen on the ligament properties ((“Anterior Cruciate Ligament

Injuries,” n.d.). Estrogen was found to have decreased the stiffness of tendons and ligaments and

thus, decrease power and performance of women, in particular (Chidi-Ogbolu & Baar, 2018).

Participating in certain sports wherein the aforementioned causes commonly occur, such as

football, tennis, volleyball, and skiing is also a risk factor (“ACL Injury”, 2019). Previous

experiences of torn ACL can increase the risk of tearing a repaired ACL by 15% and is higher in

first year after the injury. The same percentage can be observed in the opposite knee upon

acquiring the injury (Khadavi & Fredericson, 2019). This is due to the person having the

tendency to exert more effort on the other knee in order to make up for the inabilities of the

injured leg.

Other risk factors include using poorly maintained sports equipment and gears as well as

playing on artificial turf surfaces or fields (“ACL Injury”, 2019). These factors are circumstances

that could directly affect an athlete’s performance leading to the ACL injury.

Preventive Measures

Evaluation from athletic trainers and medical professionals in the field of sports can help

in giving an athlete proper instructions and feedbacks to help reduce risks of ACL injury. Proper

training that focuses on proper execution of turning, pivoting, and jumping as well as knee
 31

positioning and exercise that strengthens the leg muscles, core, hips, and lower abdomen are

highly recommended to prevent tearing the ACL (“ACL Injury”, 2019).

SECTION 2 – THERAPY, TREATMENT, AND REHABILITATION

According to Miller (2018), the treatment available for Anterior Cruciate Ligament or

ACL depends on the severity of the injury, whether other parts of knee are injured as well, and

other factors such as how active that person is, age, overall health, and how long ago the injury

occurred. This type of injury can be treated either surgically or non-surgically. The medical

doctor in charge can recommend first aid, medications, and the use of knee brace, physical

therapy, or surgery.

First Aid

If the injury is minor, the doctor will recommend putting ice on the affected knee,

elevation of the leg, and to not walk for a little while. Wrapping the affected knee with a bandage

can help reduce the swelling. The use of crutches can also help given that it helps the patient

keep weight off the affected knee. These first aid techniques help reduce the swelling and pain.

The RICE method is also used wherein R stands for “rest the knee”, I for “put Ice on it”, C for

“give gentle Compression to the knee”, and E for “elevate the leg”.
 32

Medications

There are anti-inflammatory drugs that help reduce the swelling and pain brought by the

injury. The doctor may prescribe stronger medications, depending on the severity of the injury or

some over-the-counter medications if the injury is less severe. If there is intense pain felt by the

patient, injecting the affected knee with some steroid medication may be needed.

Knee Brace

Knee braces provide extra support for the patient. These are usually worn by patients

when they run or play sports. These braces provide support for people with damaged ACL. Since

the recovery may take 12 to 18 months to fully heal, patients can use knee braces to speed up

their recovery. It helps the patient go back to their sport and it helps in the prevention of a re-

injury.

Physical Therapy

Physical exercises are very important I terms of recovering from an ACL injury or

surgery. Physical therapy is done a few days a week to help get the knee back to work. The goal

of these exercises is to regain neuromuscular control of the quadriceps, strengthen the hip, and

maintain knee and ankle range of motion of the affected leg. The sessions include different

exercises to strengthen the muscles around the knee and to help regain a full range of motion.

Patients are usually sent home with these exercises for them to do on their own. There are

different levels of physical therapy for this specific injury. For the first level, 1-4 weeks after the

surgery, exercises such as the long sitting towel calf stretch, supine hamstring stretch, quad sets,

ankle pumps, heel slides, and prone hip extension.

