Knee

What It Is

The ACL can become injured when the knee joint is bent backwards, twisted or bent to one side or another. Injury chances are higher when one or more of these movements happen at the same time. This type of injury often occurs when playing sports, particularly when pivoting, cutting (changing direction sharply) or jumping with the leg straight as it hits the ground. It can occur when changing direction quickly, stopping suddenly, slowing down while running or landing awkwardly from a jump. Most ACL injuries happen without any direct impact to the knee, although direct contact or a collision, such as a football tackle, can also cause one (AAOS, n.d.a). It tends to be common in football, soccer, basketball, volleyball, skiing and other sports where a lot of weaving, jumping, starting and stopping occur.

Anterior Cruciate Ligament Injury Anatomy

An anterior cruciate ligament injury is a tear in one of the knee ligaments that join the thigh bone (femur) to the shin bone (tibia). The ACL runs diagonally through the middle of the knee. It stops the shin bone sliding forwards in front of the thigh bone and helps keep the knee stable when it twists (AAOS, n.d.a). Injuries can range from mild, such as small tears, to severe, when the ligament tears completely or when the ligament pulls a small piece of bone away from the rest of the bone (an avulsion fracture) (AAOS, n.d.a).

Without proper treatment, the injured ligament may be unable to control movement of the knee, and the knee may feel loose or give way. Over time, this ongoing instability can damage the menisci (the cartilage pads that cushion the knee joint) and the smooth cartilage covering the ends of the bones (AAOS, n.d.b).

At times, other parts of the knee are injured at the same time. About half of ACL injuries happen together with other injuries, such as meniscus tears, cartilage damage or tears of other knee ligaments (AAOS, n.d.b). Bones in the knee can also be broken.

When the ACL is injured, you may hear a popping noise and feel your knee give way. It is likely to be painful, and the knee will usually swell within 24 hours. You may not be able to fully bend or straighten the knee, the joint line may be tender, and walking may be uncomfortable (AAOS, n.d.a). Even if the pain and swelling settle, going back to normal activities too soon can make the knee feel unstable and risk further damage (AAOS, n.d.a).

When I assess your knee, if I suspect an ACL tear, I may advise you to see your family doctor or nurse practitioner, or a specialist, who may arrange an X-ray or MRI scan. If the ACL is ruptured, you may be advised to consider surgery, but not all ACL injuries need surgery (NHS, 2025).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat an Anterior Cruciate Ligament Injury

For the first 2 to 3 days, the following steps can help bring down swelling and support the injury (NHS, 2024):

1. Ice

Wrap an ice pack (or a bag of frozen vegetables) in a tea towel and apply it to the injured area for up to 20 minutes every 2 to 3 hours (NHS, 2024). This can help reduce swelling. Never put ice directly on the skin.

2. Elevation

Keep the leg raised on a pillow as much as possible (NHS, 2024). You do not need to keep the leg completely still: once you can move the knee without pain stopping you, keep it moving gently so it does not become stiff (NHS, 2024).

3. Pain Medication

The NHS (2024) suggests speaking to a pharmacist about sprains, and says that at first you can try painkillers such as paracetamol to ease the pain and ibuprofen gel, mousse or spray to bring down swelling, with ibuprofen tablets if needed. (This medicine information comes from the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

4. Compression

Wrapping a bandage around the knee during the day can support it and help reduce swelling (NHS, 2024).

5. Crutches

Crutches can help you walk and take weight off the knee while it is painful.

Tips

After an acute injury, you will probably need to stop whatever you are doing because of the pain, but you might still be able to walk.
For the first couple of days, avoid heat (such as hot baths and heat packs), alcohol and massage, as these can increase swelling (NHS, 2024).
Being female, being younger, having a higher body weight, having looser joints and having weaker lower leg muscles are all linked with a higher chance of an ACL tear (AAOS, n.d.a).
Make sure the knee is stable enough to handle everyday activities. If your knee keeps feeling unstable or giving way, see your family doctor or nurse practitioner, as ongoing instability can damage other parts of the knee (AAOS, n.d.b).
Make sure your knees are strong enough to handle the forces of your regular activities. Exercises are key to your rehab, especially rebuilding the strength of the quadriceps (the muscles at the front of the thigh) (AAOS, n.d.a). I can work with you to build enough strength in the knee. See the My Approach tab for how I work.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Scans: an X-ray can check for broken bones, and an MRI scan shows the ligaments, cartilage and menisci (AAOS, n.d.a).
Knee brace: a doctor may recommend a brace for extra support as part of non-surgical treatment (AAOS, n.d.b).
Physiotherapy-led rehabilitation: a structured programme to restore strength and stability, which is the main non-surgical treatment (AAOS, n.d.b).
Surgery (ACL reconstruction): an operation that replaces the torn ligament with a tendon graft, usually taken from another part of your body such as the hamstring. It may be needed if you play a lot of sport and want to continue, or if you keep having problems with your knee after trying physiotherapy (NHS, 2025).

