ACL Injuries in Sports: Physiotherapy & Rehabilitation in Burlington
- Folarin Babatunde PT PhD
- Sep 28, 2025
- 7 min read
Updated: Nov 7, 2025
Cogent Rehab Blog
Folarin Babatunde PT PhD MScSEM MScPT BScPT
September 29, 2025
Understanding ACL Injuries: A Comprehensive Guide for Recovery
Introduction
The anterior cruciate ligament (ACL) is a vital stabilizer of the knee joint. It prevents excessive forward movement of the shin bone (tibia) and provides crucial rotational stability. Unfortunately, ACL injuries are common in athletes who participate in sports that involve cutting, pivoting, or sudden changes in direction, such as soccer, basketball, football, volleyball, and skiing. The rate of ACL injuries in military members (tactical athletes) is estimated to be ten times that of the civilian population, comparable to the rate of injury in professional or elite athletes.
At Cogent Physical Rehabilitation Center – Sports Physiotherapy in Burlington, we provide specialized ACL rehabilitation tailored to athletes of all levels. Our evidence-based programs are designed to restore knee function, prevent re-injury, and help you safely return to sport.
Anatomy of the Anterior Cruciate Ligament (ACL)
The ACL is one of the four major ligaments that stabilize the knee joint. It connects the femur (thigh bone) to the tibia (shin bone) and plays a critical role in maintaining knee stability.
Structure
Anteromedial bundle – resists forward (anterior) translation of the tibia.
Posterolateral bundle – provides rotational stability.
Function
Prevents excessive forward movement of the tibia relative to the femur.
Controls rotational forces such as pivoting and cutting.
Supports proprioception (awareness of joint position).
Mechanism of Injury
Valgus collapse (inward buckling of the knee) – commonly seen in female athletes during jump landings.
Sagittal plane loading (forward shear of the tibia) – frequent in male athletes during landing or deceleration.
Direct trauma – such as contact from a tackle in football or rugby.
Associated Injuries
ACL tears often occur with damage to other structures, including the meniscus, medial collateral ligament (MCL), and articular cartilage.
What Is an ACL Injury?
Injured ligaments are classified as sprains and are graded on a severity scale:
Grade 1 ACL Sprains. The ligament is mildly damaged in a Grade 1 sprain. It has been slightly stretched but is still able to help keep the knee joint stable.
Grade 2 ACL Sprains. A Grade 2 sprain stretches the ligament to the point where it becomes loose but not fully torn. This is often referred to as a partial tear of the ACL. Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near-complete tears.
Grade 3 ACL Sprains. This type of sprain is most commonly referred to as a complete rupture of the ligament. The ligament has been torn in half or pulled directly off the bone, and the knee joint is unstable, often requiring surgery, especially for athletes.
Associated injuries – meniscus tears, cartilage damage, or sprains of other knee ligaments frequently occur alongside ACL injuries.
Common Causes of ACL Injuries in Sports
ACL injuries frequently happen in high-demand activities:
Sudden stops or cutting maneuvers.
Landing awkwardly from a jump.
Direct contact or collision (e.g., football tackle).
Pivoting with the foot planted.
Learn more about other knee rehabilitation services in Burlington at Cogent Rehab.
Why Female Athletes Are at Greater Risk of ACL Injuries
Studies show that female athletes are more likely than male athletes to experience ACL injuries, particularly in sports involving cutting, pivoting, or jumping. Factors contributing to this increased risk include:
Differences in muscle strength and neuromuscular control.
Pelvis and lower limb alignment, which can increase strain on the ACL.
Greater ligament flexibility (laxity).
Hormonal influences, especially the effect of estrogen on ligament properties.
These combined factors help explain why ACL prevention programs—such as neuromuscular training and movement retraining—are especially important for female athletes.
Signs and Symptoms of ACL Injuries
A distinct “popping” sound may be heard at the time of injury, and you may feel your knee give out under you if you attempt to walk. Other common symptoms include:
Immediate pain and rapid swelling within 24 hours. The pain and swelling may go away on their own with rest. However, any attempt to return to sport without treatment risks causing further damage to the cushioning cartilage (meniscus) of the knee.
Tenderness along the knee joint line.
Difficulty walking or weight-bearing.
Loss of full range of motion.
How is an ACL Injury Diagnosed?
ACL injuries are diagnosed through:
Clinical examination (Lachman test, pivot shift test).
Imaging (MRI to confirm ligament damage).
Specialist referral when surgery is being considered.
Treatment Options For ACL Injuries
Non-Surgical Rehabilitation
This treatment approach is appropriate for partial tears, recreational athletes, or those with less instability.
Physiotherapy or conservative treatment focuses on swelling control, muscle strengthening, and movement retraining.
Surgical Reconstruction
Surgery is recommended for complete ACL tears, competitive athletes, or those with recurrent instability after an ACL injury.
The procedure involves replacing the torn ligament with a graft from either the hamstring or quadriceps tendon.
Successful surgical reconstruction requires structured physiotherapy both before and after surgery to optimize outcomes.
Physiotherapy for ACL Injuries in Burlington
At Cogent Rehab, we use evidence-based physiotherapy protocols for individuals with ACL injuries in Burlington that progress through four main phases:
Early Phase (0–6 weeks)
- Control swelling and pain.
- Gentle range of motion and quadriceps activation.
- Gait re-education.
Strength & Control Phase (6–12 weeks)
- Progressive strengthening of quads, hamstrings, and glutes.
- Balance and proprioceptive training.
- Low-impact cardio such as cycling or pool therapy.
Advanced Phase (3–6 months)
- Plyometrics, agility drills, and sport-specific exercises.