 33

Surgery

Surgery is needed when the ACL is either torn badly, the knee gives away when walking,

or if the patient is an athlete. With the help of physical therapy, the patient will be able to play

sports again within 12 months. Non-surgical treatments are usually considered first, unless

surgery is necessary. Surgery is usually needed when the ACL is not able to heal on its own

because there is no blood supply on the affected ligament. Surgery is usually required for athletes

because it helps them safely perform the movements required for their specific sport. There are

three major types of ACL reconstructive surgery; these are done arthroscopically by inserting an

illuminated scope into the joint through a small incision. First surgery is the Patella tendon –

bond autograft. This surgery involves the removal of the central one-third of the patella tendon

along with a piece of bone at the attachment sites at the kneecap and tibia. Next surgery is the

Hamstring autograft, where two tendons from the hamstring muscles are wrapped together to

form the new ACL. Last major surgery is the Quadriceps tendon grafts, these are excellent for

revision surgery, pediatric ACL tears, and PCLs. Partial and full knee replacements are also done

when necessary. Before and after surgery, proper rehabilitation is needed to strengthen the

muscles surrounding the ACL, stabilize the knee joint, reduce swelling and increase the range of

motion.
 34

SECTION 3 – THE EXERCISE FORM

The exercise form or regimen that is proposed in this case study is set of different of

different exercises that have been grouped together in accordance to the amount of time that has

passed since the ACL of a client received an injury. These exercises have been studied and

approved by physical therapists, and have multiple papers that prove the effectiveness of these

exercises in facilitating or hastening the healing process. This regimen will be listed below using

the proposed exercise routine template. After the routine, its evidence-based significance and

effects will be listed. This regimen is based on the pre-operative protocol of the Boston Sports

Medicine and Research Institute on anterior cruciate ligament injury.

EXERCISES COUNT MOVEMENT SIGNIFICANCE FOCUS

EXECUTION
Quadriceps 20s/ 3-4x Lie on your back with The tightening of The kneecap will
Setting a day knee extended fully the action of the slide slightly
straight. Contract the quadriceps upward toward the
front thigh muscles. muscles would thigh muscles.
straighten the
knee and be
pushed flat
against the floor.
This would help
maintain the
muscle tone in the
thigh.
Heel Prop 5 m/ 3x a Lie on your back with a To fully Let the knee relax
day rolled up towel under straighten the into extension
your heel or sit in a chair knee. If not, a (straight).
with the heel on a stool. weight (2 to 5
pounds) can be
placed on the
thigh, just above
the kneecap.
Heel Slides 20s/ 3x a While lying on your To regain the Do this until injured
day back, actively slide your flexion of the knee can be equally
heel backward to bend knee. bended with
the knee. Keep bending uninjured knee.
the knee until you feel a
 35

stretch in the front of the

knee. Hold this bent
position for five seconds
and then slowly relieve
the stretch and straighten
the knee. While the knee
is straight, you may
repeat the quadriceps
setting exercise.
Straight Leg 20s/once a Tighten the quadriceps To improve The ability to
day (First (quadriceps setting) as quality of the tighten lower
Lift week, much as you can, push muscle extremity muscles
without the back of the knee contraction and especially the
ankle against the floor. Then strength. quadriceps.
weights) tighten this muscle
harder. Lift your heel 4
20s/once to 6 inches off the floor.
every Tighten the quadriceps
other day harder again. Lower
(With your leg and heel back
ankle to the floor. Keep the
weights) quadriceps as tight as
possible. Tighten this
muscle harder again.
Relax and repeat.
36
 37

AFTER THREE WEEKS

EXERCISES COUNT MOVEMENT SIGNIFICANCE FOCUS
EXECUTION
Stationary 10-20m/ If you cannot pedal all To move the knee Knee joint
Bicycle day the way around, then joint and increase movement and
keep the foot of your knee flexion. flexion.
operated leg on the
pedal, and pedal back
and forth until your knee
will bend far enough to
allow a full cycle. Most
people are able to
achieve a full cycle
revolution backwards
first, followed by
forward.
Standing Hold the Stand facing the wall, To correct Hamstrings and
Hamstring flexed using the wall for imbalances. gastrocnemius.
Curl position balance and support.
for 2s/ While standing on the
2ox a day uninjured limb bend the
knee of the operated side
and raise the heel toward
the buttock.

