Clinical Education

Ligament Injuries

Anterior cruciate ligament tears:

Tears to the anterior cruciate ligament (ACL) are not uncommon. They can occur in sports players where there is a sudden change in direction (i.e. football). Likewise, they can occur in the general population, specifically when the lower leg extends forward too much or the knee rotates inwards under load.

Image – Anterior cruciate ligament injury

Image – Anterior cruciate ligament injury


  • Initial management should involve protection, rest, ice, compression and elevation (PRICE), issue of crutches.
  • Painful activities should be avoided
  • Progressive loading of the knee through active rehabilitation
  • The treatment regimen can be summarised as follows:

0-48 hrs:

  • Active pain-free exercises (gentle range of movement)

After the first 48 hrs:

  • Gradually increase strength:
  • Active knee flexion and extension
  • Knee brace, active single leg raise and inner range quads.
  • Hamstring and gluteal strengthening
  • Progress loading – Chair/wall squats and stair step-ups
  • Knee stability exercises  (e.g. pulleys with other leg, one-leg squats)
  • Low impact cardio, cycling and swimming, lower limb strengthening exercises if access to a gym

Functional Strengthening:

  • Bike
  • Pool running
  • Jogging
  • Swimming

Sport Specific skills:

  • Jumping and landing
  • Running-straight line
  • Running-figure of eight
  • Rapid changes of direction (cutting drills)
  • Kicking-gradual increase


  • Image from OpenI – Licensed by CC
  • Image from OpenI – Licensed by CC
  • Image from OpenI – Licensed by CC