How important is it to see a physiotherapist for my injured ACL?

Q: I injured my ACL in a stupid accident while shooting baskets in the neighborhood. Now I'm benched for the season in my senior year of college. The surgeon who treated me mentioned the risk of arthritis later and also suggested I see a physiotherapist now to help regain strength and proper alignment. How important is this really? I'm pretty depressed and discouraged and don't give a rip. I'm not sure I have it in me to do a rehab program if I can't play.

A: Your attitude is completely understandable. It is discouraging to play your heart out only to end up on the bench due to an unfortunate incident. Some people in the medical field say there are no such things as "accidents." There are always reasons why people get sick or are injured. And this idea may be very true when it comes to ruptures of the anterior cruciate ligament (ACL) of the knee.

Sure it's easy to say the ligament ruptured when the athlete was tackled and another player landed on that leg. Or when the basketball player's foot was planted on the floor and she got knocked over while trying to pivot and shoot.

But the truth is these events happen many, many times to other athletes who don't end up with an injury. So we try to accept what has happened and make the best of it -- maybe even learn a few things we had not expected along the way.

But there are other reasons to buck up and get busy with rehab and recovery. Studies show there can be long-term consequences such as reinjury or joint arthritis developing years later. A good rehab program can help you avoid some of these unpleasant possibilities.

The therapist can help you reduce neuromuscular risk factors contributing to injuries such as posture, landing biomechanics, ground reaction forces, core stability, trunk displacement, and proprioceptive repositioning error. Changes in movement patterns from any one of these factors increase the strain on the ACL and seem to be contributing to the increased risk of ACL injuries.

With proper training and good body mechanics, athletes can be protected from new injuries or avoid reinjury of the same area. Knee geometry cannot be changed but improving muscle strength, motor control, and neuromuscular coordination could make a difference. And many athletes with ACL ruptures are able to return to full participation in the sports of their choosing. You may yet want to take advantage of this aspect of rehab as well.

Reference: Helen C. Smith, MS, ATC, et al. Risk Factors for Anterior Cruciate Ligament Injury: A Review of the Literature - Part 1: Neuromuscular and Anatomic Risk. In Sports Health. January/February 2012. Vol. 4. No. 1. Pp. 69-78.

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