Thursday, November 14, 2019

PT Pathologies: Anterior Cruciate Ligament Sprain - Grade III

In the United states, ACL sprains seem to be one of the most discussed diagnoses.  A grade 3 sprain is considered to be a complete tear of the anterior cruciate ligament.  This major source of stability is located where the end of the femur meets the top of the tibia.  This ligament is in the middle of the knee and prevents the tibia from sliding in front of the femur.  There are many diverse ways to sprain an ACL, such as getting hit from the side as one would in football, overextending the knee joint and quickly stop moving or changing direction while running.

        At the time of the injury, one might hear a popping sound.  Within the next 6 hours the knee will begin to swell and pain, especially with bearing weight, will commonly occur.  To diagnose an ACL sprain, during the physical exam the doctor will check the patient's knee for swelling and tenderness.  Also, the injured knee will be moved in a variety of positions to test the patient's range of motion and function of the joint.  A physical exam can diagnose an ACL tear alone, but X-Rays, MRI's and Ultrasound may be used to determine the severity.  Three contributing factors to an ACL sprain are biomechanics, the way one's body moves, muscular imbalances, which includes females who have stronger quads than hamstrings, and finally overtraining.  Combining all three creates a very high chance that the individual could potentially be lead to an ACL injury.

        When dealing with patients who are trying to overcome an ACL sprain, it is quite common that they will be very motivated.  Typical patients are usually athletes and will work harder than other age groups to return to their sport.  If an individual grade 1 (partially stretched) sprains their ACL it is possible that the injury will progress to a Grade 3 (complete tear) with continued stress and vigorous exercise.   Treatment without surgery to repair an ACL sprain would include a specific program, use of an electrical stimulation machine to fire the quadriceps muscle, and strength.  Treatment after surgery will include icing and compression, exercises to increase patient's ability to move and strength.

        Approximately 200,000 ACL injuries occur a year and half of those patients require surgery.  Directly after surgery, Physical Therapists typically give the patient a list of home exercises.  While at the rehabilitation center, patients will be guided through weight bearing exercises and gradually will be able to walk without crutches and return to normal gait.  After this is achieved the therapist will incorporate exercises to improve balance, running and jumping.  The main goal  with this type of patient is to help them return to their sport as soon as possible but regarding all limitations.  After pain and swelling is completely gone and feelings of instability have diminished, therapists usually release their patient to return to sports and regular activity.

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