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Author Topic: ACL Injury / Physio Advice  (Read 3464 times)

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Offline knowles

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ACL Injury / Physio Advice
« on: June 02, 2010, 02:32:05 AM »
Hi everyone,

I injured my knee 6 weeks ago today playing football, I had an MRI scan 3 weeks ago however due to NHS waiting times I will not get an appt. with a consultant for roughly another 6 weeks. I am looking for some advice from people with experience who could offer suggestions as to the extent of my injury and any Physio work that I should undertake while I await the results. I will explain exactly what happened to me.

6 weeks ago while playing football I side stepped a challenge and just as I was planting my left foot on the ground I was twisting my hips and upper body slightly, I heard a snap, hit the ground and couldn't get up, severe pain and almost instant swelling. Straight to A&E and I was given crutches and a tubigrip. I was unable to walk or put weight on the leg for 10 days and for these 10 days I was fully dependent on the crutches. Now I still have instability while navigating steps and discomfort in general while I am walking. I can fully straighten my leg however I have an inability to fully bring my heel towards my behind as I can on my other leg, however over the 6 weeks this has imporved slightly. However it still hurts to attempt this kind of movement.

I have done extensive reading regarding ACL injuries and I am pretty sure that I have torn my ACL according to how the injury occured and the noise at the point of impact. Further more the instant swelling and post injury symptoms make me almost certain it's a tear. But I'm no specialist and I haven't had my scan results so I guess I still have some hope in the back of my mind.

Now I am a keen footballer, I play for 2 amateur teams which means that I play football and train 4 or 5 times weekly and I have done for the last 18 years. It's OK having an injury and knowing a tiimescale but this whole not knowing and waiting is killing me. I understand that if I went private I could be operated on and back playing within 6 months however I can't afford private treatment unfortunately.

I would be so grateful if people with more experience than I could help to attempt and answer some of my main questions if possible;

1/ I have read account of people actually fully tearing the ACL, but astonishingly they can walk/limp pretty much immediately after the injury. Now, I have pretty strong hamstring muscles and strong calf muscles however I was unable to put weight on my leg for 10 days. Does this indicate a serious tear that will probably require surgery?

2/ According to my account above of what happened and my symptoms since, could it be possible that I have not actually torn any ligaments? For example could it be a sprain? If it was a sprain would I still have issues with movement in my knee after 6 weeks?

3/ Assuming the worst and I have torn one of my knee ligaments... Should I be seeing a professional Physiopherapist now while I am completely unsure about the extent of the damage or should I wait for my MRI results before I consider any excercies or physio?

4/ Again assuming I have a tear, does delaying surgery cause any issues or problems potentially or any potential for further aggrevation?


I feel a little daft posting this considering I have not had my results yet but it is so frustrating not knowing what is wrong with you after 6 weeks of being unable to do what you love doing the most, i.e. playing football for myself.


Chris

Offline Snowy

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Re: ACL Injury / Physio Advice
« Reply #1 on: June 02, 2010, 03:39:53 AM »
First of all, I'm so sorry to hear about your injury. I'm three months out from a full ACL tear myself, so I remember that feeling of waiting for confirmation all too well.

I'm not an expert, but based on what I know of ACL injuries (and my own experience) this is what I can tell you.

1) Every injury is different. I suffered a partial ACL tear four years ago, was on crutches for a week, and suffered horrible instability for months afterwards - the leg would just buckle and collapse. The tear was small enough that it was missed on an MRI, but manual testing in a doctor's office revealed it about three years later - my knee was still lax. My recent injury was a complete tear - in theory, more serious - but I was partially weight-bearing from about the second day and have had almost no instability since. There could be any number of reasons for this (most likely that I was in lousy shape four years ago, and am in good shape now) but the take home is that there's no such thing as a "typical" ACL tear and response. Advice on surgery differs depending on where you are, but it's really not so much about the degree of tear but whether or not it leaves the joint lax and unstable. I really should have had surgery after my partial tear because the instability left me at a high risk of causing further damage, and I do now have early stage osteoarthritis in that knee.

2) See above. While you're displaying a lot of symptoms that are characteristic of an ACL tear, it is quite possible that it's not. The good news is you shouldn't have to wait to see the consultant to find out; if you go to your GP, there are tests they can do in the office that will determine whether the joint is lax. This will give you a good idea of whether or not you're looking at a tear and/or reconstruction. It's probably worth knowing that complete ACL tears rarely happen in isolation, so there might be other damage (e.g. to the meniscus or MCL) that is also causing problems.

