The document discusses the history and importance of physical therapy, particularly for recovering from ACL injuries and reconstruction surgery. It notes that physical therapy has been used since World Wars I and II to treat injured soldiers and became more widespread in the US following laws in the 1940s and 1960s. Physical therapy is described as playing a key role in rehabilitation after ACL surgery to help regain strength, stability, flexibility and prevent reinjury through exercises and education. The goal of physical therapy is to return patients to full strength and ability to participate in physical activities.

1. Artise 1
Lauren Artise
Mrs. Tillery
5th period
14 October 2011
ACL Tear Prevention
The knee is an important joint to the body. The ACL, one of the four major ligaments in
the knee, is responsible for mobility and turning when dealing with strenuous activities (Knee
Anatomy 2). When torn, this ligament requires surgery to repair. In addition to surgery, physical
therapy has become an extremely effective way in helping patients recover from medical
disabilities and surgeries such as ACL reconstruction (Moffat 1).
Years after physical therapy was originated, the practice of physical therapy was brought
to the United States with the coming of the poliomyelitis epidemics from the 1800s to the 1950s
and after the damages of World War I and World War II. Poliomyelitis was a disastrous viral
disease that took many lives, especially during the 1920s and 1930s. The most common way to
treat this disease was to keep those infected in isolation with bed rest and eventually surgery.
Marguerite Sanderson and Mary McMillan were the first to take part in the training of
“reconstruction aides” and possessed the duty of caring for the soldiers and civilians wounded in
the war. During World War II, however, vast improvements were made in the medical care and
surgical strategies of those effected, which resulted in the increase of lives saved. The techniques
acquired for victims of poliomyelitis were then carried to the United States in 1940 by Sister
Elizabeth Kenny.
Six years later, the Hospital Survey and Construction Act of 1946, also recognized as the
“Hill Burton Act,” allowed an increase in the practice of physical therapy in hospitals. Physical

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therapists had to once again deal with the wounded as the Korean War sparked. In 1967,
amendments to the Social Security Act encouraged more states to participate in the practice of
physical therapy. As time passed, orthopedic physical therapy emerged and became an important
way for patients to recover from disabilities and injuries, such as ACL tears in the knee (Moffat
1).
For instance, the knee joint is the largest joint throughout the body, composed of bones,
ligaments, and muscles. Being a vital part to body movement, knees are often one of the most
common areas of injuries during sports and athletic activity. The knee is comprised of four
different bones, each of which is necessary for knee movement. The femur, or thigh bone,
connects to the tibia, or shin bone, by the meniscus. The patella, or kneecap, is a guard that
provides a protection to the ligaments inside the knee. The fibula, also known as theoutter shin
bone, is blended in with the tibia to form the leg below the knee and above the foot. Most of the
knee movement occurs between the femur, patella, and tibia.
In addition, ligaments hold the responsibility of the knee’s stability. The knee has four
ligaments, each with a specific purpose. The Medial Collateral Ligament (MCL), located on the
inside of the knee, resists different forces that come from the outer surface of the knee, known as
valgus forces or knock-kneed, while the Lateral Collateral Ligament (LCL), running on the
outside of the knee, resists forces pushing from the inside of the knee, known as varus forces or
bow legged (Varus of Valgus? 1).The Anterior Cruciate Ligament (ACL), one of the most vital
components to the knee, travels from the back of the knee to the front and prevents the tibia from
moving forward. Twisting movements are the most common way to injure the ACL, in which
surgery and rehabilitation are often necessary. The Posterior Cruciate Ligament (PCL) runs from
the front of the tibia to the back of the femur and is also responsible for controlling the

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movement of the tibia and keeping the components of the knee in place. Together, these four
ligaments make up the knee joint.
Also involved in the knee joint, the menisci is composed of two crescent-shaped cartilage
menisci that rest on the medial, or inner, and lateral, or outer, sides of where the bottom of the
femur meets the top of the tibia.The meniscus acts as a shock absorber for the knee and prevents
the femur and tibia from rubbing against each other, which would cause pain andwearing of the
bones.
Finally, the knee joint is surrounded by the quadriceps and the hamstrings, which help the
mobility and stability of the knee. Four different muscles form together to create the quadriceps
muscle group that specializes in leg strength, knee extension due to quad contraction, and hip
flexion. This group of muscles links together and attaches to the patella. The hamstrings, also
known as the secondary ACL, work to allow knee flexion, provide stability on each side of the
joint, and keep the tibia secure from moving forward or rotating to the side (Knee Anatomy 2).
In addition, the calf muscles, made up of the gastrocnemius and soleus, are necessary in order to
have maximum strength and functionality in the knee and leg (Anatomy of the Calf Muscles 1).
Consequently, it is not uncommon for someone to tear their ACL in sports or during
recreational activity. In fact, 70% of all ACL injuries occur in a non-contact situation. Twisting
movements are the main cause of injury to this crucial ligament (Lowe 1).Although surgery is
not necessary in order to function in daily activities, it is needed in order to play any form of
sport or intramural activity, since the ACL controls the cutting, or sudden change in direction
that is often required during these games (ACL-surgery 1).

