So you tore your ACL, now what?
You can probably pinpoint the precise moment when you felt – and maybe even heard – that painful pop in your Knee. You likely spent the following days unable to put weight on your leg, diligently following the RICE protocol (rest, ice, compression, elevation) while awaiting the results of your MRI scan. Then your doctor delivered the bad news: you tore your anterior cruciate ligament – also known as your ACL.
It sucks, but it happens – a lot. Although the exact prevalence of ACL injuries is difficult to determine, a 2017 review estimated that around 350,000 reconstructions – the procedure that’s become an almost automatic certainty for everyone, everywhere with an ACL tear – are performed each year in the United States alone. Cumulatively, those surgeries cost Americans over $3 billion every single year.
But while ACL tears are often treated as a one way ticket to Surgery – do not pass GO, do not collect $200 – there’s growing evidence that many ACL ruptures can actually recover and heal on their own without going under the knife.
Understanding ACL tears
First things first: what’s an ACL, and what happens when you injure it?
The ACL is a small ligament with a big job. It helps hold the femur (thigh bone) and tibia (shin bone) together, stabilizing the joint in rotational and side-to-side movement.
Things like sprinting, cutting, and landing from a jump can put a lot of force on your knee, and if the muscles in your leg aren’t up to the task of absorbing that force, that stress gets put directly on the ACL ligament. These types of injuries aren’t limited to just football players and MMA fighters, either. About 70% ACL injuries happen from non-contact events, rather than direct blows to the knee.
Research suggests that female athletes are two to eight times more likely to experience an ACL injury as male athletes – mainly due to differences in anatomy and ligament strength that put women at higher risk.
So do you need surgery?
It’s important to clarify that an ACL injury and an ACL tear aren’t the same thing. A tear is a type of injury to the ACL, and how serious it is determines what kind of treatment is necessary to get back on your feet. If you’ve got a grade 1 or 2 injury – defined as a sprain or partial tear of the ACL – you might not need surgical intervention.
Those who partially tear their ACLs (where at least half of the fibers remain intact) usually don’t require surgery if they’re not having any problems with instability. As long as you’re not experiencing any knee locking, sudden weakness, or buckling, conservative treatment is often a better choice of action than surgery.
In fact, the impressive KANON trial out of Sweden showed that nearly 60% of even severe ACL tears in their study healed within 5 years without surgery. Further research suggests that that number could be as high as 90% if placed on a restricted-movement bracing/taping protocol.
So how do you fix an ACL injury without surgery?
Increasingly often, patients are opting for non-surgical options due to their cost-effectiveness and potential to allow them to avoid surgery (and the months-long recovery time) altogether. Even if you do choose to go under the knife, the following conservative therapies are also extremely effective as supplemental treatment, leading to a quicker and more complete recovery following reconstructive surgery.
- Chiropractic Manipulation: Using gentle hands-on force to bring the the knee joint back into its optimal alignment can help reduce pain and inflammation, improve range of motion, and allow soft tissues to heal properly. A chiropractor can also help correct biomechanical issues in your hips, ankles and feet to help minimize stress on the knee as it heals.
- Physical Therapy: Rehabilitative exercise programs can help improve range of motion, strength, and stability in the knee. Physical therapy can also help reduce pain and swelling, and prevent further injury.
- Bracing/Kinesio Taping: Restricting movement with an orthopedic brace or kinesio tape can help support ligaments as they heal and reduce the risk of further injury.
- Graston Therapy: Also known as IASTM or ‘myofascial scraping’, Graston is an instrument-assisted method of breaking down scar tissue, eliminating muscle adhesions, increasing blood flow and promoting a better healing environment.
- Cryotherapy: Cold therapy can help bring down pain and edema in the knee. It can usually be performed at home, using ice packs or a specialized machine.
What if your ACL is completely torn?
Unfortunately, complete tears to the ACL aren’t as likely to heal on their own. But even if the ACL doesn’t heal, studies have shown that many can still recover and return to high levels of function with good rehabilitation just as well as surgical repair!
Many push the surgical route because they want to prevent knee osteoarthritis later on, but there’s actually no current evidence that surgical repair prevents arthritis. In fact, some evidence even suggests that surgical ACL repair might increase the chances of developing osteoarthritis later in life.
Obviously, there’s no denying that some ACL tears (particularly those that occur in combination with MCL tears and medial meniscus tears) are best corrected surgically to offer improved stability and function. However, there’s really no rush to do this, as there are no definite signs to indicate whether surgical reconstruction is the best course of action. Often, the best approach is to wait and see how things feel over time.
But don’t wait to start rehab!
Whether you choose the surgical approach or not, it’s critical to start the rehabilitation process (or ‘pre-habilitation’ if you’ve already made the decision on surgery) as soon as possible.
Not tomorrow, not next week – start doing your knee rehab ASAP.
As swelling and pain calms down, it’s especially crucial to get the quad muscle going, as this muscle group tends to become weak and inhibited quickly. Most patients will be instructed to start with quad sets (see below) and then work their way up to more advanced quadricep exercises. You want to restore extension and flexion as quickly as possible.
Getting on the rehab train early will help reduce stiffness, improve range of motion, and rebuild strength and endurance. At Ascent Chiropractic, our ACL recovery protocol typically includes a combination of exercises, stretches, myofascial release therapy, chiropractic manipulation, and taping or bracing.
Recovery time can vary depending on the severity of the injury and the treatment approach. Low-grade ACL injuries may only take a few weeks to heal, while more severe injuries usually require several months of rehabilitation.
Disclaimer: This is not a substitute for medical care. Please consult a doctor or healthcare professional to get a medical diagnosis, rule out any serious complications and get advice on a treatment plan for your particular condition before beginning any self-treatment described here.
The Ascent Chiropractic Difference
The number one priority should be to find a doctor who understands the ACL tear recovery process in its entirety, and to be diligent with your prescribed rehab routine.
There’s a reason Shepherd Express recently named us the top Milwaukee chiropractor in their Best of Milwaukee 2022 awards – we’re experts in the biomechanics of everything from your head to your toes, and we combine the best of both chiropractic and rehabilitative therapy treatments. So if you’ve been diagnosed with an ACL tear and given a one-way ticket to surgery, give us a call.
Ready to get started? Make an appointment at Ascent Chiropractic by calling 262-345-4166 or using our online scheduling app.
