How to manage an ACL INJURY (Soft tissue)
The RICER treatment Regime
This regime is the main immediate treatment for Grade I and II sprain, but can also be essential for a Grade III sprain.
Rest
How:
- Control mobility of injury rather than completely immobilising it
- Rest the knee in a comfortable position for 24-48 hours before engaging in active rehabilitation (depending on severity of injury)
Why:
- Without rest, external stresses are still placed on the knee
- This stress will interfere with healing process and prolonging recovery
- It also restricts blood flow to knee
Ice
How:
- Apply ice over the knee and surrounding tissue for about 10-20 minutes every 2 hours
- Can use a commercial ice pack, crushed ice in wet towel/plastic bag, immersion in iced water or frozen cup of water moving continuously over the area
- Note:
o It is important not to apply the ice directly to skin – wrap ice in wet cloth/towel to avoid ice burns
o Ice shouldn’t be applied to area if the athlete is sensitive to cold or has circulatory problems
o Children have a lower tolerance to ice treatment
Why:
- Ice decreases bleeding, swelling and localised pain
- It also decreases muscle spasms and secondary damage to injured site
Compression
How:
- Apply compression to the knee in order to reduce space available for swelling to spread and increase
- Apply an elastic wrap to achieve a firm/even pressure to injury and maintain compression continuously for 72 hours (depending on severity of injury)
Why:
- It reduces bleeding and swelling and also provides support for injured knee
Elevation
How:
- Elevate knee above the level of the heart as often as possible for 72hrs
- Elevating knee:
o Eliminates the effects of gravity on blood pooling
o Assists in venous and lymphatic drainage of blood and other fluids from the injured area
Why:
- It mainly reduces bleeding, swelling and pain
Referral
How:
- Must refer to a doctor or physiotherapist as soon as possible
Why:
- Because it will provide a definitive diagnosis of knee injury (which grade it is categorised into) and management process for rehabilitation
Further treatment/management for a Grade III sprain
If the ACL sprain is a rupture (Grade III sprain), the athlete will need to have an ACL reconstruction (surgery) for complete recovery of the ACL, because it can't heal itself when it is ruptured. After the athlete has had an ACL reconstruction, they will have to attend appointments with a physiotherapist and complete the exercises required in order to regain strength and support for the knee, speed up the recovery process, as well as regain full range of motion of the knee.
This regime is the main immediate treatment for Grade I and II sprain, but can also be essential for a Grade III sprain.
Rest
How:
- Control mobility of injury rather than completely immobilising it
- Rest the knee in a comfortable position for 24-48 hours before engaging in active rehabilitation (depending on severity of injury)
Why:
- Without rest, external stresses are still placed on the knee
- This stress will interfere with healing process and prolonging recovery
- It also restricts blood flow to knee
Ice
How:
- Apply ice over the knee and surrounding tissue for about 10-20 minutes every 2 hours
- Can use a commercial ice pack, crushed ice in wet towel/plastic bag, immersion in iced water or frozen cup of water moving continuously over the area
- Note:
o It is important not to apply the ice directly to skin – wrap ice in wet cloth/towel to avoid ice burns
o Ice shouldn’t be applied to area if the athlete is sensitive to cold or has circulatory problems
o Children have a lower tolerance to ice treatment
Why:
- Ice decreases bleeding, swelling and localised pain
- It also decreases muscle spasms and secondary damage to injured site
Compression
How:
- Apply compression to the knee in order to reduce space available for swelling to spread and increase
- Apply an elastic wrap to achieve a firm/even pressure to injury and maintain compression continuously for 72 hours (depending on severity of injury)
Why:
- It reduces bleeding and swelling and also provides support for injured knee
Elevation
How:
- Elevate knee above the level of the heart as often as possible for 72hrs
- Elevating knee:
o Eliminates the effects of gravity on blood pooling
o Assists in venous and lymphatic drainage of blood and other fluids from the injured area
Why:
- It mainly reduces bleeding, swelling and pain
Referral
How:
- Must refer to a doctor or physiotherapist as soon as possible
Why:
- Because it will provide a definitive diagnosis of knee injury (which grade it is categorised into) and management process for rehabilitation
Further treatment/management for a Grade III sprain
If the ACL sprain is a rupture (Grade III sprain), the athlete will need to have an ACL reconstruction (surgery) for complete recovery of the ACL, because it can't heal itself when it is ruptured. After the athlete has had an ACL reconstruction, they will have to attend appointments with a physiotherapist and complete the exercises required in order to regain strength and support for the knee, speed up the recovery process, as well as regain full range of motion of the knee.