Welcome to Hills Physiotherapy
Allied Health Services in Rowville, Emerald, and Knox
Hills Physiotherapy has been operating in Emerald for over 30 years, providing the premier physiotherapy, osteopathy, exercise physiology, pilates, remedial massage, myotherapy and associated health services to the hills. With our new locations in Emerald and Knox we’re excited to be able to offer our extensive experience to the Dandenongs and surrounds.
Book Online or call us on 1300 9 HILLS
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More TipsAre ACL Reco’s a thing of the past? Guest blog by Lachlan Porter
Anterior Cruciate Ligament (ACL) injuries are often met with the automatic assumption that surgery is the only way forward. This belief stems from decades of medical practice, where a complete tear of the ACL was seen as an irreversible injury that could only be addressed through surgical reconstruction. However, new research has revealed that this isn’t necessarily the case. ACL injuries can heal without surgery, and many patients have successfully returned to their regular activities with a comprehensive rehabilitation program alone.
In fact, a large multi-centre study recently showed that as many as 50% of ACL injuries heal naturally without the need for surgery or bracing. A further study, examining the effects of a bracing protocol combined with rehabilitation, found that as many as 90% of ACL injuries showed healing after 12 weeks. These findings challenge the traditional view that surgery is the only effective treatment and provide hope for patients seeking alternatives.
At Hills Physiotherapy, we’ve seen remarkable results with both partial and full healing of the ACL both naturally and with bracing protocols, demonstrating that the body is capable of remarkable recovery when given the right support. This article will explore the latest research on ACL injuries and how our clinic integrates these findings to offer the best care possible for our patients (see these other blogs for more interesting ways evidence is improving practice!)
A New Perspective on ACL Injury Treatment
The growing body of research on ACL injuries has significantly shifted the way these injuries are managed. The traditional approach was to treat any significant ACL injury, whether partial or complete, with surgery to restore stability to the knee joint. However, emerging evidence suggests that this is not the only option.
One of the most significant breakthroughs in ACL injury management is the understanding that the ACL can heal naturally. The KANON trial, revealed that patients who opted for rehabilitation alone—not surgery—had outcomes comparable to those who had surgery. In this study, exercise therapy alone allowed patients to maintain functional knee stability, and many even returned to their previous activity levels.
Further studies have provided even more compelling evidence. One notable trial found that 50% of patients who underwent conservative treatment (rehabilitation alone) had a fully intact ACL after just two years, with no need for surgery. Additionally, a study comparing the long-term outcomes of surgical and non-surgical treatments found that patients who opted for rehabilitation had less incidence of osteoarthritis than those who had surgery. This challenges the idea that ACL surgery is always the best option for preventing long-term joint problems.
While surgery remains an option for some patients, these studies suggest that a thorough rehabilitation program, in some cases coupled with bracing, can be equally effective in restoring function and stability to the knee. And this is not just theory—at Hills Physiotherapy, we’ve witnessed the success of rehabilitation-based treatment with and without bracing, with patients showing significant improvement and returning to sports after ACL injury.
The Importance of Rehabilitation in ACL Injury Recovery
One of the most important insights to come from recent research is that exercise and rehabilitation are the cornerstones of ACL injury recovery. Whether a patient opts for surgery, bracing, or conservative management, physical rehabilitation plays a critical role in ensuring the best possible outcomes.
Elite athletes, who are often under the highest pressure to recover quickly and effectively, offer valuable lessons in the importance of rehabilitation. Studies have consistently shown that athletes who undergo rigorous and focused rehabilitation have the highest rates of return to sport (RTS). This is because rehabilitation for elite athletes is comprehensive, individualized, and undertaken with the goal of returning to their highest level of performance.
However, rehabilitation isn’t just for elite athletes. The benefits of physical therapy are felt by everyone, regardless of age or activity level. Evidence from studies like those conducted by Failla et al. (2016) and others shows that patients who follow a structured rehabilitation program, even without surgery, have significantly improved chances of returning to their pre-injury level of activity. In fact, those who engaged in rehabilitation prior to undergoing delayed surgery had better long-term outcomes, including higher RTS rates (72% compared to 63% for those who had immediate surgery).