Standing 2s/ 20x a Stand facing a table, Prevent atrophy Strengthening the
Toe Raise day hands on the table for (a loss of muscle affected calf
support and balance. mass) and muscles.
Keep the knees extended improve the
fully. Tighten the function of entire
quadriceps to hold the lower extremity
knee fully straight. Rise
up on ‘tip-toes’ while
maintaining the knees in
full extension.
Hip 8s/ 2x a Lie on your uninjured Knee injury is Better muscle
Abduction day side. Keep the knees often associated activation and
fully extended. Raise the with lack of hip performance.
operated limb upward to strength and that
a 45 degree angle hip abduction
exercises can
improve the
condition.
Wall Slides 8s/ 2x a Stand upright with your Can increase To improve leg
day back and buttocks mobility and strength. Rapid
 38

touching a wall. Place flexibility. gains in your

the feet about 12 inches mobility once you
apart and about 6inches incorporate them
from the wall. Slowly into your daily
lower your hips by routine.
bending the knees and
slide down the wall until
the knees are flexed
about 45 degrees.

SIX WEEKS AFTER INJURY AND ONWARD

EXERCISES COUNT MOVEMENT SIGNIFICANCE FOCUS
EXECUTION
Chair Squat 3 sets of In the chair squat Dynamic strength Boost your exercise
10 to 15x exercise, you lower your training exercise performance,
buttocks toward the that requires decrease your risk
chair until your buttocks several muscles of injury, and keep
touch the chair. Do not in your upper and you moving more
sit or rest on the chair, lower body to easily throughout
but instead immediately work together the day.
and slowly return to the simultaneously.
standing and starting
position. Remember to
keep your head over
your feet and bend at the
waist as you descend.
After the first week, you
may hold dumbbells
while performing this
exercise. Start with 3 to
5 pounds in each hand.
You may add 2 to 3
pounds per week until
you reach 10 pounds in
each hand.
Step Up 3 sets of 5 For this exercise, place a They can improve The moves target
repetitions small stool or a book or your balance, your legs, upper
for the a block of wood on the coordination, and body, and core,
first week. floor, about 2 feet from agility. building strength
You may a wall chair. Place the and flexibility.
add 1 foot of the operated limb
repetition on the stool. Maintain
per balance by holding onto
session, the wall or chair. Slowly
until you step up onto the stool
reach 3 and slowly let the knee
 39

sets of 15 straighten. Slowly lower

repetitions, the opposite foot to the
floor, trying not to rest
but instead slowly
returning to the
‘stepped-up’ position.
One Legged 3 sets 15x Continue the toe-raises Prevent atrophy One Legged Toe
Toe Raise from phase 2, but now (a loss of muscle Raise
try to rise up and down mass) and
slowly on just the improve the
operated side. Hold the function of your
uninjured foot off the entire lower
floor and hold the wall extremity
or a chair or table for
balance and support.
Hamstring Hold the Bend slowly forward at Tightness behind The hamstring
Stretch stretch for the hips, keeping the the knees and legs muscle group
15 to 20 knee fully extended pulls your posture crosses both the hip
seconds until you feel gentle out of neutrality and the knee and
and repeat stretch in the back of and puts strain on causes action in
3 to 5 your thigh and knee. your back both joints
times. muscles. Most
people who have
back pain have
tightness in their
hamstrings.
Calf Stretch 15-20s/ 3- Keep the heel flat on the If your calves are Foot pain, heel pain
5x floor and the knee fully tight and (plantar fasciitis),
extended. Lean forward inflexible and achilles tendon pain
at the hips with the arms can’t do their jobs and dysfunction,
supporting your weight. (that we talked shin splints, calf
about above) pain, knee pain and
which are all vital even hip and back
to the normal pain.
biomechanics of
walking?
 40

Evidence-Based Significance and Effects

• QUADRICEPS SETTING - According to Palmeiri-Smith, RM and Lepley, LK. (2015)

Patients with high and moderate quadriceps strength symmetry had larger central

activation ratios as well as greater limb symmetry indices on the hop for distance

compared to patients with low quadriceps strength symmetry (P<0.05).

