Non-surgical solutions for ACL injury with Dr. Kieran Richardson
The latest episode of World’s Best Physio features Dr. Kieran Richardson and Sam Suke. The following is an educational article based on the interview. Below the article is a full transcript with timestamps.
Educational Article: Navigating ACL Recovery Without Surgery
For decades, the standard response to an Anterior Cruciate Ligament (ACL) tear was "you need surgery." However, modern sports medicine is undergoing a paradigm shift. Based on the insights of specialist physiotherapist Dr. Kieran Richardson, here is what you need to know about non-surgical ACL recovery.
1. Your ACL Has the Potential to Heal
The long-held belief that the ACL cannot heal itself is largely a myth. Research dating back to the 1990s has shown that when the knee is supported correctly and the patient follows a structured rehabilitation program, ACL fibers can reattach and heal [20:08]. In many cases, meniscus tears present alongside the ACL injury also heal during this process [20:51].
2. Understanding Modern Protocols
If you choose the non-surgical path, you aren't just "doing nothing." You are following a specific protocol designed to create the environment for healing:
The BLEX Protocol: This is a weight-bearing approach where you wear a brace to protect the ligament while remaining mobile. It allows for "pre-hab" and active recovery at home, which is often more practical for daily life than more restrictive protocols [17:02].
Exercise-Based Rehab: Even without a specialized brace, many patients achieve excellent outcomes through high-level strength and neuromuscular training alone.
3. Surgery vs. Physiotherapy: The Outcomes
Studies comparing surgical reconstruction to high-quality physiotherapy often show similar long-term outcomesregarding pain, function, and the development of arthritis [07:37]. Surgery is a sophisticated tool, but it is not always "superior care"; for many, physiotherapy is actually the "best care" because it avoids the risks of infection, graft failure, and the trauma of a second injury to the body [07:11].
4. The Importance of "Holding Your Horses"
Many patients feel pressured to book surgery immediately after an injury. Dr. Richardson suggests a "wait and see" approach while engaging in physiotherapy [33:52]. Rushing into surgery can sometimes perpetuate problems, whereas giving the body 3–6 months of dedicated rehab can reveal whether the knee is stable enough to return to sport without an operation.
5. Building Self-Efficacy
Perhaps the greatest benefit of the non-surgical route is self-efficacy. Recovering through movement and strength builds a deep trust in your own body [31:36]. Instead of feeling "broken" and needing a surgical fix, you learn that your body is a "master of healing" capable of adapting to significant challenges [11:30].
Conclusion: If you have sustained an ACL injury, you have options. Before deciding on surgery, consult with a physiotherapist experienced in non-surgical management. You may find that your body has all the tools it needs to get you back on the field.
Video Transcript Summary
[00:31] Introduction to Specialist Physiotherapy: Dr. Richardson explains his background as a titled specialist physiotherapist in Australia, a designation held by only about 200 of 40,000 physios. His focus is on the non-surgical management of pain and injury across the entire body.
[06:08] The Shift to Non-Surgical Care: Kieran discusses how early research (dating back to the 1980s and 90s) showed that physiotherapy outcomes for hip and knee arthritis are often equal to surgery. This led him to apply similar non-surgical principles to ACL tears.
[10:41] Evidence for Natural Healing: Mention is made of a community of over 36,000 people who have successfully recovered from ACL and meniscus tears without surgery, highlighting that the human body is a "master of healing."
[12:56] The BLEX Protocol vs. Cross Brace Protocol: * Cross Brace Protocol: Requires the knee to be bent at 90° in a brace, involves blood thinners due to immobility, and has specific inclusion criteria. [17:54]
BLEX Protocol (Australian Knee Injury Study): A more practical, weight-bearing approach. It uses a brace to prevent full straightening but allows walking and home-based exercises. [17:02]
[18:54] Debunking the "ACLs Don't Heal" Myth: Richardson explains that the idea that ACLs cannot heal originated from a 1960s dog study where the animals weren't braced or rehabbed. He cites 1994 research by Dr. Ihara showing that many ACL and meniscus tears heal naturally when properly supported. [20:08]
[31:36] The Power of Self-Efficacy: A major advantage of the non-surgical route is building the patient's faith in their own body’s ability to handle challenges, rather than relying on "something outside of their skin." [32:05]
[39:12] Clinical Experience: Having overseen thousands of cases, Richardson emphasizes that while surgery is sometimes necessary, many patients rush into it without realizing that high-quality rehab is a viable primary option.