Successful Return to Sport After ACL Injury with Acupuncture and Physical Therapy

12/25/2013 6 Comments

Successful Return to Sport After ACL Injury with Acupuncture and Physical Therapy

According to a recent article in the Journal of Orthopedic and Sports Physical Therapy Anterior Cruciate Ligament, or ACL, rupture is “one of the most physically, financially, and emotionally devastating sport-related knee injuries,” which is something I can personally attest to.

I tore my ACL in 2003 and had reconstructive surgery because I wanted to return to sport which, at the time, was martial arts. I had good insurance then as well so my out of pocket costs were manageable, but I remember seeing the hospital bill - $50,000.

It took an entire year of weekly acupuncture and Physical Therapy for me to participate in my sport at the level I wanted to, and it was two years before I didn’t notice my knee feeling different during activity.

I am proud to say, however, that one year after my surgery I successfully completed a very vigorous 24 hour martial arts test including 12 hours of continuous fighting, running and forms. A decade later, my ACL repair is still holding strong with no concerns.

What I didn’t know until I read this article, was how rare my case is. Only 44% of athletes successfully return to sport after an average 3-1/2 years following an ACL repair. When quizzed about their subjective experience of performance after a successful ACL repair and return to sport, only 50% percent of high-school and college athletes indicated that they were able to perform at their pre-injury level.

Furthermore, up to 30% of athletes who return to sport after an ACL repair re-injure their ACL or tear the ACL on the opposite knee due to a number of factors, neuromuscular weakness and asymmetry primary among them. Due in part to the increased joint laxity and increased angle between hip and knee, female athletes with previous ACL repair are 4 times more likely to re-injure their knees after returning to sport compared to their male counterparts!

My ACL repair actually puts me in the top 5% of female athletes who have an ACL repair. I absolutely credit my success to the individualized and dynamic Physical Therapy I received along with consistent Acupuncture treatments. I actually started acupuncture two days after my surgery and continued treatment every week for an entire year, and then every other week for 2 years thereafter. Even my surgeon was amazed with my recovery (and he was the surgeon for the Blazers here in Portland).

Preventing an ACL Injury

So if you are engaged in sport, how do you prevent an ACL injury? Sometimes you just can’t, life happens, but you can greatly decrease the possibility of injury with proper neuromuscular training. According to this research article, of primary importance are the following:

balanced strength between the quadriceps and the hamstrings
symmetry between right and left leg strength
overall balance and stability as well as stability of the knee joint in particular
trunk (core) strength and stability

Exercises should be specific to your strengths and weaknesses and to your sport. Whether you continue with regular physical therapy as a preventative measure or not, seeing a Physical Therapist for a personalized exercise regime is research-proven to be effective in decreasing the instance of ACL injury by 43-73%.

Regular acupuncture is also recommended. Acupuncture can decrease and resolve minor aches and pains, keep muscles physically loose and energetically balanced, and cause natural endorphins and anti-inflammatories to be released by the body improving performance and recovery rates for minor injuries.

Recovering from an ACL Injury

If you are unfortunate enough to experience an ACL injury or tear, there is still a lot you to can do to ensure a strong recovery and decrease your likelihood of experiencing a secondary ACL injury.

Get Acupuncture Right Away - the sooner you start to decrease inflammation and pain, the sooner and more successfully you will recover.
Get Physical Therapy Right Away & Before Surgery - the sooner you start Physical Therapy to address your injury, the stronger you will recover. The stronger you are going into surgery, the faster your recovery will be out of it.
Consult with a Physical Therapist about Graft Type - There are several different types of grafts available for ACL repair - patellar, hamstring, cadaver. Depending upon your age, gender, sport and natural joint tension or laxity, different grafts may be recommended. A PT who is familiar with the latest research on these options is best able to advise you about graft type.
Continue Physical Therapy and Acupuncture After Surgery - As I mentioned above, I can attest to the strength of this combination. I know that it is the combination of these two therapies that has placed me in the top of 5% of female ACL repair recipients.

I have extensive personal and professional experience with using acupuncture to treat ACL injury and ACL surgery recovery. I also have extensive professional experience treating general knee pain and injury, meniscus injury and surgery recovery as well as full knee replacement. If you are looking for help treating any knee condition, I would be honored to be a partner in your care.

My go to Physical Therapist for knee injury prevention, knee injury, ACL injury and ACL surgery recovery is my husband - Brian Kitzerow, DPT at Goodell Physical Therapy. He always keeps up on the latest research and has a thoughtful and thorough approach to every patient.

6 Comments

Cherie

7/10/2014 08:54:58 am

I do Martial Arts and had a Hamstring ACL graft 14 months ago. Im deperatley trying to get back but am struggling with my knee swelling and clicking. Ive just started acupuncture today but it may be to late. I notice a weakness in my hamstring so am working on strengthening this.
Any help you could offer would be great

Rebecca Hurwood link

7/10/2014 10:20:16 am

Hi Cherie, I am so glad to hear you're adding Acupuncture into your recovery plan - its not too late at all.

I highly recommend electro acupuncture for knee surgery recovery and deep needling directly into the joint if you can tolerate it. You can greatly increase Qi and Blood flow that way (read improved fluid exchange for decreased inflammation into that statement from a western perspective) and achieve measurable change.

