ACL Tear / ACL Injury
What is an ACL Tear?
The anterior cruciate ligament (ACL) is one of the primary stabilizing ligaments in the knee. An ACL tear is a common sports injury, often occurring during sudden stops, pivots, or awkward landings. Athletes in football, basketball, soccer, and skiing are particularly at risk.
Common Symptoms
A “popping” sound or sensation at the time of injury
Rapid swelling within hours
Knee instability or “giving way” with activity
Loss of full motion and difficulty walking normally
Physical Therapist Diagnosis
A physical therapist can perform several clinical tests to identify an ACL injury. The Lachman test, anterior drawer test, and pivot shift test are the most reliable for detecting ACL tears. Therapists also evaluate swelling, joint stability, range of motion, and muscle activation. While imaging such as MRI can confirm the diagnosis, skilled clinical assessment often provides immediate insight into the likelihood and severity of injury.
Why it Happens
Most ACL tears are non-contact injuries caused by poor landing mechanics, deceleration with rotation, or strength/mobility imbalances. Contact injuries (like direct blows to the knee) can also tear the ACL, often alongside other structures like the meniscus or MCL.
Why it Doesn’t Always Heal on Its Own
The ACL has a very limited blood supply, which means it rarely heals naturally. While surgery is sometimes necessary, especially for athletes who need cutting and pivoting movements, many individuals can still benefit from comprehensive rehabilitation to restore strength, stability, and function. There is also some interesting new evidence coming out that not everyone requires surgery after tearing their ACL, making PT all that more crucial!
Ideal Physical Therapy Treatment
The best outcomes for ACL rehabilitation come from a comprehensive, progressive program tailored to the individual. Physical therapy should begin as soon as possible (even before surgery) by restoring range of motion and reducing swelling, then transition into targeted strength, balance, and movement retraining. As the athlete progresses, therapy must incorporate sports-specific drills, plyometrics, and agility work to prepare for the demands of return-to-play. Dry needling can also be helpful for reducing secondary muscle tightness and improving quad activation.
Key elements of an ideal ACL rehabilitation program include:
Movement assessment to identify risk factors and prevent re-injury
Manual therapy and mobility work to restore range of motion early
Dry needling for quadriceps or hamstring tension
Strength and neuromuscular training targeting the glutes, hamstrings, and quads for knee stability
Sports performance progression including cutting, agility, plyometrics, and return-to-play testing
Collaboration with surgeons when post-surgical care is required
Expected Outcomes
With consistent rehabilitation, individuals recovering from an ACL tear can expect to regain knee stability, restore athletic confidence, and safely return to their sport within 9-12 months typically. A structured program also reduces the risk of re-injury and helps athletes improve mechanics that may have contributed to the original injury.