• HEEL PROP – According to Biggs, A., Jenkins, W., Shelbourne, D., and Urch, S. (2009)

Heel prop is important in recovering ACL injury because it allows the knee to fall into

hyperextension.

• HEEL SLIDES – According to Alberta (2020). Heel slides are important in acl injured

patients because helps regain the range of motion by stretching the muscles on top of the

thigh.

• STRAIGHT LEG LIFT – According to Sears, B. PT (2019) Straight leg lift is a great

way to help improve the strength of quadriceps and muscles in your hips. It helps target

those muscles that support your knee and help with normal walking.

• STATIONARY BICYCLE - can improve range of motion in the knee joint, according to

Massachusetts General Hospital Sports Medicine. According to Brannagan, M. (2019) it

may be unable to put much weight on your affected knee, rehabilitation works to regain

some stability that might have been lost. Riding a bicycle improves circulation to the

lower extremities and also works the muscles both above and below the knee, which can

improve support for the joint.

• STANDING HAMSTRING CURL – According to Frankston and Mornington

Peninsula’s Premier Personal Trainers (2020). When using the hamstring curl it is best to
 41

perform these unilaterally in the initial General Preparatory Phases of training. This will

allow for the correction of any imbalances from the left to right sides.

• STANDING TOE RAISE and ONE-LEGGED TOE RAISES – are important for walking

and balancing. According to Wilson, RJ. (2017), tiptoe training will strengthen your feet,

calves, and legs. It might even help with back pain by aligning your body in a natural

stance.

• HIP ABDUCTION - According to Garrison C. (2015) in a hip-focused training program

of healthy women aged between 18 and 25 years, investigators saw significant

improvements in landing kinematics after the training, signifying a potential model for

ACL prevention.

• WALL SLIDES – Wall slides are important to regain knee flexion, according to Wilson,

C. (2020).

• CHAIR SQUAT - helps build strength and tone in your quadriceps, gluteus maximus and

calves, according to Nunley, K. (2020).

• STEP-UPS – According to The prehab guys LLC (2019). Step ups and step downs are

both amazing exercises for prehab and rehab purposes alike. But in order to truly

maximize your gains in the gym or clinic, you need to perform them correctly.

• HAMSTRING STRETCH, QUADRICEPS STRETCH, and CALF STRETCH -

Stretching those muscles are equally important. They need to be pliable enough to allow

the joint to move through a full range of motion, according to Quinn, E. (2019).
 42

CHAPTER IV – CONCLUSION

SUMMARY OF FINDINGS

In the case of the injury, a torn ACL has become common enough to the point that

multiple surgeries has been made to treat a torn ACL. These surgeries are in no way

experimental and are actually considered a common surgery for athletes. There are multiple

completely fleshed-out programs ready to be chosen by clients, from simple surgery-therapy

packages to expensive knee replacement surgery. Multiple organizations, such as gyms, online

fitness instructors, and even medical schools and hospitals offer rehabilitation programs, multiple

choices of surgery, or both.