How I can help (see the My Approach tab)

Strength and balance work alongside your physiotherapist's programme
Hands-on work for swelling, stiffness and overworked muscles
Help working out whether a brace might help and how to get one

Treatment

My Approach

The ACL sits deep inside the knee, so I can't work on the ligament itself. My work is on everything around it: easing swelling and stiffness, keeping the muscles around the knee working, and rebuilding the strength and balance your knee needs to feel stable again.

If it's a mild sprain: the knee is sore but feels stable, you can walk on it, and my assessment doesn't point to a bigger tear. I can treat this directly, following the stages below.

If it may be a severe or complete tear: you felt a pop, the knee swelled up quickly, it gives way, it's locked, or you can't take weight on it. See your family doctor or nurse practitioner, or go to urgent care, first. Once you've been assessed, I work alongside your doctor, surgeon and physiotherapist and provide supportive care. A locked knee shouldn't be forced straight or bent. After ACL surgery, I need your surgeon's okay before hands-on treatment, and I follow their limits on movement and weight-bearing.

I start by assessing your knee's movement, swelling and stability, the strength of your thigh and hip muscles, your balance and the way you walk.

Acute: New

Leg raised, ice at home (I'll show you how), and after the first couple of days, gentle work above the knee to help swelling drain
Massage for the back, hips and other leg, and the arms and shoulders if you're on crutches
Gentle kneecap mobilisation, thigh tightening, straight-leg raises and heel slides, within the ranges you've been cleared for

Subacute: Healing

Trigger point and myofascial work for the thigh and hamstrings, with warmth for tight tissue that limits straightening
Scar work once any surgical scars have healed
Squats in safe ranges, step-ups and balance work, building to gym-based strength work for the thighs and hips

Return to Sport

Running, jumping, landing and change-of-direction drills, built up step by step
Taping for support as you return

Ligament recovery is slow. After surgery, your surgeon and physiotherapist decide when you're ready for sport, and I'll help you get there.

If the leg is numb, cold or blue, or has changed shape, get urgent help (see When to Get Urgent Help).

What to Expect

Typical Course

Typical course: For a mild sprain, most people come once or twice a week for the first few weeks, then weekly, spacing out as the home programme takes over, and usually feel back to normal within a few weeks to a couple of months. For a severe sprain or tear, visits fit around your doctor's, surgeon's and physiotherapist's plan; recovery usually takes several months, and after reconstruction a return to sport can take up to a year.

What I Focus On

Assessment & Referral

Swelling Control

Compensation Relief

Thigh & Hip Strength

Balance & Return to Sport

Please read

When to See a Doctor First

When to Get Urgent Help

Call 911 or go to the emergency room at your nearest hospital if you heard a crack when you were injured, the knee or leg has changed shape or is pointing at an odd angle, the leg or foot is numb, tingling or has pins and needles, or the skin has turned blue or grey or feels cold. These can be signs of a broken bone (NHS, 2024).

Sources

References

American Academy of Orthopaedic Surgeons (n.d.a) Anterior cruciate ligament (ACL) injuries. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.b) ACL injury: does it require surgery?. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/treatment/acl-injury-does-it-require-surgery/ (Accessed: 7 October 2026).
NHS (2025) What is ACL (anterior cruciate ligament) surgery?. Available at: https://www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery/what-it-is/ (Accessed: 7 October 2026).
NHS (2024) Sprains and strains. Available at: https://www.nhs.uk/conditions/sprains-and-strains/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooAnterior Cruciate Ligament (ACL) Injuries

What It Is

Anterior Cruciate Ligament Injury Anatomy

Self-Care & Treatment

How to Treat an Anterior Cruciate Ligament Injury

1. Ice

2. Elevation

3. Pain Medication

4. Compression

5. Crutches

Tips

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

Acute: New

Subacute: Healing

Return to Sport

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooAnterior Cruciate Ligament (ACL) Injuries

What It Is

Anterior Cruciate Ligament Injury Anatomy

Self-Care & Treatment

How to Treat an Anterior Cruciate Ligament Injury

1. Ice

2. Elevation

3. Pain Medication

4. Compression

5. Crutches

Tips

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

Acute: New

Subacute: Healing

Return to Sport

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Chondromalacia Patella

Fat Pad Impingement

Iliotibial Band Friction Syndrome

Interphalangeal Joint Sprain

Book a session