Treatment for ACL Injury

Anterior Cruciate Ligament (ACL) Injury

What is an anterior cruciate ligament (ACL) injury?
The anterior cruciate ligament (ACL) is one of the major ligaments in the middle of the knee. Ligaments are strong bands of tissue that connect one bone to another. The ACL connects the thighbone (femur) to the shin bone (tibia). This ligament, along with the posterior cruciate ligament, helps keep the knee stable and protects the femur from sliding or turning on the tibia. A sprain is a joint injury that causes a stretch or a tear in a ligament.

Sprains are graded 1, 2, or 3 depending on their severity:

•grade 1 sprain: pain with minimal damage to the ligaments
•grade 2 sprain: more ligament damage and mild looseness of the joint
•grade 3 sprain: the ligament is completely torn and the joint is very loose or unstable

The ACL may be completely torn or partially torn. Most injuries are complete tears.

How does it occur?
The anterior cruciate ligament is frequently injured in forced twisting motions of the knee. It may also become injured when the knee is straightened further than it normally can straighten (hyperextended). It sometimes occurs when the thigh bone is forcefully pushed across the shin bone, such as with a sudden stop while you are running or a sudden transfer of weight while you are skiing.

What are the symptoms?
There is usually a loud, painful pop when the joint is first injured. This is often followed by a lot of swelling of the knee within the first several hours after the injury. This swelling is called an effusion and is made up of blood in the knee joint. You may find it difficult to fully bend or straighten your knee.

If you have torn your anterior cruciate ligament in an injury that occurred months or years ago and you haven't had reconstructive surgery, you may have the feeling that the knee is giving way during twisting or pivoting movements.

How is it diagnosed?
Your healthcare provider will examine your knee and may find that your knee has become loose. If you have swelling in the joint, he or she may decide to remove the blood in your knee with a needle and syringe. You may need X-rays to see if there is an injury to the bones in your knee. An MRI (magnetic resonance imaging) scan may also be done and should clearly show the condition of your ACL (as well as that of other ligaments and cartilage).

How is it treated?
Treatment includes the following:

•Put an ice pack on your knee for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain goes away.
•Keep your knee elevated whenever possible by placing a pillow underneath it until the swelling goes away.
•Take an anti-inflammatory medicine or other drugs prescribed by your healthcare provider. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider's approval.
•Do the exercises recommended by your healthcare provider or physical therapist.

Your provider may recommend that you:

•Wrap an elastic bandage around your knee to keep the swelling from getting worse.
•Use a knee immobilizer initially to protect the knee.
•Use crutches.

For complete tears, you and your healthcare provider will decide if you should have intense rehabilitation or if you should have surgery followed by rehabilitation. The torn anterior cruciate ligament cannot be sewn back together. The ligament must be reconstructed by taking ligaments or tendons from another part of your leg and connecting them to the tibia and femur.

You may consider having reconstructive ACL surgery if:

•Your knee is unstable and gives out during routine or athletic activity.
•You are a high-level athlete and your knee could be unstable and give out during your sport (for example, basketball, football, or soccer).
•You are a younger person who is not willing to give up an athletic lifestyle.
•You want to prevent further injury to your knee. An unstable knee may lead to injuries of the meniscus and arthritis.

You may consider not having the surgery if:

•Your knee is not unstable and is not painful and you are able to do your chosen activities without symptoms.
•You are willing to give up sports that put extra stress on your knee.
•You are not involved in sports.
If a growing child tears an ACL, the healthcare provider may recommend that surgery be postponed until the child has stopped growing.

How long will the effects last?
When you tear your ACL you will have pain and swelling for several weeks. You need to stop doing the activities that cause pain. If you continue doing activities that cause pain, your symptoms will continue.

If you have a completely torn anterior cruciate ligament the effects will be chronic. Your knee may feel loose and feel like it will give way when you are running and making quick turns. Rehabilitation exercises and a special brace will help improve these symptoms.

