Knee Pain: Is ACL Injury All In the Knees?

When we think of anterior cruciate ligament injuries we think of contact sports right? We imagine some one playing netball or rugby running into each other and *bam* this person has now torn their ACL. Is this really the case though?

When we think of anterior cruciate ligament injuries we think of contact sports right? We imagine some one playing netball or rugby running into each other and *bam* this person has now torn their ACL.

Believe it or not, this is NOT the most common cause of ACL injuries! The most common mechanism of ACL injury is actually non-contact. This means something happened (to cause the injury) but it’s not a contact, traumatic event.

How does ACL injuries happen then?

We (as a profession/research community) think poor motor coordination is why people experience ACL injuries. Motor coordination errors lead to poor movements such as excessive valgus and overloading of the ACL tissue, which can both lead to injury.

Your brain has a role to play

It might not seem obvious initially but the brain (and nervous system) controls our movements. A 2019 study found evidence of the possibility that neural biomarker predisposes individuals to ACL injuries. It is hypothesised that altered neurologic pattern can lead to aberrant biomechanical function and consequentially causes injury. This may also be the reason why some patients continue to suffer recurrent ACL problems despite a successful surgical outcome.

Rehabilitation is not just about getting more strength

Too often we think rehabilitation is just about getting more strength but that is not the case. We also look at how you move (if there are excessive motor coordination errors, your functional capacity (what you can do or cannot do), how sensitised your tissues are (how easy is it to cause discomfort or even pain), how much load tolerance you have (how much weight you can carry, how many repetitions of an exercises can you do). There are a lot of factors that come into play to deliver a truly successful rehabilitation outcome.

The idea of rehabilitation is to get you back to the life you want to live. This may be having a stellar golfing career, playing with your grandchildren, or your weekly tennis games with your neighbours. It doesn’t matter! Rehabilitation is about you, your goals, and what you want out of it.

How Square One is different?

Firstly, we are one of the only movement/exercise-based clinic in Singapore. Most clinics – chiropractic, osteopathic, physiotherapy (you name it) – focus on manual therapy (i.e. massage, chiropractic adjustment, dry needling) while exercises constitute to less than 10% of each treatment. Often, healthcare providers complain about patients being not compliant to the prescribed exercises. If we as healthcare providers treat exercises as a footnote, who can blame these patients?

To challenge the status quo, Square One Active Recovery now offers ninety percent movement and exercise-based therapy while manual therapy stays strictly as adjunctive care. This is congruent with all international clinical guidelines! We deliver results. Over eighty percent of our patients are discharged from our care within 4 to 9 visits!

Secondly, Square One is not about man-made constructs and ideals. We don’t believe in symmetry, alignment, and posture. In fact, none of these practices are supported by research evidence. There is no high quality study that is able to demonstrate that having “good” alignment or posture is going to give you better health outcomes. We are about you. We don’t impose our goals on you. We believe in helping you achieve what you want. Because we care about you as a person.

Get help for your knee pain with us

Are you ready to take action? Keep an open mind and let us help you manage your knee pain. Again, we are one of the most successful practices in Singapore (not in size or financially but in clinical outcomes) who can consistently deliver long-term results in four to seven visits.


We are evidence-based. We promised you the best care you can get.


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