In the case of the treatment, the exercises were proven to be effective based on the

multiple studies done before this. The studies referenced tested the effectiveness of each

individual exercise in rehabilitating an ACL injury, and all the results in the studies show that the

exercises were indeed effective. There were slight differences such as intensity or frequency

based on the client, but the routine is otherwise applicable to all clients who have a torn ACL.
 43

INDIVIDUAL CONCLUDING STATEMENTS

Abam

Through this case study, I was able to gain an insightful comprehension that the Anterior

Cruciate Ligament is basically an infamous knee injury caused by sports e.g. Football or Track

and Field. It laid stress on different bones and muscles mainly in the lower extremities of a

player, making him susceptible to ACL. Some of us are more likely to have such injury because

of our poor body mechanics. As a dancer that habitually uses my lower limbs, I am vulnerable to

being injured if I belittle my movements and the way my body adjusts to keep its balance. One

instance is if I twist my legs abruptly that shows no coordinated effort of the muscles and bones,

resulting to an ACL tear. And as a nursing student, a firm and practical understanding of ACL

can accentuate the importance of proper body mechanics. It can save a lot of unnecessary pain

and injury throughout my course since I routinely help patients through a range of different

motions that can exert either of us if executed improperly. The stance, natural posture and

motion of the human body, particularly as it relates to lifting, repositioning, and moving patients.

I need to know how to use the muscles, tendons, and ligaments in my lower extremity as I

perform movements to get the most leverage without risking injury. If I get an ACL tear, with

the help of the case study we conducted, I will be able to determine what muscle, ligament, or

tendon was affected seeing that the human body has dozens of muscle groups, various types of

joints and complex weight distribution. I would also be able to identify the exercises needed

while or after rehabilitating. Utilizing this case study can help stress the principles of body

mechanics as a healthcare student. For players, dancers, or even students with poor body

mechanics, it can make the muscles more likely to be injured when they are stressed. Also, weak,

under exercised muscles can rob the back of its support. PATHFIT 2 Fitness Exercises helped
 44

me engaged in physical activities increasing heart rate and preserving physical and mental health.

Whether we engage in a light exercise such as Tai Chi, or high intense activity like step ups, it

provides a huge range of benefits for the body and mind. It essentially became a stress reliever

for me after continuous major subjects that even though I am overwhelmed with responsibilities

as a nursing student and doesn’t have fitness regime, Pathfit 2 is still better than none especially

to me who currently have an inactive lifestyle. It taught me to just work at my own pace, doing

too much too quickly can increase the risk of injury. Pathfit set targets based on the goals you

established at the start of the class and celebrate small wins after performances to boost

confidence. I really enjoyed both Pathfit 1 and 2 with the same instructor. After all, a class is

more sustainable if a person enjoys.

Cuenca

PATHFIT 1 and 2 really pushed me beyond my limit. I am comfortable in speaking of

both PATHFIT classes because the courses were both taught by Mr. Pasilan. This paper has been

exhausting to do, but even this cannot beat the exhaustion I feel every time we perform in class.

Regarding this paper, as I read through the related literature, I realized that injury like an ACL

tear cannot happen to me easily simply because I am too sedentary. However, my obesity might

make it harder for my ligaments to limit my movement so that might result in me having an

injury. As a nursing student, to be able to understand the inner workings of the ACL is amazing

to me. To understand how it works and how exactly it tears amazes and terrifies me at the same

time. Usually, the ACL gets torn through excessive speed or turning. But based on the references

I read, all it takes is a wrong step for the ACL to get injured, and that wrong step can spell the

difference between me continuing on my journey towards being a nurse and me being kicked out
 45

of the course because of a disability. Making this study made me realize that so many

movements we make in our day-to-day life could end in permanent disability if the odds are

against us. Our bodies are constantly being pushed to its limit without us even feeling it, and it is

easy for us to take for granted what supports are normal movement until they get injured. In the

end, PATHFIT might have been one of the hardest courses I had this year, but I cannot deny the

lessons it gave me, both in academics and in what my body can actually do. I am thankful that I

had to go through this course because if I had a choice, I do not think I would have signed up for

PATHFIT but if I did not, then I would not have learned the things I know today about the

body’s capabilities.

