Walking with a completely torn ACL is certainly realistic for most people
- Walking with a completely torn ACL is certaintly achievable for most people relatively quickly
- The most likely time that walking is impacted is within the first few days after an ACL tear due to the onset of pain and swelling upon injury
- If you have torn your ACL you will normally have good enough functionally in your knee that enables you to walk and even jog in straight lines
- However, rupturing the ACL can lead to instability in the knee. The feeling of the knee giving way is most often felt with certain movements that involve sudden changes of direction
- When giving way or buckling of the knee occurs this increases the risk of further injury such as damage to the cartilages in the knee and this in turn can lead to an increased risk of developing premature osteoarthritis
- In most cases movements in straight lines including walking and running are achievable and should not cause further damage
- These activities can often be performed with relative ease even if you have completely torn your ACL
- The extent to which walking is impacted by an ACL rupture is often linked to the level of pain and swelling in the knee. This is most often felt in the first few days after injury
- In this respect if you have just hurt your knee on the sports field or somehow else and you are showing symptoms of an ACL injury – it is also possible that other areas of your knee have also been injured such as the surrounding cartilage and other ligaments
- Any other damage to your knee in addition to tearing of the ACL is likely to contribute in vary degrees to pain and swelling in your knee
- Therefore it is the combination of a torn ACL and any other damage to your bad knee which can impact your ability to walk
Function of the Anterior Cruciate Ligament that is connected
- The function of the ACL is primarily to provide stability and balance. The ACL prevents the tibia from sliding forward over the femur and provides stability for pivoting and twisting movements
- If you have torn your ACL then you may lose the ability to pivot or change direction suddenly without the knee feeling like it is giving way – preventing you from returning to your normal activities and sports like football, hockey or tennis
- The purpose of an ACL reconstruction is to stop this instability. However, it should be noted that there are a number of studies which indicate some people have been able to function normally with a torn ACL and return to sport
- Whether or not you will be able to return to your normal physical activities and sports without surgery is dependent on a number of factors
Do you need medical advice prior to walking on a completely torn ACL?
- If you suspect an ACL injury then it is advised to consult your doctor or physio as soon as possible for both diagnosis and initial injury management
- Walking on a completely torn ACL is normally possible without incurring any further damage however the extent of knee instability may not be known immediately. It is best to avoid any sudden twisting or pivoting in the knee until you have been fully assessed by a doctor
- Complete ACL tears can often be diagnosed with a reasonable degree of certainty immediately by a physician who has experience in assessing knee injuries
- To fully diagnose the extent of a cruciate ligament injury the physician may wait for the swelling to subside before taking conclusive scans or carrying out tests. This is to ensure that the test results are as accurate as possible
Walking limitations after completely tearing the ACL
- Sometimes it can be difficult to walk following an ACL injury as you may have stiffness or swelling which limits your legs flexibility and range of motion
- Approximately 80% of ACL injuries result in significant bone bruising which necessitates minimal weight bearing in the first instance. To reduce swelling apply ice for 15 to 20 minutes regularly at least 4 to 5 times a day
- So whilst you can walk with a completely ACL, sports that require sudden changes of direction such as football, basketball, or hockey may result in the knee giving out or buckling
What can you do to improve walking with a completely torn ACL
- You can look at using crutches in the first instance to support your knee until the swelling is reduced and knee flexibility has improved
- ACL recovery protocols including No HARM and RICER should begin immediately after the injury event to limit further swelling and bleeding in your knee and to help improve flexibility
- Undertake gym and strength work on your knee to build functionality back to pre-injury levels including locking and extending of the knee.
- Another key factor that can impact your walking after tearing the ACL is your tolerance to the rehabilitation process and following the correct protocols
- Option to have surgery to replace the ACL graft which should be considered and discussed carefully with your surgeon and doctor. If the decision is made to have surgery, then it is important to prepare your knee with ACL prehab exercises
When can’t you walk with a completely torn ACL
- Less frequently a patient may experience imbalance issues or ongoing severe pain after an ACL injury that prevents them from walking without the assistance of crutches
- If the injury has caused other structural knee issues that needs to be assessed by a doctor – knee functionality may be further impaired as a result
If you can walk normally after tearing your ACL do you need surgery?
- Whether or not your ACL injury requires reconstruction surgery is a personal decision that is based on a number of factors including your fitness levels, age, and physical activity requirements going forward
- As noted previously, most people will be able to walk successfully with a torn and ACL and even be able to jog in straight lines. Often the capacity for the knee to engage in twisting and pivoting motions is significantly compromised with a torn ACL
- Whilst the majority of people with a torn ACL will elect to have surgery there are also many people who choose of course not to have surgery.
- Not having surgery is a real option that should be discussed with your surgeon. Do not hesitate to seek a second opinion if you are not comfortable with the advice that you have received
Can you walk with a partially torn ACL – what is the difference?