If your Acupuncturist has experience with herbs, a topical herbal soak or wash can also be very helpful for reducing swelling - a good herbalist will be able to formulate a bulk formula for topical use based on your specific symptoms.

Strengthening the hamstring is important and I definitely support you in following your physical therapist's recommendations (assuming you have one for surgery recovery) around that. It isn't just a matter of strengthening the muscle, but encouraging the connective tissue to heal and regrow which requires muscle recruitment just as much as strength building. Recruitment is another work for activation, and activating the muscle properly can neurologically re-pattern the brain-body connection. You need your muscles to work in tandem, and your hamstring has been out of commission for a while to heal meaning other muscles have taken up the work and there is likely an imbalance there. Recruitment is the purveyance of a PT and something I'd expect them to be working on with you.

If you aren't confident in your Physical Therapist, look for someone who has Manual Therapy certification from NAIOMT or the Ola Grimbsy Institute. PT's with this kind of training often have the ability to do an almost cellular level of work on helping you rebuild and rebalance your musculature.

Lastly - be patient. It can easily take two years before the full results of an ACL repair can be seen. Your body is getting used to a whole different self in relation to this injury, surgery and recovery and it will take time. If you want to return successfully to Martial Arts, you have to do the work which I know you are capable of - Acupuncture, Physical Therapy, LOTS of good hydration, whole foods diet as much as possible (sugar is a big inflammation no no) - and not overexert yourself in the mean time. Martial arts often involves a lot of shearing and twisting motion in the knee joint, requiring a high level of function and recovery.

The great thing about Martial Arts is that there is so much to learn, you can really focus and hone in on different skills you may not have spent time on before. Every injury is an opportunity to narrow and deepen your focus for a while. Its hard to use your legs? Sit on the bench and focus only on punches and parries - you'll be amazed how much stronger and faster your hands will become and when your legs come back into play you will be a whole new force to be reckoned with!

Know also that a standard course of treatment in China for any disorder is 10 acupuncture treatments in 10 days and then you reassess. Here in the US we find that virtually impossible and largely unnecessary. I usually see patients once a week for 4-6 weeks and then reassess. Expect that it could take 3 months of weekly acupuncture treatment in conjunction with PT to get the kind of results you want to see.

Good luck, Cherie, keep me updated! And let me know if you have any more questions. ~Rebecca

Catherine Felix

4/14/2016 02:23:47 pm

I recently had to under go a pretty intense knee surgery. The whole process leading up to the surgery was traumatic for obvious reasons. I don’t want to go into too much detail but during the surgery, my team used a FAW blanket called the Bair Hugger and it helped so much with my post surgical recovery. I credit the super quick recovery to the blanket. I was able to get back to exercising in no time. Here are some facts about the system http://www.fawfacts.com

Rebecca Kitzerow, LAc link

6/14/2017 10:20:09 am

Thank you for sharing, Catherine, so glad you got relief!

Cindy Murphy

6/14/2017 08:37:23 am

Glad I found this article. I am seeing an Accupuncturist for a consult this week. I had ACL reconstruction 1 yr ago. I have been in PT ever since. Have had 2 surgeries to clean up major arthrofibrosis. I am frustrated with the lack of mobility and am ready to give the accupuncture a try. After the reconstruction I had full extension, but lost it after the surgery to clean up the scar tissue. Any suggestions on what to look for or questions to ask would be much appreciated.

Rebecca Kitzerow, LAc link

6/14/2017 10:29:37 am

Hello Cindy, so glad you found my article helpful! As to what to ask when at the Acupuncturist, I would suggest the following:

-what is their experience treating knee surgery recovery?
-what type of Acupuncture do/can they employ? I.e., TCM (traditional chinese medicine), electrostim, japanese acupuncture, classical acupuncture, TAN (distal only) style, etc?
-how many sessions do they expect it will take and/or are there benchmarks we are watching for to track progress?

When it comes to style, there isn't any bad answer - as long as they are proficient in it and it works, that is all that counts. In my personal opinion, the more styles they can bring to bear (okay, right word wrong spelling I think.. you know what I mean!), frankly, the better because if one style doesn't work for you, you want them to have another method to fall back on. I find that TCM with electro-stim generally works best for me, where you really get into the joint, but there are some cases that only respond to TAN (gentle, energetic only) methods. If I didn't have those options at my fingertips, however, it would be harder to ensure that I can find a treatment approach to match every patient. I'd want someone that has at least a couple different methods to work with OR a person who is so highly proficient and experienced in treating knee surgery recovery specifically, that they specialize in orthopedics and have a superb track record (recommendations/referrals).

As to duration of treatment and assessment, that cannot typically be accurately predicted at the first session, but I personally feel like it is important to ask that question and to have a plan, a place to start and something to watch for in the way of progress benchmarks. Ultimately, you need results and you need to feel like you're getting somewhere in treatment and not spinning your wheels. Having some baseline plan helps you assess what is working and not working to ensure that you're really making progress along the way.

I hope that helps, Cindy and I wish you the best of luck! I'd love for you to come back and post about your progress as you go along. Keep in touch!

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