You Tweaked Your ACL – Now What?

Most often when a goalie tears their ACL it is from a contact injury. They get tangled up and the knee gets forced into a position it is not meant to ever be in and OUUUUCHH! The ACL takes the brunt of it.

There are three grades of ACL tear (you might hear it called a strain):

Grade 1 – some minor damage to the ACL, the fibres are overstretched, not torn. There might be a bit of swelling, but the knee is stable

Grade 2 – some fibres are torn. There is likely some pain and swelling and the knee may or may not feel unstable. It will depend on the degree of the Grade 2 tear from mild to severe.

Grade 3 – so long ACL, that mother is completely torn. If you do something to your knee (or someone falls on you) and you hear and feel a “POP” (others might hear it too) and then your knee swells up like a balloon, the chances are that you have completely torn your ACL. Not always, but typically. Oddly enough, after the initial injury, it might not be THAT painful. It very likely will feel unstable.

If you think you have sustained an ACL injury, then step #1 is to ice it, rest it and elevate it. Try to keep the swelling out as much as you can for step #2, which is getting it assessed by a good sport physio or sport medicine doctor.

Depending on the level you play at, your team trainer may not have the experience or skill to pick up on a tear with a manual assessment. Your family doctor likely will not be able to either.

You want to try and keep the swelling out of the knee as much as possible, and get it assessed as soon as possible so the sport physio or sport med doc can get a good physical assessment.

Some knees when they are blown up like a balloon will not give enough movement for an assessment, so then you need to wait for the swelling to subside before you can get a good physical exam.

Unless you are a pro or high level player, don’t expect them to send your right off for an MRI right away. Physical exam is the primary means of diagnosis.

Regardless of the grade, you should be sent to physio to help maximize your recovery. Make sure you go and make sure you do the exercises they give you.  If they are just giving you ultrasound and electrical stim without any active therapy, range of motion work, etc., beyond the first two weeks, better start looking for a new physio.

Resist the temptation to get back on the ice, just to test it out and see. Moving around the crease with an unstable knee is a great way to go from a partial ACL tear to a complete tear and maybe damage your meniscus in the process.

Your priorities are:

  • Get the swelling out
  • Get full pain free range of motion back – quadruped rock back
  • Make sure your quadriceps are firing (they may be shut off through a reflex inhibition from the injury) using things like Quad Sets
  • Start working on closed chain pain free patterns – unloaded squats, body weight squats, single leg balance, etc.

Here’s what those look like…

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That will get you started – remember that you cannot accelerate the healing time for a tissue.  All you can do is give it an optimal environment for healing and in the early stages that means being patient.

I will be back tomorrow or the day after with some progressions as your knee gets feeling better and you get closer to a return to the ice.

For now, have a beauty day!

PS – – if you haven’t downloaded my new GoalRobber Checklist yet, you can get it HERE for free