Symptoms
Does this sound like you
- A pop or snap at the moment of injury
- Swelling that builds within a few hours
- Pain and trouble taking weight on the leg
- Not being able to fully straighten or bend the knee
- A knee that feels loose or shifts when you turn
- The knee giving way on stairs, slopes or quick turns
Assessment
We start with the story: how you fell or landed, whether you felt a pop, and how quickly the knee swelled. Then we examine both knees. We check the swelling and how far the knee bends and straightens. We gently test how far the shin bone moves forward compared with your other leg. We also check the cartilage cushion inside the knee (the meniscus) and the other knee ligaments, because they are often hurt at the same time.
If the tests point to a tear, or to other damage in the knee, we explain what we found. We also recommend that you see a doctor or nurse practitioner, who can order a scan and, if needed, refer you to a surgeon.
Treatment
Early treatment has three goals: calm the swelling, get the knee fully straight again, and switch the thigh muscles back on. Some people need crutches or a brace at this stage. For braces, see splints and bracing.
From there, rehab is a staged exercise plan. It works the muscles at the front and back of the thigh and around the hip. It builds from strength and balance to jumping, landing and changing direction. Hands-on treatment can ease pain and stiffness along the way, but exercise is the main treatment. The later stages often move into strength and conditioning.
If you are having surgery
The usual operation is an ACL reconstruction: the surgeon replaces the torn ligament with a graft, often taken from one of your own tendons. Rehab starts before the operation. Many surgeons want the swelling down, the knee fully straight and the thigh muscles working before they operate, so that is what we work on first. After surgery, we follow your surgeon's protocol.
Getting back to sport
When you go back depends on testing, not on a date alone. If you had a reconstruction, we plan the final stages with your surgeon, because the new ligament needs time to grow strong. Return-to-sport tests usually compare your injured leg with the other one for strength, hopping, landing and changing direction. Our testing guidelines are on the ACL return to sport page.
Before that final testing, we train for what your sport asks of the knee. On skis or a snowboard, that means absorbing bumps, landing jumps and stopping hard. In the bike park, it means drops, rough trail and putting a foot down fast.
Our ACL prevention series suits this stage. Its four videos train landing and loading for skiing and snowboarding through balance, coordination and strength. A key focus is keeping the knee in line with the hip and foot. A knee that drops inward when you land is linked to a higher risk of ACL injury. Keep doing the series after you return to help lower that risk.
When to come in
Book an assessment if you felt a pop in your knee, it swelled quickly, or it feels loose or gives way. Come in before ACL surgery to start rehab, and after surgery when your surgeon says you can start physiotherapy. If an old ACL injury still does not feel right on skis or the bike, an assessment and a return-to-sport test can show what is missing.
Go to the emergency department right away, or call 911, if any of these happen:
- the knee looks out of shape
- you cannot put weight on the leg, even for a few steps
- your foot is numb, cold or pale
The people
Who treats it
Partner · PhysiotherapistSport physiotherapy and return to sport · Movement analysis and exercise programming · Complex orthopaedic and post-surgical rehabilitationVillage North · Whistler Athlete Centre
Partner · PhysiotherapistHand and upper-limb rehabilitation · Concussion and vestibular rehabilitation · Sports and spinal injuriesVillage North
Partner · PhysiotherapistComplex neck and back problems · Sports injuries · Concussion and vestibular rehabilitationVillage North
PhysiotherapistPelvic health and pelvic floor physiotherapy · Pre- and post-natal rehabilitation · Sports injuries and post-surgical rehabilitationVillage North · Whistler Athlete Centre
PhysiotherapistRunning injuries · Post-surgical rehabilitation, including ACL and rotator cuff · Concussion and vestibular rehabilitationVillage North
PhysiotherapistACL rehabilitation, with or without surgery · Concussion and vestibular rehabilitation · Running injuriesVillage North
PhysiotherapistSnow sports injuries · Acute sporting knee injuries · Strength and conditioningVillage North · Whistler Athlete Centre
PhysiotherapistPelvic health for men and women · Antenatal physiotherapy · Hip, pelvis and spinal injuriesVillage North · Whistler Athlete Centre
- By referral
Care
How we help
Physiotherapy
Assessment, hands-on treatment and a plan built around your sport, from physiotherapists whose patients compete on the World Cup with Canada's ski and snowboard teams.
Read more ServiceSports Physiotherapy
Assessment and treatment of sports injuries by physiotherapists who hold a Sports Physiotherapy Diploma or title, with experience from junior to elite athletes.
Read more ServiceStrength and Conditioning
Exercise programming that builds strength and control in the later stages of rehabilitation, taking your recovery on to the demands of your sport or your job.
Read more ServiceSplints and Bracing
Heat-moulded thermoplastic splints for wrist, finger, thumb and scaphoid injuries, carpal tunnel and post-operative protection, and standard or customized braces for injured joints.
Read moreACL Return to Sport
You can download our functional testing guidelines for ACL reconstruction/knee injuries below.
Watch the video 4 levels · about 17 min eachACL Prevention
The ACL prevention series was developed to help you develop optimal biomechanical loading and landing strategies with skiing/boarding through body awareness and coordination, strength endurance and stability exercises to help minimize your risk.
Start level 1FAQ
The questions we hear most
Do I need surgery for a torn ACL?
Not always. Some people manage well with rehab alone, especially if the knee feels stable day to day and their sport involves little twisting. Others choose surgery because the knee keeps giving way, or because they want to return to sports with jumping and quick changes of direction. The decision is yours to make with your surgeon. We help by testing how the knee works and explaining what each option involves.
Can I ski or snowboard with a torn ACL?
Not right away. Later, some people can, depending on how stable the knee is and what else was injured. Skiing or snowboarding on a knee that gives way risks more damage to the cartilage inside it. Before you go back on the hill, we test your strength, balance and control, and talk through whether a brace makes sense. A doctor or nurse practitioner, or your surgeon if you have one, should be part of that decision.
How long until I can get back to sport?
No set date. It depends on the injury, whether you have surgery, and how your knee responds to rehab. You go back when your knee passes our return-to-sport tests. After surgery, your surgeon also needs to agree that the new ligament is ready. Going back before then raises the chance of hurting the knee again.
Should I wear a knee brace?
Sometimes. A brace can help early on, after the injury or after surgery, and some people choose a custom ligament brace for skiing or biking once they return. It supports the knee, but it does not replace the strength and control you build in rehab. We supply standard and custom knee braces.
This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.