A comprehensive rehabilitation program includes strength training, neuromuscular exercises, and sport-specific activities that work to restore joint function and improve stability. Importantly, rehabilitation helps improve the body’s ability to adapt to the stress of physical activity, reducing the likelihood of re-injury. The KANON study found that patients who adhered to an exercise therapy regimen alone or in combination with delayed surgery were able to return to activity at similar rates as those who had surgery right away.
The role of rehabilitation cannot be overstated. Regardless of whether a patient decides to undergo surgery or opt for a conservative approach, rehabilitation is a crucial part of recovery. By focusing on building strength, stability, and function in the knee, rehabilitation not only supports the healing process but also helps ensure that the knee can withstand the stresses of daily activities and sport in the future.
Bracing: A Useful Tool for Many
Another option that has gained traction in recent years is the use of bracing during the rehabilitation process. Bracing, when used strategically, can provide additional support and protection to the injured knee, particularly during the early stages of recovery.
The Cross-Bracing Protocol, a study examining the benefits of knee bracing during ACL recovery, showed impressive results. This study found that 90% of patients who followed a strict bracing protocol combined with rehabilitation saw signs of ACL healing after just three months. The brace was worn for the first four weeks to immobilize the knee at 90 degrees, and then the range of motion was gradually increased while continuing rehabilitation exercises. This approach allowed for natural healing while reducing the risk of re-injury during the crucial early phase of recovery.
While this method has been shown to work well for many patients, bracing is not suitable for everyone. Some people may find wearing a brace for an extended period of time uncomfortable, or may not require this level of protection. For those who are not as concerned with a full ACL recovery, or who need more mobility during their daily lives, a hinged knee brace with a less restrictive range of motion can still provide the support needed to protect the knee and prevent re-injury during rehabilitation.
Ultimately, the decision to use bracing should be made on a case-by-case basis, in consultation with a physiotherapist who can assess the specific needs of the patient and guide them toward the most appropriate treatment option.
What makes us decide to go ahead with surgery then?
Surgical intervention, however, remains appropriate in certain scenarios (and if I don’t mention them the Ortho’s will kill me). Key factors influencing the decision to proceed with ACL reconstruction include:
- Symptomatic Instability: Persistent knee instability, characterized by episodes of the knee giving way during daily activities or sports, is a primary indication for surgery.
- Activity Level and Athletic Goals: Individuals engaged in high-demand sports or occupations that involve pivoting, cutting, or rapid directional changes may benefit from surgical reconstruction to restore knee stability and function sooner (this is still hotly debated).
- Associated Injuries: Concurrent damage to other knee structures, such as meniscal tears or collateral ligament injuries, may necessitate surgical intervention to address the combined pathology effectively.
- Patient-Specific Factors: Age, overall health, activity level, and personal preferences play a significant role in the decision-making process. A younger athlete may not have the muscle development and physiology to support the rigorous rehabilitation needed for non-surgical management. Shared decision-making between the patient, physio and surgeon is essential to tailor the treatment plan to individual needs.
Conclusion: A Menu of Options for ACL Injury Management
The latest research demonstrates that an ACL injury does not always have to result in surgery. Whether through rehabilitation alone, bracing, or a combination of both, there are several effective ways to manage and recover from an ACL injury. The key to success in any approach is the rehabilitation process.
At Hills Physiotherapy, we’ve seen firsthand the positive outcomes that can be achieved with a tailored rehabilitation plan, even without the need for surgery. We work closely with each patient to design a personalized treatment program that supports natural healing and gets them back to doing the activities they love.
If you’ve suffered an ACL injury, you don’t have to automatically assume that surgery is the only option. With the right care and a dedicated rehabilitation plan, full recovery is possible—and you may even return to sport or your daily activities stronger than before.
