PHYSIOTERAPY MANAGMENT AFTER ACL INJURY

COVER SLIDE, JOSIP:

Hello everybody. It is good to see you all. We want to thank you for coming. As you all
know, my name is Josip, and this is my colleague Marko and today we are going to tell you
something about “Physiotherapy management of ACL injury”. We chose this topic because
we both train football and this injury is quite common in this sport.

There are six main points I'd like to discuss: anatomy and biomechanic, acl injury itself,
etiology, symptoms, treatment of injury and our role as physiotherapist.

ANATOMY AND BIOMEHANICS, MARKO:

Let's start with anatomy and biomechanics.

The ACL is located inside the knee joint. The knee is trochoginglymus joint. Ligaments
found in the knee are ligament patellae, popliteum obliqum, popliteum arcuatum,
collaterale fibulare et tibiale, ACL and PCL.

WHAT IS ACL INJURY?, JOSIP:

What is an ACL injury?

It is an injury in which stretching or tearing of one or more ligament fibers occurs. The injury
most often affects young athletes, and it happens with landings, sudden changes of
direction or hyperextension.

When we talk about causes, there are contact and non-contact causes of injury.

HOW TO INJURY OCCURS, MARKO:

Non-contact injuries are caused by incorrect movement of the lower extremity.

There are 3 degrees of this type of injury.

At the first degree, ligament stretching occurs, and with the second and third degree of
injury, one or more ligament fibers burst. For every degree there is a characteristic
sensation of pain, difficulty performing movements and edema.

SYMPTOMS, JOSIP:

When we will talk about the symptoms of the injury. There are early and late signs of injury.

Early signs are crepitus, frequent knee dislocation, severe pain, and rapid swelling.

Late signs are feelings of instability in the knee, pain, reduced range of motion, inability to
perform physical activity.

TRETMANET/HEALING, MARKO

Now we will show you what the treatment process looks like after an injury. After the injury
we apply R.I.C.E. therapy.

R means rest.

I mean ice, and it stands for the application of ice that reduces edema and pain.

C is for compression that reduces edema.

E is for elevation. With the help of elevation, blood does not linger in the legs and the result
is reduced edema.

Physical therapy and kinesitherapy are carried out even before surgery to replace the
muscle mass that will be lost during rest.

5 STAGES AFTER SURGERY, JOSIP:

In first month (0-4 weeks) the goal is to reduce pain, do full extension, strengthen the
quadriceps

Next step, after 5-12 weeks the range of motion is increased, also we are adding weight
and the person is returning to daily exercise, activities, and dynamic actions (skips, etc.)

MARKO:
13-20 weeks later, person does a full range of motion and is returning to running and
jumping, we are adding proprioception exercises

21-32 weeks a person can do one-legged jumps and landings, changes of direction and is
able to return to the field

THE ROLE OF PHYSIOTHERAPIST, JOSIP:

The role of the physiotherapist is to apply physical therapy, most often cryotherapy and
electrotherapy.

Cryotherapy causes vasoconstriction of vessels, and this reduces edema. Electrotherapy

uses electrostimulation that prevents muscle atrophy formation and increases the
strength and activation of muscle quadriceps femoris and also, TENS, which has an
analgesic effect.

MARKO:

Kinesiotherapy is also done by a physiotherapist who, during the exercise, must pay
attention to many things such as breathing, proper body position, proper exercise, patient
overexertion and many other things.

JOSIP:

After the injury, it is important to motivate the patient, because it can happen that the
recovery does not go according to plan, so the patient becomes depressed and loses the
will to train. Then the task of the physiotherapist is to motivate the patient.

MARKO:

Every physiotherapist must educate the patient on how to perform knee exercises and
stretching exercises at home.

JOSIP:
Before each kinesiotherapy or physical therapy, it is necessary to observe the patient's
knee. Then we check whether the knee edema has increased or decreased. The knee can
also be palpated and with palpation we know where the patient feels pain.

With this injury, it is necessary to do a Lachman test and a front drawer test, which if
positive indicates an ACL injury.

ACL INJURY AS A WORLD PROBLEM , MARKO:

NOW, LET ME CONCLUDE THIS PRESENTATION. 100,000 people in the U.S. suffer from an
ACL injury. Often the cause of injuries can be reduced physical activity, which causes
obesity. When people start doing some activity they neglect stretching and warming up. If
an injury occurs and a person returns from physical therapy, they often neglect the
recommended knee exercises, which puts them at risk of re-injury.