SAAF CAMP

Anterior Cruciate Ligament (ACL) ... By Keith Dorsette      

Anterior Cruciate Ligament, commonly referred to as ACL, is a vital part of body’s mechanical structure. It is a ligament that connects the thigh bone (femur) and the shin bone (tibia). Collagen is a substance that is found in soft tissues and bone throughout our body. The ACL is made up from type 1 collagen. The function of the ACL is to provide stability in the knee area. Despite the actual size of the ACL, it’s durability is quite remarkable. It can withstand pressure (force) up to 500Lbs.

The ACL assists with stability by ensuring that the tibia does not move too far forward. Additionally, it assists with rotary functionality for the knee, as in when the knee rotates. As you can imagine, a healthy and functioning ACL will enable you to walk, run and be as active as your body is designed to be.

If you are a SAAF CAMP trainee, you should be thinking in prevention mode by now. Your question should be  … if a healthy ACL is made of up collagen, how can I help my body produce healthy collagen? While there are a few answers that may contribute to this, a short answer is vitamin A. Foods like carrots and sweet potatoes are rich in vitamin A and can assist your body with the production of collagen.

In the world of athletes, ACL issues are a bit more common. As, the demand for performance of the ACL is increased due to the athletic regimen. Additionally, in activities that require rapid change of direction or pivoting, the threshold of force on the ACL is challenged more. If you have sustained an ACL injury, the rest of this article may assist you in formulating a plan to a solid (not speedy) recovery.

Some signs of an aggravated ACL may be a POP in the knee, pain, hemorrhaging within the knee joint, immediate swelling and the knee giving way. “Lachman’s” test is a standard practice to determine if there is an ACL tear. This can be done while lying down (on back) and having all of the leg muscles totally relaxed. Holding the femur with one hand and the tibia with the other, gently bend (pull) the tibia against the femur approximately 20-30 degrees. If the ACL is not torn, you will feel an end point to the movement. If the ACL is torn, there will be no end point – the tibia will move forward more than normal. If you feel any of this, you should get a radiological exam, MRI, x-ray … immediately.

The body is an amazing vehicle. It’s ability to adapt is beyond amazing. With an ACL injury, there is a process of healing that needs to be addressed carefully and methodically. It is not like a cut that can be patched up with a band aid or stitches. To repair an ACL, your body will need graph tissue. This can come from another part of your body or someone else’s. When that tissue is introduced to the ACL, your body will adapt to it and make it work. This process is referred to as ligamentization. It is the process of turning graph tissue into an ACL. For a simple term to describe this process or phase, let’s call it the remodeling phase.

This graph tissue requires all of the nutrients and collagen that are delivered by the blood. Think of these ingredients as the tools that your body will need in order to remodel the graph tissue into an ACL. Throughout this process, you should be very focused on ensuring that your blood is clean and collagen rich. Therefore, after you finish reading this article, you should invest some time into reading subject matter that guides you on how to keep your blood clean. You already know how to increase your collagen production (hint: vitamin A). After a few months, the graph tissue will use these tools to build you a new ACL. During this process, it is suggested that you participate in light exercises that will gradually replenish and build strength around the knee area. Do not over do it! Do not rush!

Returning to regular walking can take from 4-8 weeks. Depending on the injury, the surgeon with impose limitations as deemed fit. Although, for some, weight tolerance can be soon after surgery. It will feel uncomfortable and even painful. Crutches will be needed and should be used as directed. The more nurturing you are with the healing process, the stronger the ACL will become. Stretching and range of motion movements are suggested to expedite and facilitate a full recovery.

Returning to sports can take north of six months. This should not be rushed! It is also dependent on any other procedures that may have been done (such as with the meniscus). Additionally, your participation in physical therapy can impact the timeliness of your return to pre injury level. While you are waiting to return to the game so to speak, you are not sitting around! You should be engaging in a gradual process of rehabilitation via exercises that stimulate muscle building, agility, balance and range of motion. Week by week, month by month, the level of the exercises increases. If you were to visualize a ladder that has 100 steps, with the steps in the 90s being competition level, this will help you set a pace of rehabilitation. The lower steps are the basics, such as stretching, range of motion exercises, balance and stability. No weights, no time trials, just you managing your own body weight and going through the stages of introducing the ACL to it’s new host. These may be the first 10 steps of the ladder. Perhaps each step is taken on weekly at this stage. As you gain confidence and strength, the drills can increase in their demand. Gradual and patience is the key.

As you feel the progress, you should consult with a physical therapist to monitor the functionality of the knee. You will have to undergo a series of tests which will give you an idea of just how far you have come and how far is left to go before returning to the game. Some of the staples for such tests include one legged hop or squat, active or resisted leg exercises or side shuffles.

Keep in mind that someone else’s recovery time is not applicable to you! While some may return to full form within six months, others may take a year or more. What is important is that you return when it is the right time for you. *There are numerous references available online from reputable orthopedists and physical therapists that may introduce you to exercises and routines that can benefit your recovery.

In closing, whether you are recuperating from an ACL related issue or not, you must be mindful of how much weight your body is carrying. Your joints are designed to support and function as per your physiological design. If you are more than 10 pounds overweight and that weight is predominantly visceral and or subcutaneous fat, you are increasing the likeliness of organ and joint failure. If you are in a recovery process, it is in your best interest to get as close as possible to a healthy weight that will not add additional force to a recovering joint. It is always suggested that you are on 24/7 guard duty with the status of your health. If you get distracted while on guard duty, conditions will penetrate and cause damage. Prevention is always better than Treatment. –Keith Dorsette is the developer and senior trainer for the SAAF CAMP NCD Prevention and Health and Wellness Program. He is also the Health And Wellness correspondent for the SAAF CAMP TV Show. Visit Us At: saafcamp.org