Next Steps
Here is how we manage and rehabilitate ACL injuries at Hills:
Image 1 – ACL Treatment Pathway at Hills Physiotherapy
- Step 1 – The ACL Injury is diagnosed via Physiotherapist or Medical Professional, this may be confirmed by MRI (which is bulk-billable for most patients, with a GP referral)
- Step 2 – Hills Physiotherapist completes an initial assessment and Physical test
- Step 3 – Based on a combination of the initial assessment +/- MRI, the patient and Physiotherapist can determine whether a referral to an Orthopaedic specialist (surgeon) is required. Bracing protocols can also be discussed as an option where appropriate.
- Step 4 – Regardless of choice regarding surgical consult and/or bracing, rehabilitation can commence immediately, so that you are working on the most beneficial factor in your recovery from the very first days.
MORE INFORMATION:
If you’d like to enquire about ACL rehabilitation with us – please book online at hillsphysiotherapy.com.au or call us on 1300 9 HILLS. Click here to book direct with Lachlan!
Written and researched by Lachlan Porter
References
[1] Zbrojkiewicz et al., 2018
[2] Filbay et al., 2022
[3] Kessler et al., 2008
[4] Filbay et al., 2022
[5] Jacobi et al., 2016
[6] Hurd et al., 2008
[7] Frobell 2013
[8] Frobell et al., 2010
[9] Reijman et al., 2021
[10] Beard et al., 2022
[11] Failla et al., 2016
Blog Archive
Physiotherapy
With a wealth of experience in all sports, work injuries, and advanced pain control techniques - our Physiotherapists will diagnose your condition and work with you to address the root of the problem.
Remedial Massage
Using "hands-on" techniques to reduce pain and spasm in soft tissues and relieve stress. This is an essential part of maintaining a healthy body.
Clinical Pilates
Sophisticated exercise classes to correct abnormal movement patterns, and strengthen sore bodies. Suitable for all ages and fitness levels.
Myotherapy
Effective treatment of painful conditions using massage, needling and other pain relieving techniques. Can have amazing health benefits.
Orthotist
Analyses movement problems and fabricates devices to support normal movement. Foot orthotics, Knee braces, custom lymphoedema garments, and fracture management.
And Many More Services
- Dry Needling
- Aquatic Therapy
- Chronic Pain Management
- Spinal Manipulation
- Sports Injuries
About Us
Physiotherapy aims at relieving joint pain and restoring normal movement for any muscle, joint or bone injury. Skilled therapists will use a range of techniques including manipulation, massage, dry needling, aquatic physiotherapy, craniosacral therapy and exercise prescription to achieve results and relieve pain.
Hills Physiotherapy has been operating at the corner of Monbulk and Main Roads for over 30 years, providing the highest quality care to the community. We are located across from Woolworths and Worrell Reserve.
Opening Hours
Emerald
- Mon - Fri
- 8am - 8pm
- Saturday
- 8am - 12:30pm
- Sunday
- Closed
Knox
- Mon
- 8:30-6pm
- Tues
- 9-5:30pm
- Wed
- 9:30-8pm
- Thurs
- 9am - 8pm
- Fri
- 9 -5pm
- Sat
- 8am -12pm
Rowville
- Mon - Fri
- 8am - 7pm
- Saturday
- 8am - 12:30pm
- Sunday
- Closed
A Word From Ben Kewish
Hills Physiotherapy is committed to offering the highest quality in Allied Health Care, with experienced therapists providing a range of complementary medical services. All of our clinicians offer focused, one-on-one service aimed at delivering results today. We work WITH you, the patient, to address the cause of your pain or dysfunction, so that you can become independent of our services and pain-free long term. After becoming the premiere Allied Health facility in the Dandenongs, we are excited to offer our services to Rowville and surrounds, and think that our range of services make Hills Physiotherapy hard to beat.
- Ben Kewish
Owner and Physiotherapist