Follero

This paper enabled me to have a profound understanding about the different ligaments

located on the knee especially the Anterior Cruciate Ligament since the ACL is the main focus of

this study. Because of this paper, I was able to learn the importance of biomechanics on our daily

life. It is astounding to think that different parts of the body such as muscles, tendons, and

ligaments work in harmony with each other to be able to perform a movement. As a young

physically active nursing student I, myself, is susceptible to different injuries such as sprain. This

study affected me positively as I become more conscious to proper execution of pivoting,

turning, jumping, and landing to avoid injuries. This also highlighted the different exercise form

that can be done if I get injured like the stationary bicycle which focuses on the muscles located

in the lower extremities of the body such as the legs. This exercise will help me regain range of

motion, stability, and circulation which can help me improve the support in the joint affected.

My experience with the class PATHFIT2 was exhausting since it does not only require physical
 46

work but also intellectual. Regardless the hardships I experienced, I am still very thankful

because I was able to understand and integrate PATHFIT2 to nursing to which our instructor Mr.

Earl Pasilan emphasized.

Gonzales

Before conducting and writing this study, I had so little knowledge regarding the topic. I

had come across this specific injury because I have friends who experienced this and went on

surgery. However, I have not dug that deep, therefore majority of the information gathered were

new to me. It affected me knowing that this type of injury can happen to anyone when playing

sports. It can be very severe which requires surgery with some very invasive procedures. The

recovery period takes up to weeks and the physical therapy sessions can lead up to months. This

could be a hassle because it limits the person’s ability to perform daily activities, especially

walking. There are many ways on how get injured, but it is mainly through sports. I personally

don’t consider myself sporty or physically active, however sports cannot be avoided in college,

and everybody is required to participate in one through PATHFIT classes. This injury usually

happens on athletes, however, people who participate in sports should always be careful and be

mindful. There simple ways on how to prevent this type of injury. One is to train oneself with

sports. That’s what I have to do when I participate in sports, I have to train myself well so that

this injury won’t happen to me, and so should others because this injury is not a joke. This study

enlightened me in a way that, before, I haven’t been interested in sports related injuries because

I’m not an athlete and I don’t play sports that often, but this study made me realize how equally

important it is as with athletes. As a student nurse, being mindful and knowledgeable regarding

injuries are an essential in the career. My experiences in the class are one of a kind and
 47

something I haven’t expected that I’d be doing or performing. To start off, the routine,

techniques, and dances taught in class are very new to me given that it is from another culture.

These are concepts I haven’t encountered yet in my life, but I ended up loving it. They were

difficult to execute at first because they were very new, however, once we got a hang of it, it was

fun. The course was an essential and helpful for my course because not only does it talk about

the execution of sports and physical fitness, but it also focuses on the anatomy.

Patega

Before I started writing the paper, I have little to no knowledge regarding the benefits of

physical therapy. But as I was reading some studies related to what I'm writing, I've come to

realized that doctors prescribe patients who have certain orthopedic conditions or are recovering

from orthopedic injuries or surgeries to undergo physical therapy. This treatment helps patients

increase functionality and strength using individualized rehabilitation training, exercises, and

treatments. Aside from increasing mobility and strength, physical therapy provides several other

benefits that improve your overall health and well-being. This realization made me more

cautious in engaging to daily life activities, because at the end of the day, prevention is still

better than cure. To sum it all up, my experience in PATHFIT does not just consists of reading

facts, It was a wholesome experience, because I've got to engage in dances and exercises that

requires precaution which made me realized the value of avoiding an injury and how physical

therapy helps in addressing it.