- Neuromuscular re-education.
Return to Sport Phase (6–9+ months)
- Functional testing (hop tests, agility drills).
- Gradual reintroduction to sport.
- Education on re-injury prevention.
A recent study showed that physiotherapy-led interventions such as Pilates and Tai Chi may improve pain, proprioception, and strength in young and middle-aged adults with partial ACL tears.
Learn more about our Sports Injury Physiotherapy in Burlington.
Standard vs. Accelerated ACL Rehabilitation
Rehabilitation following an anterior cruciate ligament (ACL) injury or reconstruction can follow different timelines depending on the individual’s goals, healing response, and sport demands. The two primary approaches—standard and accelerated rehabilitation—share the same objective of restoring knee stability and function but differ in pacing and progression criteria.
The table below outlines the key distinctions between these two approaches to help patients and clinicians understand which method may be most appropriate for specific recovery needs.
Table: Standard Versus Accelerated ACL Rehabilitation
Aspect | Standard Rehab | Accelerated Rehab |
Timeline | Return to sport at 9–12 months | Return to sport as early as 6 months |
Progression | Gradual progression in motion and strength | Faster advancement, earlier running/agility |
Focus | Graft healing time, safety | Functional milestones, early activity |
Advantages | - Lower risk of re-injury - Best for recreational athletes | - Faster return for elite athletes - Maintains fitness earlier |
Risks | - Longer time away from sport | - Higher risk of re-injury if rushed |
Best For | Recreational athletes, those with combined injuries | Competitive athletes with strong rehab support |
Key Takeaway:
Standard rehab is safer and better suited for the general population.
Accelerated rehab may be considered for elite athletes but requires close supervision and careful monitoring.
Physiotherapy For Preventing ACL Injuries
Prevention programs can significantly reduce ACL injury risk:
Neuromuscular training to improve jump-landing mechanics.
Strengthening the hamstrings and glutes.
Balance and proprioceptive exercises.
Warm-up routines such as the FIFA 11+ injury prevention program.
Why Choose Cogent Rehab for ACL Injuries?
Sports rehabilitation expertise with advanced academic and clinical backgrounds in sports and exercise medicine.
Individualized rehab programs tailored to your sport, vocation, and lifestyle.
Evidence-based care for both surgical and non-surgical cases of ACL injuries.
State-of-the-art rehab equipment and a performance-focused approach that will help you get back in the game.
Ready To Recover From An ACL Injury and Gain Confidence to Return To Sport
ACL injuries can be career-changing, but with proper treatment and physiotherapy, most athletes can return to sport successfully. At Cogent Physical Rehabilitation Center in Burlington, we guide you from injury through recovery to peak performance.
Contact us today at (905) 635-4422 or book your consultation today.
Frequently Asked Questions (FAQ) About ACL Injuries
Q1: Do all ACL tears require surgical reconstruction?
No. Surgical intervention is typically reserved for individuals with complete ruptures, recurrent instability, or those returning to pivoting or high-demand sports. Partial tears and lower-demand athletes may achieve satisfactory outcomes with structured physiotherapy alone.
Q2: What is the expected recovery timeline following ACL reconstruction?
The standard recovery timeline is approximately 9 to 12 months. Return to sport is determined by objective criteria including strength, functional testing, and movement quality, rather than time alone. Accelerated protocols may allow earlier return for selected athletes under close supervision.
Q3: How can the risk of a secondary ACL injury be reduced?
Risk reduction strategies include neuromuscular training, ongoing lower limb strengthening, biomechanical retraining, and adherence to evidence-based injury prevention programs such as the FIFA 11+ warm-up program.
Q4: Which sports present the highest risk of ACL injury?
Sports involving sudden deceleration, pivoting, or jumping—such as soccer, basketball, volleyball, skiing, and football—present the greatest risk. Female athletes are at a particularly higher risk due to biomechanical and hormonal factors.
Sources
Quatman CE and Hewett TE. The anterior cruciate ligament injury controversy: is "valgus collapse" a sex-specific mechanism? Br J Sports Med. 2009;43:328-335.
Aguero AD, Irrgang JJ, MacGregor AJ, Rothenberger SD, Hart JM, Fraser JJ. Sex, military occupation, and rank are associated with the risk of anterior cruciate ligament injury in tactical athletes. BMJ Mil Health. 2023;169:535-541.
Antoranz Y, de Villarreal ES, Vecino JD, Jimenez-Saiz SL. Sure steps: Key strategies for protecting basketball players from injuries - systematic review. J Clin Med. 2024;13:4912.
Xiao M, Lee JJ, Boissiere J, Sherman SL, Safran MR, Abrams GD, Hwang CE. Video Analysis of Acute Lower Extremity Injury Mechanisms in Soccer Demonstrates Most Anterior Cruciate Ligament, Achilles, and Muscle Injuries Occur Without Direct Contact: A Systematic Review and Meta-analysis. Arthroscopy. 2025;41:3650-3662.
Rommers N, Rossler R, Tassignon B, Verschueren J, De Ridder R, van Melick et al. Most amateur football teams do not implement essential components of neuromuscular training to prevent anterior cruciate ligament injuries and lateral ankle sprains. Knee Surg Traum, Arth. 2022;30:1169-1179.
Giummarra M, Vocale L, King M. Efficacy of non-surgical management and functional outcomes of partial ACL tears. A systematic review of randomized controlled trials. BMC Musculoskelet Disord. 2022;23:332.
Chen P, Wang L, Zhou W, Wang L. Efficacy of knee function of kinesio taping among individuals with anterior cruciate ligament reconstruction: a systematic review. PLoS One. 2024;19:e0299008.
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