When can I return to my normal activities?
Everyone recovers from an injury at a different rate. Return to your activities will be determined by how soon your knee recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your normal activities when, starting from the top of the list and progressing to the end, each of the following is true:

•Your injured knee can be fully straightened and bent without pain.
•Your knee and leg have regained normal strength compared to the uninjured knee and leg.
•Your knee is not swollen.
•You are able to walk, bend and squat without pain.

How can I prevent an anterior cruciate ligament sprain?
Unfortunately, most injuries to the anterior cruciate ligament occur during accidents that are not preventable. However, you may be able to avoid these injuries by having strong thigh and hamstring muscles and maintaining a good leg stretching routine. Practicing coordinated jumping and landing may help prevent ACL injuries. In activities such as skiing, make sure your ski bindings are set correctly by a trained professional so that your skis will release when you fall.

Written by Pierre Rouzier, MD for RelayHealth.
Published by RelayHealth.
Last modified: 2009-01-09
Last reviewed: 2009-01-07
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Kinesio Tape for Sports Injuries

What is Kinesio Tape?



For over 25 years, Kinesio has provided comfort and stability to our loyal users. Kinesio Tape offers patients a more gentle approach to rehabilitation than those provided by conventional athletic tape. On the heels of our unprecedented publicity and positive feedback from the 2008 Olympic Games in Beijing, we here at Kinesio would like to invite you to experience what athletes and medical practitioners around the world are calling the rehabilitative and enhancement tool.

Kinesio Tape is a Latex free, non-medicated, thin, porous cotton fabric with a medical grade acrylic adhesive. The tape is comprised of elastic qualities which are designed for a 30-40% longitudinal only stretch when applied. Our bodies were designed to move and the Kinesio Taping Technique promotes movement and motion. With Kinesio Tape, we are not only limited to supporting and stabilizing musculature, but allowed to provide rehabilitation while encouraging movement!

How it Works:
The technique relies heavily on insertions and origins of muscles. The built-in stretch of the tape can help stabilize injured muscles, support fatigued, weakened and/or strained muscles, and can also help facilitate a stretch for those muscles in spasm.

In addition to muscle support, Kinesio Tape can lift the skin to increase the space between the skin and muscle. This reduced localized pressure in the affected area helps promote circulation, lymphatic drainage, and lessen the irritation on the subcutaneous neural pain receptors. As an end result, the Kinesio Taping Technique reduces pain and inflammation.

Since the introduction of Kinesio Tape in the United States, medical practitioners such as PTs, ATCs, OTs, DCs, MTs and MDs have recognized and embraced this effective, safe and best of all, easy-to-use modality. The method and tape allow the individual to receive the therapeutic benefits 24 hours a day with both comfort and ease because it can be worn for several days per application. Currently, Kinesio Tape is being used in hospitals, clinics, high schools, colleges, professional sports teams, and even at the Olympic level!

For more information, please visit www.kinesiotaping.com or consult with one of our health care professionals!


Chiropractor Fairfax VA, 22031

Testing New Exercise Technique

Testing New Exercise Technique


A year ago, Michael Bemben, professor of health and exercise science in the University of Oklahoma College of Arts and Sciences, was invited to the National Press Club in Washington, D.C., to formally announce the partnership between the American College of Sports Medicine and Sato Sports Plaza of Japan. The partnership is an effort to facilitate independent research projects around the country to examine the efficacy of a new type of training technique.



Bemben's lab at the university is currently only one of four labs outside of Japan that has been working with the KAATSU-Master training system, testing the effectiveness of reducing blood flow to exercising muscle. This technique allows for a reduction of the external loads that need to be lifted from a traditional high load of 80 percent of a person's strength down to 20 percent while maintaining all the benefits of the high-intensity programs. KAATSU-Master has been in development for more than 40 years in Japan and now is working on building research abroad regarding the many benefits and uses for the equipment.



KAATSU-Master may be used by both professional athletes and older adults in need of activities that limit physical stress to the body, giving them both similar benefits of weight training without having to lift heavy loads and deal with high joint stress. Other advantages may include faster rehabilitation or physical therapy for orthopedic problems, reduced hospital stays, and reduced muscle and bone loss during space flight. Both NASA and the Japanese space agency JAXA are working with KAATSU-Master for use in space exploration.



