Therapeutic Healing

for a Torn ACL

TAYLOR YOUNG | HHP 375
SOAP Note
Subjective
A 15 year old girl came in
with a knee injury. She was
recommended by her
school trainer to seek
further help.  lateral and medial joint line
She is very active. She
plays softball, basketball,
and runs track. Other than
the knee injury, she is
healthy and in great shape. 
Objective
The subject is 5 foot 2 inches,
125 pounds. She is well
nourished and seems to be in
no distress. She lacks a few
degrees of terminal extension
due to pain. She has both
tenderness. 
MRI was performed, which
shows an anterior cruciate
ligament tear.
 SOAP Note Continued
Assessment and Plan

We had a lengthy discussion today regarding her knee. We talked

about the diagnosis of anterior cruciate ligament tear and went over
options. We think, given the fact that she would like to get back to
competitive level sports, including pivoting activities, that it is
reasonable for her to consider anterior cruciate ligament tear
reconstruction for her knee. We had a long discussion regarding graft
options. We think that it is very reasonable to for her to choose
between hamstring autograft and allograft for reconstruction. We
went over the surgery and recovery time. We additionally think that
she should continue to work on her preoperative therapy to try and
regain all motion. We talked about the risks of stiffness
postoperatively with her knee being stiff preoperatively. All the
questions were answered. She will consider her options and let us
know.
Cryo/Thermo

The two most • 1. Rest and mobalization: once an ACL tear is diagnosed it is important that the
affected area be rested immediately. Any further movement or stress will only
aggravate the condition and prolong recovery. It is also important to keep the injured
important things area as still as possible.
• 2. Ice: By far the most important part. The application of ice will have the greatest

to remember are effect on reducing bleeding, swelling and pain. Apply ice as soon as possible after the
injury has occurred or been diagnosed.

• The most common recommendation is to apply ice for 20 minutes every 2 hours for the
Further more: first 48 to 72 hours.
• During the first 24 to 72 hours be sure to avoid any form of heat at the injury site. 
E-Stem

Electrotherapy can greatly reduce the amount of pain that you experience
in your knee and can provide some increased range of motion and
flexibility.

Surround the kneecap by placing the TENS unit pads on either side of the
knee. Once the pads are in place, turn the machine on to the desired level.
Do rotations of 25 to 30 minutes 2 to 3 times a day.
Ultrasound

 After ACL surgery, scar tissue can build up on the ligament, restricting flexibility
but ultrasound therapy is thought to help limit this formation of scar tissue.
 The patient should lye down with their knee bent at a 20 or 30 degree angle.
 During your session, your physiotherapist will pass an ultrasound beam directly over
the site of the injury. The intensity and frequency of the beam can be varied, according
to your individual needs: lower frequency application penetrates deeper into the body
so is used when the injury is deep, and for injury closer to the skin surface a higher
frequency can be selected.
 Mechanical Energy
 Your ACL helps to stabilize your knee
by preventing forward slippage of your
shin bone underneath your thigh bone.
 Restoring knee range of motion should Your hamstrings, by nature of their
be one of your primary goals prior to attachment points behind your thigh
ACL surgery. If your knee is bending and knee, can also help to add stability
and straightening fully before surgery, to your knee joint. Your physical
it is likely to quickly recover full therapist may prescribe hamstring
ROM after surgery. Exercises that may strengthening exercises during your
be done may include:  ACL prehab. Hamstring stretches may
 Heel Slides
include:
 Hamstring Sets
 Prone Hang for knee extension
 Prone Knee Bends
 Stationary bicycling  
 Seated Hamstring Curls
 Proprioception is a term that describes
your body's ability to understand
where it is in your environment. Good
balance and proprioception are
essential to keeping your knees in the
correct alignment when running and
jumping, and this can help keep stress
and strain off your ACL.Your PT may
have you perform various balance and
proprioception exercises to help you
prepare for your ACL surgery. These
may include:
 Single Leg Standing
 BOSU Exercise
BAPS Board
 Tge T-Stance Exercise
HOP Test
Single leg hop tests are a method that your physical therapist or
doctor may use to determine your ability to return to high-level
athletics following knee surgery. They are commonly used during
the return to function phase in an ACL rehabilitation protocol to
assess the functional stability of your knee.
 HOP Test Continued
SINGLE LEG HOP
 For single leg hopping, stand
on one foot with your toes
behind a line marked on the
floor.
 Hop forward as far as
possible, landing on the same
foot from which you took off.
 Measure and record the
distance you hopped in
centimeters (cm).
 Repeat the test two times for
both legs, recording the
distance hopped each time.
SINGLE LEG TRIPLE
HOP
 For straight line triple hopping,
stand on one foot with your
toes behind a line marked on
the floor.
 Hop forward as far as possible
for three consecutive hops.
 Measure and record the
distance you hopped in
centimeters.
 Repeat the test two times for
both legs, recording the
distance hopped each time.
SINGLE LEG DIAGONAL
TRIPLE HOP
 For diagonal triple hopping,
mark a line on the floor about
six meters long. (Using
adhesive tape here is a good
idea.
 Stand on one foot and hop
forward and over the line.
 Continue hopping in a zig-zag
pattern over the line for three
hops.
 Record your distance hopped
(in centimeters) for your
injured leg and uninjured leg.
TIMES SINGLE LEG
HOP OVER 6 METERS
For single leg distance hopping,
stand on one foot with your six-
meter line extending out in front
of you.
Hop as quickly as you can on
one foot until you reach the end
of the six meters.
Record the time it takes for you
to hop six meters on one foot.