3) Yes. I can't recommend this strongly enough. The PT will assess your joint and take into account the likely damage when they give you your exercises. Whether you end up going the surgery route or not, one of the most important things you can do is regain strength and range of motion. They'll help you with that stiffness that's restricting your movement now. Regaining extension is particularly important. You'll also get valuable advice on what you should and shouldn't be doing while you wait to have the diagnosis confirmed, which will help reduce the risk of further damage.

4) With ACL reconstruction, it's generally not done immediately because it's critical that you regain strength and range of motion (especially extension) before the operation. The best timeframe is between 6 weeks and 3 months after the initial injury, depending on your progress (and assuming there isn't other damage that requires immediate treatment.) If you go into surgery with range of motion still limited, it's extremely hard to regain it afterwards. However, the bad news is that walking around without an ACL does increase the risk of causing long-term damage to the knee. Because the joint lacks the lateral support provided by the ACL, it's prone to moving further than it should and this eventually translates to the dreaded arthritis. If you have to wait a long time for surgery, you may want to consider getting a brace to allow you to return to more activities. My PT got me in one fairly early and I was even able to ski again (gently) with it for support. Again, working with a PT will help you avoid the things that increase the risk of damage while you wait for surgery.

There are a couple of other things worth mentioning. The first is that this board is an amazing resource - do check out the information hub (cruciates section) for a ton of information on ACL injuries, making the decision whether or not to have surgery, prepping for surgery, and exercises you can do.

The second is that it's worth being a squeaky wheel with regard to the appointment times. I live in Vancouver, where we have really awful wait lists - I was initially told it would be at least two years before my surgery (5 months for the MRI, 18 for the initial consult, 6 from consult to surgery) and I'm now scheduled for my ACL reconstruction on July 9th, just four months after my injury. I suffered a huge amount of frustration and spent a lot of time on very persistent phone calls, but it did pay off in the end - and this seems to have been the case for quite a few folk here.

I'll be keeping my fingers crossed for you that your injury isn't as bad as you fear, and you're able to recover without the need for surgery. (This isn't impossible by any means - MCL tears, for example, generally heal on their own.) Do keep us posted on how things go for you. And don't worry at all about posting at this stage - there are many people here (myself included) who have been where you are now, so we know just how it feels and how maddening that wait for answers is.
« Last Edit: June 02, 2010, 03:49:46 AM by Snowy »
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline tez27

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Re: ACL Injury / Physio Advice
« Reply #2 on: June 02, 2010, 06:15:57 PM »
Hi Kris sorry about your injury but you have come to the right place, Snowy is a mine of information in all things acl related so she is a good source of information as is this whole forum.
As Snowy said there is no such thing as a typical acl rupture, in my case I was able to walk on the leg right away all be it it was very painfull and I couldn't bend it for the first couple of weeks but I never had a lot of swelling  whereas a lot of people like yourself cant weight bare at all after injury and most people have a lot of swelling so there is not a constant of what you should look out for.
Physio is important at this stage I have been going to a private physio who has been a great help in my prehab for my acl reconstruction, so of its at all possible get yourself a private physio even if its just to get them to test your knee to see what they think the problem is while you are waiting for your mri results
Dont know if any of that helps but best wishes anyway I hope things improve soon.
Take care Tez
L K injured 25th June 2008
scope Jan 5th 10
diagnosis ACL rupture
fiberous band excised from acl
ACLr July 19th 2010  scope on 24th Sept 2011
ACL has failed incorrect tunnel placement
23rd July 2012 1st stage of a 2 stage ACL revision
10th May 2013 2nd stage ACL revision

Offline knowles

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Re: ACL Injury / Physio Advice
« Reply #3 on: June 02, 2010, 08:23:44 PM »
Thanks a lot snowy really useful info. The annoying thing is that the doctors and consultants that I have already seen should have reccomended this to me but they didn't. The doctor at the A&E was so arrogant, he wasn't even going to tell me it was suspected ligament damage, never mind that I should be getting physio on it. Nor did they tell me to put Ice on it which I understand is crucial. I only applied ice after 24 hours once I had self diagnosed after reading up on very very resourceful and brilliant sites like this.
Anyway one bad experience with a doctor but this site gives me faith in people once more, thanks.