OU's lab has completed several different studies on men and women of various ages, including 18- to 25-year-olds and 50- to 64-year-olds, using KAATSU-Master to compare both the acute and chronic responses of muscle and bone to traditional high-intensity weight training and muscle endurance weight-training interventions.



In general, they have found an increase in markers for bone formation; a decrease in markers of bone resorption; increases in hormones responsible for muscle growth; increases in muscle strength and size; no changes in inflammatory markers; and increased muscle activation that are similar to or enhanced when compared to traditional high-intensity resistance training programs.



If this training technique is confirmed to be safe and effective by this new research initiative by the American College of Sports Medicine, then it is hoped that a program ultimately could be established that would certify trainers worldwide to use this equipment in a variety of settings with many different populations.



The Department of Health and Exercise Science is the third-largest department in the OU College of Arts and Sciences. Faculty, graduate students and undergraduate students have multiple ongoing research projects that involve different aspects of exercise physiology and health promotion. For more information, visit their Web site at http://hes.ou.edu.



Source: Michael Bemben

University of Oklahoma

Treatment for Medial Meniscus Tear

A great summary from the Sports Injury Clinic...

What is a medial meniscus injury?
The medial meniscus is more prone to injury than the lateral meniscus as it is connected to the medial collateral ligament and the joint capsule and so is less mobile. Hence, any forces impacting from the outer surface of the knee, such as a rugby tackle, can severly damage the medial meniscus. In addition, medial meniscal injuries are often also associted with injuries to the anterior cruciate ligament. Other mechanisms of injury may be twisting of the knee or degenerative changes that are associated with age. Any of these circumstances may lead to tearing of the medial meniscus, which in serious cases may require surgical intervention.

Symptoms of medial meniscus tear
A history of trauma or twisting of the knee
Pain on the inner surface of the knee joint
Swelling of the knee within 24-48 hours of injury
Inability to bend knee fully- this may be associated with pain or a clicking noise
A positive sign (pain and/or clicking noise) during a "McMurrays test"
Pain when rotating and pressing down on the knee in prone position (video).
"Locking" of the knee
Inability to weight bear on the affected side

Types of meniscal injuries:
Degenerative Changes: This may lead to edges of the menisci becoming frayed and jagged
Longitudical Tears: This is a tear that occurs along the length of the meniscus
Bucket- Handle Tears: This is an exaggerated form of a longitudical tear where a portion of the meniscus becomes detached from the tibia forming a flap that looks like a bucket handle

Treatment of medial cartilage meniscus injury

What can the athlete do:

Apply RICE to the injured knee.
Wear a heat retainer or support.
Gentle exercises to maintain quadriceps strength, although care should be taken not to aggravate the symptoms.
Take a glucosamine / joint healing supplement.
Consult a Sports Injury Specialist.

A Sports Injury Clinician May:

The first aim of the sports injury specialist will be to correctly diagnose the injury. He/she may do this by utilizing specific tests for meniscal tears such as a "McMurrays" test. Once diagnised the practitioner may consider two different modes of treatment depending on the extent of the injury.

1. Conservative Treatment
This may be indicated in the case of a small tear or a degenerative meniscus and may involve:

Ice, compression and recommendation of NSAIDs e.g. Ibuprofen.
Electrotherapy i.e ultasound, laser therapy and TENS.
Manual therapy
Once pain has subsided, exercises to increase range of movement, balance and maintain quadriceps strength may be prescribed. These may include: squating, single calf raises and wobble-board techniques.

2. Surgical Intervention
In the event of more severe meniscal tears such as a bucket handle tear, arthroscopic surgical procedures may be necessary to repair the lesion. The aim of surgery is to preserve as much of the meniscus cartilage as possible. The procedure itself will normally invlove stitching of the torn cartilage. The success of the surgery depends not only on the severity of the tear but also on the age and physical condition of the patient. Younger and fitter patients are known to have better outcomes.

Following surgery a rehabilitive exercise program will be outlined for the patient which may include strenghtening and balance training. Full co-operation with the rehabilitive technique will be necessary to maximise recovery.