 48

Ramos

In this case study, I was able to gain knowledge about the Anterior Cruciate Ligament is

basically an infamous knee injury caused by sports most especially in basketball. It laid stress on

different bones and muscles mainly in the lower extremities of a player, making him susceptible

to ACL. Some of us are more likely to have such injury because of our poor body mechanics. As

a nursing student, we have been reminded by our professor’s of the importance of proper body

mechanics. The effects of improper body mechanics can especially be observed when we lift

heavy objects or when we are tasked to move immobile patients. And also in this study I learned

a lot about ACL, Anterior Cruciate Ligament in not easy to cured because the ACL cannot be

restore to a normal function through reconstruction, so we must take measures to preventing

ACL injuries from occurring through training and more studies so that it will help us to

understand why this happens, so that it can be prevented. And also recovery from ACL surgery

can take anywhere from six months to a year. Active rehabilitation via physical therapy is

required to help the knee to heal and to: Reduce pain and swelling. Restore range of motion. I

need to know how to use the muscles, tendons, and ligaments in my lower extremity as I perform

movements without getting risking injury. Through this case study I was able to gained

awareness in my body movements and also I was able to distinguish some forms of exercise to

used in order to recover the ACL. PATHFIT 2 Fitness Exercise helped me to be more Fit and

Healthy. I really enjoyed both PATHFIT 1 and 2 with the same instructor, Sir Earl Pasilan. I

hope in our next PATHFIT, we can have the same instructor.

 49

Rojas

Upon writing the study, I have gained insights on how important it is to maintain proper

body mechanics. The anterior cruciate ligament may be our chosen topic, but all ligaments and

tendons serve various purposes to our body to enable our daily functions efficiently in a stable

manner. As a nursing student, we have been frequently reminded of the importance of proper

body mechanics. Implementing it aids us in conserving energy as well as to prevent injuries that

we may acquire over time. The effects of improper body mechanics can especially be observed

when we lift heavy objects or when we are tasked to transfer or move immobile patients. It wears

our backs and knees down and over-using these parts of our body will prove to be a heavy

consequence in the future. Aside from that, even in our daily lives, we take little notice to how

we move our bodies. As long as we are able to move it. Through this case study, I was made

aware of actions such as turning and jumping and how they may cause stress to the connective

tissues, particularly the ACL, when executed in an unorderly manner. These things are actions

that we may seldomly do, but it is still important to prevent potential injuries to ourselves. Even

in our PATHFIT exercises, we should take note of the proper execution of particular steps in the

dances and exercises that we had performed. This had made me reflect on my own body

mechanics and see my errors as well as understand and learn how I can improve myself.

Royo

Anterior Cruciate Ligament Injuries involves a lot of stress in different bones and

muscles in the lower limbs. It has different causes especially on people who love playing sports

and also has different treatments that can be surgical or non-surgical. As an athlete it is important
 50

to know about ACL injury, by having knowledge about ACL injuries it might help other athletes

to avoid this kind of injury by sharing the information like how it can be prevented when playing

or preparing for a game. For an instance a person gets injured, the thing that a person must do is

to apply what he/she learned about this study to avoid more complications. By this study I can

apply it to my course. Being a nursing student, I need to learn on how to control my body

mechanics, especially in assisting the patients. I can apply what I have learned as a nursing

student. And as an athlete I can share what I have learned to my fellow athletes. In PATHFIT

class, ACL treatments can be used as an exercise to prepare students from any kind of ACL

injuries. And by the help of PATHFIT subject, every student will know what treatment can be

applied when having ACL injuries, especially the athlete students in Ateneo de Zamboanga

University.

SUMMARY OF STATEMENTS

We admit that PATHFIT was a hard course for all of us. But as nursing students, it has

given us important information and lessons that we would not have received from a usual

nursing class. The routines, practices, and dances made us aware of how important it is to take

care of our bodies. We easily take for granted the fact that we can move the way we move

because of all the muscles, tendons, and ligaments that keep our body together. A single torn

muscle or ligament can cost us our future, and this subject made sure that we realize how

important it is to not only know about our body, but to also take care of it. We are thankful for

having this course, and we hope to apply the learnings we received from it in our lives, but in our

careers and to ourselves.

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