Offline Snowy

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Re: ACL Injury / Physio Advice
« Reply #4 on: June 03, 2010, 12:32:36 AM »
Really glad I could help. :) I'm astonished you weren't told to ice your injury - that should be automatic when you have any injury with swelling and pain. It may have been a bad night in A&E, but they really should have given you more advice.

This site has been a fantastic resource for me - it has helped so much just hearing from people who are going through (or have previously been through) the same kind of thing, and comparing notes on what we're being told and what we're doing. I've also found the Information Hub to be a really great source of information at times when I've had to wait to see my doctor or PT.

I would also chase up your scan results; 3 weeks seems a long time to wait. If it sounds like they're going to be a while, definitely get your GP or physio to do the tests for ligament laxity and tell you what they think.

Good luck getting some answers!
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline Cosmicsnuffle

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Re: ACL Injury / Physio Advice
« Reply #5 on: June 04, 2010, 09:47:19 AM »
Hi Chris,

Well put Snowy and Tez! - I'd second the "squeaky wheel" analogy.... I ruptured my ACL, sprained MCL, parrot beak tear to lateral meniscus and substantial kissing contusions in September 09, was just told to RICE at A&E and go to see my GP if it still hurt after 7 days. So many frustrations - referred to soft tissue clinic instead of ortho,  I ended up going to the hospital on crutches to "chase" down my MRI results as each department denied having them - and in October my initial OS consultation came through for FEBRUARY. I was still NWB 6 weeks after injury, my knee was locked and I was in agony :-(

As with Snowy it took lots of assertive/persuasive phone calls - I was seen by an OS in December, scoped in January to release a trapped ACL stump and trim the meniscal tear and reconstructed two weeks ago.
Be polite.... my aim was to ensure my OS and his secretary knew me by name (for good reasons!)!

The longest and hardest time was the time from injury to diagnosis. Once you can put together a plan of action you will have something to aim for.

In the meantime finding a good PT can be part of that light at the end of the tunnel.

....and time - sometimes the wait in the NHS is a pain - whether by design or not, sometimes it is exactly what your knee needs.

Good Luck - we look forward to hearing how your knee journey goes :-)
Oct 04 - torn meniscus
Dec 05 meniscal trim and debridement
Sep 09 torn ACL, kissing contusions, knee locked 30-60o
Jan 10 ACL stump debrided, lateral parrot beak meniscal tear trimmed
May 10 ACLr (Hamstring)
Aug 11 mfx (focal lesion lateral femoral condyle)
Jun 14 100k walk London-Brighton 28hrs

Offline knowles

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Re: ACL Injury / Physio Advice
« Reply #6 on: June 24, 2010, 10:39:55 PM »
Just an update on my status as your advice was REALLY helpful. I got my results briefly by phone, although I am still awaiting my clinical appointment they have already put me on the waiting list for surgery at my request. Complete tear of the ACL. I'm now on the waiting list so looking like 2-4 months for my OP!

Offline Cosmicsnuffle

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Re: ACL Injury / Physio Advice
« Reply #7 on: June 24, 2010, 11:33:36 PM »
Hey that's great news (about the waiting list!) .... not so great the complete ACL tear  :-\.

Glad you managed to get the ball rolling - wee look forward to following your progress..

Meantime - it may be worth trying to see a physio to get some pre-hab exercises  :D ....

 :)


Oct 04 - torn meniscus
Dec 05 meniscal trim and debridement
Sep 09 torn ACL, kissing contusions, knee locked 30-60o
Jan 10 ACL stump debrided, lateral parrot beak meniscal tear trimmed
May 10 ACLr (Hamstring)
Aug 11 mfx (focal lesion lateral femoral condyle)
Jun 14 100k walk London-Brighton 28hrs

Offline Snowy

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Re: ACL Injury / Physio Advice
« Reply #8 on: June 25, 2010, 05:55:18 AM »
Ack...that's too bad about the tear. Not a surprise given your description of the injury and the sensations, but I was hoping you were one of the lucky ones.

The best thing you can do now is get working on building your strength, flex and extension before surgery. Definitely get to a physio (if you haven't already, of course.)

There are also some great post-ACLr diaries over on the post-op section of the board if you're wanting to find out what to expect from surgery and its aftermath. I've found them very worthwhile as I prepare for my op.

Good luck!
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA