ACL injuries | Osteopath in Liverpool | Liverpool Osteopaths

Anterior Cruciate Ligament (ACL) injuries. ACL injuries | Osteopath in Liverpool | Liverpool Osteopaths

ACL injuries can be extremely debilitating and as such it’s important to have a good understanding of what they’re all about.

Characteristically, the injuries don’t always involve a significant trauma. The mechanism is often threw a twisting injury such as landing from a jump, pivoting the change direction or deceleration. This onset causes a classic popping or snapping sound accompanied with rapid swelling. Weight bearing can be very difficult following this type of injury.

An accurate diagnosis is very important; failure to properly assess the injury can lead to the patient developing reoccurring instability in the future.


There are a number of tests an osteopath can do to assess the integrity of the ACL. Lachman’s test has been shown to be the most useful test. Accompanying this test with an AP draw test and pivot shift test helps to improve the sensitivity of the osteopath’s examination.

Other findings such as difficulty walking, swelling and reduced range of movement are generally displayed too.


It may be the case that you are sent for some imaging in the form of an x-ray or an MRI. This is mainly to rule out a fracture or identify any other associated injuries such as damage to the meniscus, ligaments or joint surfaces.


This covers three main areas. Non operative treatment, surgery and graft re-rupture.

Not everyone requires surgery on their ACL. If the patient has a stable knee there are several indications for a non-surgical approach. Indications not to go down the surgical route are if the patient doesn’t want surgery, they’re willing to modify their activities, a less physically active patient or someone who isn’t likely to do the post-surgical rehabilitation.

Surgery is indicated in cases such as ones with reoccurring instability, an associated meniscal tear that’s not recovering, multiple ligament injuries and an occupation where instability may cause harm.

Surgical management of ACL injuries is often successful, however sometimes the patient will reinjure themselves during rehabilitation.  In this case, a re-graft may be needed.


Rehab is essential and needs to be extremely comprehensive. A return to sport or daily activities too quickly can predispose the patient to further injury.

ACL injuries | Osteopath in Liverpool | Liverpool Osteopaths
Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Renstrom, P et al. 2008

There are generally four phases of rehabilitation for an ACL.

(1) protection and controlled mobilisation,

(2) controlled training,

(3) more intensive training, and

(4) return to play.

Early on the osteopath and patient will look to reduce pain and swelling and get the patients normal range of movement back. Then we would progress to lowerlimb and core training before moving onto training the neuromuscular system to cope with the patient’s specific needs and demands.


As always, prevention is better than a cure and there are a number of ways you can reduce your risk of sustaining an ACL injury. A variety of strength training, core training and neuromuscular drills can all be implemented to good effect.