Physical Therapy Can Fully Restore Sports Injuries

Lake Region senior Hilary Perron responds well to Matt Breton’s strenuous demands to build up her leg muscles so that she can return to the sports she loves.

You just injured your knee playing basketball and have just been diagnosed with a torn ACL. It hurts a lot and you’re worried about whether or not you’ll be able to continue playing the sport you love. According to Matt Breton, Physical Therapist at North Country Health System’s Rehabilitation Department, the answer is yes. With proper treatment, not only will the leg be fully restored, with improved muscular strength and control due to PT, hopefully it will function even better.

Seventeen-year-old, Lake Region Union High School senior, Hillary Perron is finding out first-hand what having a torn anterior cruciate ligament, or ACL, means. Hillary tore her ACL last fall playing on the high school’s soccer team.

“I went to step in front of a ball that a girl was carrying down the field and it just popped out,” recalls Hillary. This is Hillary’s second experience with a torn ACL. The ACL in her other leg was torn when she was a high school freshman, forcing her to sit out of sports her sophomore year. Both injuries were non-contact ACL injuries, meaning that, like 78% of these injuries, they were caused by sudden turning of the knee. She underwent reconstructive surgery both times.

Hillary Perron and Matt Breton, PT, have built a great working rapport at
North Country Hospital’s Physical Therapy.

Understanding the Knee

The knee is basically a hinge joint made up of three bones held firmly together by ligaments that stabilize the joint. The bones that meet at the knee are the upper leg bone (the femur), the lower leg bone (the tibia), and the knee cap (the patella). On each bone there is a smooth protective layer of tissue called cartilage, which allows the bones to glide upon each other. Between the femur and tibia there is the meniscus, two cushions that aid in protecting the joint and cartilage.

Ligaments

Ligaments are dense structures of connective tissue that fasten bone to bone and stabilize the knee. Inside the knee joint are two major ligaments:

• The anterior cruciate ligament (ACL)
• The posterior cruciate ligament (PCL)

These cross in the center of the knee (that's why they're called cruciate ligaments -a crucifix is a cross). They control the backward and forward motion of the knee. The ACL in particular restrains excessive forward motion of the knee as well as the inward twisting or rotation of the knee. The ACL is frequently injured with severe turning of the knee and is the second-most commonly injured knee ligament. The ACL, commonly damaged by athletes, is often torn during sudden dislocation, torsion, or hyperextension of the knee and can be excruciatingly painful. It is a frequent injury in football, hockey, lacrosse, skiing, skating and basketball, due to the enormous amounts of pressure, weight, and torque the knee must withstand.

Females are More Susceptible to ACL Injury

According to emedicine.com women are more susceptible to ACL rupture, and new research shows that women may be up to 8 times more likely than men to rupture the ACL. Researchers continue to debate why women are more likely to tear their ACL than men. Some theories center on the “anatomical and hormonal differences among men and women.” Studies being conducted include the following possibilities: correlation between a woman’s monthly hormone changes and susceptibility to an ACL injury; a narrower intercondylar notch (groove located at the end of the femur) in women; an imbalance in strength between the quadriceps and hamstrings (muscles that are on the front and back of the thigh...women have stronger quadriceps and weaker hamstrings); and a difference in running and jumping posture. ACL injuries occur most commonly in individuals aged 14 – 29 years most likely because these years correspond to a high degree of athletic activity.

Early Rehab is Crucial

There are several options for the treatment of an ACL injury. Despite which option is chosen, early rehabilitation of the knee is crucial to restore motion, control swelling, and increase strength.
Matt Breton, who has a Master’s Degree in Physical Therapy and is a board certified Orthopaedic Clinical Specialist as well an NSCA Certified Strength and Conditioning Specialist, works with Hillary twice a week At this point in her rehabilitation she is concentrating on training to build up the basic strength and coordination of the muscles of her knee, hip and core. A number of different programs are used by different physical therapists. The therapy program chosen depends on the patient’s goals, current activity level, type of surgery performed (if any), coexistent injuries, the surgeon, the insurance policy, and time constraints.
When asked if the exercises hurt, Hillary responded that it was like a workout, hard on the muscles but no pain to the knee.
Hillary will continue with Physical Therapy for several more weeks. She will not be ready to compete on the high school tennis team this year, but hopes to be able to play tennis, soccer and basketball in college.
“Hillary has been a very good patient,” says Matt with a smile. “She is an active participant in her rehab. She understands that she is the one ultimately responsible for the work.”
Hillary and Matt have built a great working rapport between each other. Hillary responds well to Matt’s strenuous demands to build up her leg muscles so that she can return to the sports she loves soon.

Prevent injury and Enhance Performance

The Santa Monica ACL Prevention Project has developed the PEP Program in order to implement a strategic training program to decrease the number of ACL injuries incurred by female athletes. This prevention program consists of a warm-up, stretching, strengthening, plyometrics, and sport specific agilities to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint. Studies have shown that adding these specific neuromuscular and proprioceptive exercises to the training regimen can reduce the number of non-contact ACL injuries by two-to-four-fold. Coaches and trainers need to emphasize correct posture, straight up and down jumps without excessive side-to-side movement, and reinforce soft landings. More information on the PEP program may be found at http://www.aclprevent.com/index.htm
Physical Therapy at North Country Hospital
North Country Hospital is pleased to offer the community a fully staffed physical rehabilitation department. Matt Breton is one of 12 highly qualified physical therapists who specialize in such areas as Orthopaedics, Aquatics, Lymphodema, Pulmonary Health, Wound Care, Pediatrics, Orthotics, Incontinence, Geriatrics, Inpatient, and back pain. They are all friendly and easy to work with.
When asked about her experience with Matt Breton, Hillary Perron responded, eyes twinkling, “Matt is so easy to work with – he has been great about adjusting to my moods...I can be moody.” Being able to adjust to a teenage athlete’s moods when she is sidelined for a second year of high school sports is a skill reserved only for the very best. North Country Health System is proud to offer the best in physical therapy.

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