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Unfortunately, it is proven that females are six times more likely to tear their ACL than
their male counterparts. Several risk factors instigate ACL injuries. Anatomically, females have a
narrower femoral notch, which impairs the movement of the ACL, and a larger Q- angle, in
which wider hips force female knees to turn inwards, making them more susceptible to tearing.
Biomechanically, females have weak hips and less developed muscle in the leg as well as
incorrect techniques when landing. When females are undergoing their menstrual cycle, their
joints tend to be more relaxed, creating a hormonal disadvantage against males.
Environmentally, however, both females and males can suffer from weather conditions and
constant play that can cause growing stress on the knees. All these factors take a heavytollon the
ACL as well as the other ligaments within the knee (Lowe 1).
In actuality, there are three different grades in which a person can tear an ACL. In a
grade 1 sprain, the ACL is slightly damaged but still functional and does not require surgery to
recover. A grade 2 sprain is a partial ACL tear, where surgery depends of the severity of the tear.
A grade 3 is a complete ACL tear, where the ACL is no longer attached and where both surgery
and rehab are required (Anterior Cruciate Ligament Injuries 1).
Scientifically, ACL reconstruction surgery is the process in which the ACL is
reconstructed by use of an autograft or allograft. An autograft is harvested from the patient’s own
body, usually from a tendon within the leg. Allografts are taken from cadavers and are used to
act as the patient’s new ACL. Since the ACL is a ligament and not a tendon, the body undergoes
the process of ligamentization, where the tendon graft slowly changes itself into a ligament
(Marumo 1).When performing surgery, surgeons either use the technique of open surgery or
arthroscopic surgery. During open surgery, a large incision is cut on the front of the knee.
However, with today’s technology, surgeons often perform arthroscopic surgery, which involves

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smaller incisions and use of a camera for viewing the inside of the knee. The arthroscopic
technique is more popular for both patients and surgeons because of the smaller scars left from
surgery and the reduced risk factor (Anterior Cruciate Ligament (ACL) Surgery 1).
After surgery, most surgeons require their patients to complete physical therapy before
being released to sports activities. Physical therapy allows patients to gain strength in the main
muscle groups surrounding the knee, stability in the knee through balance exercises, stretching of
the muscles, and teaches patients techniques to prevent ACL tears.
In reality, physical therapy begins the day of surgery. Patients are required to spend hours
each day in a continuous passive motion (CPM) machine in order to keep flexion in the knee and
avoid having the knee become immobile. In addition, patients are given a knee brace and
crutches as well as orders to complete physical therapy with a professional immediately after
surgery (Admin 1).
During physical therapy, therapists follow a general protocol combined with different
forms of exercises to complete with patients over the course of a couple months. In order to be
cleared in six months, the ACL has to be completely healed, the muscles around the knee have to
be strong enough to support and protect the knee, the patient needs to have balance to avoid
another tear, and the body has to be flexible in order to be able to stretch and twist easily during
extensive activity.Patients must be aware of the fact that it is vital for them to come back after
they are cleared by the orthopedic surgeon so that they does not reinjure the knee by playing on it
before the ACL and the rest of the knee has had maximum time to heal and become strong again.
The purpose of physical therapy is to relieve the discomfort and pain of people of all ages
who suffer from conditions that limit their physical well being. The therapy process treats

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patients with medical disabilities and informs patients about ways to overcome and relieve
tension in areas of stress. The main goal of physical therapy is to return patients to maximum
strength and back to participating in demanding physical activities. Ultimately, the three key
objectives of physical therapy are assessment of the patient and of the injury, rehabilitation of the
area suffering from a health condition, and education on ways to avoid further injuriesand grow
stronger in all aspects of physical health (Physical Therapy 1).

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Works Cited
“ACL-surgery.” PTC Physical Therapy, LLC. N.p., n.d. Web. 14 Nov. 2011. <http://www.my-
physical-therapy-coach.com/surgery.html>.
Admin. “Orthopedic Sports Medicine Corner: Guidelines for the 1st Week after ACL
Reconstruction .”NISMAT. N.p., 8 Mar. 2007. Web. 14 Nov. 2011.
<http://www.nismat.org//acl_postop>.
“Anatomy of the Calf Muscles.” Better U Inc.N.p., n.d. Web. 14 Nov. 2011.
<http://www.fitstep.com///.htm >.
“Anterior Cruciate Ligament (ACL) Surgery.” WebMD. N.p., 14 May 2010. Web. 14 Nov. 2011.
<http://www.webmd.com/to-z-guides/cruciate-ligament-acl-surgery>.
“Anterior Cruciate Ligament Injuries.” American Academy of Orthopaedic Surgeons.N.p., Mar.
2009. Web. 14 Nov. 2011. <http://orthoinfo.aaos.org/.cfm?topic=a00549 >.
“Knee Anatomy.” Sports Injury Clinic.N.p., n.d. Web. 14 Nov. 2011.
<http://www.sportsinjuryclinic.net/rapist/.php>.
Lowe, Walt, Dr. “ACL Risk Reduction.” Dr. Walt Lowe. N.p., n.d. Web. 14 Nov. 2011.
<http://www.drwaltlowe.com/injury-risk-reduction/>.
Marumo, Keishi. “The “Ligamentization” Process in Human Anterior Cruciate Ligament
Reconstruction With Autogenous Patellar and Hamstring Tendons.” The American
Journal of Sports Medicine.N.p., n.d. Web. 14 Nov. 2011. <http://ajs.sagepub.com////>.

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Moffat, Marilyn. “The History of Physical Therapy Practice in the United States.” Life and
Health Library.N.p., n.d. Web. 17 Oct. 2011.
<http://findarticles.com///_qa3969/_200301/_n9302437/>.