- In terms of your ability to walk after an ACL tear, you should in most instances be able to walk and run in straight lines after an ACL injury regardless of whether or not you have completely or partially torn your ACL
- However there may be a noticeable difference in your ability to pivot or turn suddenly in the injured knee compared to before you incurred the ACL tear
- With a completely torn ACL, turning or twisting can be much more difficult and you may experience a giving way or buckling sensation. This collapasing sensation has the potential to cause further structural damage to your knee such as tearing to cartilage
- If the ACL is partially intact then it is possible that the ACL will continue to perform its role and provide stability and balance to the knee under the stress of twisting motions
- However, a partially torn ACL which has been weakened and no longer at full strength may be at a greater risk of further tearing especially when under high intensity physical load
What to do if you tear your ACL?
- Upon injury of an anterior cruciate ligament, a common tear symptom is the accumulation of excess blood swelling to your knee which will limit functionality and can lead to further discomfort and pain. As discussed above, you should consult your doctor immediately for assessment if you suspect a knee injury
- It is important to follow proper injury management protocols that aim to actively reduce blood swelling (RICER) and avoid activities which can cause further aggregation and inflammation to the knee (No HARM)
- It is not likely that you will cause more damage walking with a torn ACL however limiting twisting and pivoting motions should be front of mind
- Importantly, preparing and conditioning your knee through an appropriate treatment and exercise plan will be important to successful post ACL injury recovery
- For instance, if the decision is to have surgery then restoring knee extension and knee flexion, regular icing, reducing swelling and strenthening the quadriceps before surgery is key
No HARM to help recovery after a complete ACL tear
- The no HARM principles are essentially about avoiding activities that can cause an increase in blood swelling to an injured body part
- In that respect if you have suffered a knee injury or ACL rupture than it is important to implement No HARM in particularly within the first 48 to 72 hours after incurring the injury
- No HARM principles for injury treatment essentially refer to the avoidance of Heat, Alcohol, Running and Massage within the first few days to avoid dilation of blood vessels to the injured area which can be detrimental to the repair process
Heat: avoid application of heat packs, saunas and heated swimming pools.
Alcohol: avoid drinking alcohol after an injury as the substance can cause inflammation and blood swelling within injured areas of the body
Running/exercise: avoid any strenuous running or placing excess strain on your knee exercise such as running or gym work on your bad leg
Massage: if applied directly to your injured knee, massage can cause an increase in blood flow and swelling to the injured area which should be avoided for at least the first 48 to 72 hours after the injury event
RICER to help you reduce swelling and control pain after an ACL tear
- RICER principles essentially refer to the active reduction of blood flow and swelling to the injured body part and is highly effective within the early onset of an ACL tear (especially within the first 48 to 72 hours after the injury)
- In the first few days after tearing your ACL it is important that you take care of yourself by reducing swelling and controlling your pain through Rest, Ice Compression and Elevation.
- In the event that you have surgery continue to implement RICER in the early to intermediate stages of your ACL recovery timeline.
Rest: limit any sudden movements or twisting. You should basically be resting at home after the first day or two after tearing your ACL by keeping the knee as elevated as much as possible.
Rest is required to reduce the metabolic demands of the injured tissue and to avoid activities that cause stress on the injured area. Rest immediately after an ACL tear is also needed to avoid disrupting the early phases of the repair process.
Ice: regular icing is a key component to reduce knee swelling, An ice pack should be applied to the knee for 20 minutes every one to two hours within the first 48 to 72 hours after tearing the ACL. Icing also helps to alleviate pain caused by the injury.
Ice is used to cool and reduce the temperature of the tissue in the injured area, reduce metabolic demand and limit the bleeding.
Compression: wearing a compression bandage or sleeve is also another key component to controlling and reducing knee swelling.
Compression helps limit oozing of fluids from the damaged capillaries into the tissue and controlling the inflammatory process.
Elevation: Keep you knee elevated as much as you can by lying on the floor/couch/bed with sufficient support under the knee such as a towel or pillow.
Elevation of the knee lowers pressure in the local blood vessels and reduce bleeding in the injured area. It also helps to drain excess fluids and inflammation.
Referral: upon the onset of a sports injuring whether or not it be in relation to the ACL knee or another part of the body, it is very important to see a physician to assist with performing a diagnosis of the injury and to help guide you through your next steps of recovery.
- If you have torn your ACL you should still have strong enough stability in your knee that enables you to walk without the knee buckling!
- Movements in straight lines including walking and running are normally achievable and should not cause further damage to your knee
- After incurring an ACL knee injury consult your doctor or physician for a full diagnosis and injury management advice
- The onset of pain and swelling upon tearing your ACL is likely to have the most signficant impact on your ability to walk in the first 1 to 2 days. As swelling reduces walking should become easier
- No HARM and RICER injury management techniques should begin immediately after the ACL injury to limit further swelling and bleeding
- Importantly if you suffer an ACL injury then you need to avoid sudden twisting movements or sports that require changes in direction which can cause damage to knee cartilage
Good Luck With Your ACL Injury Rehabilitation!
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