ACL Injury and Back Pain

A patient recently came to see me with right-sided low back pain that had been bothering her for about six months.

She noticed it most when she first started squatting down and first thing in the morning. Naturally, the focus seemed like it should be the low back.

But when I assessed her, something interesting happened:

I couldn't reproduce her pain with the typical low-back orthopedic testing.

So instead of continuing to chase the painful area, we looked at the rest of the system.

She had suffered an ACL injury about 25 years ago that had never been fully rehabilitated. On assessment, she could barely get that knee to 90 degress of flexion and was missing roughly 10 degrees of full extension.

More importantly, she had developed movement strategies around that knee.

She avoided putting weight through it when getting down to the ground. She wouldn't jump on that leg. And when she ran a half marathon, her low back pain would increase.

That changed the way we looked at the problem.

We weren't just dealing with a "tight" or "weak" low back.

We needed to restore the movement and stability that she had been missing for years.

We first worked on restoring knee motion. Eventually she regained full knee extension and roughly 120 degrees of knee flexion.

And something pretty remarkable happened:

Her low back pain went away.

From there, we continued working on how she stabilized through her trunk using intra-abdominal pressure, along with improving hip stability and her ability to properly load the leg.

Today, she's back to running with her daughter - and she's even progressed to doing sprint drills.

This is exactly why I believe assessment is so much more than simply looking at where someone hurts.

Pain is a signal, not necessarily the source of the problem.

If your back hurts, the answer isn't always found by only examining your back.

Sometimes we need to look at the hip, knee, ankle, thoracic spine, breathing mechanics, strength, stability, and the way your entire body moves together.

The goal isn't simply to make the painful area feel better.

The goal is to figure out why it started hurting in the first place - and then give your body the capacity to handle the things you want to do.

That's the difference between simply treating pain and actually assessing the person in front of you.