ACL Prevention: What Can We Do?
How do we combat the ACL Epidemic?
First, if you are a youth athlete make sure you play different sports challenging different muscle groups/joints…DO NOT SPECIALIZE UNTIL YOU ARE OLDER aka COLLEGE! All the best athletes in the world played multiple sports including LeBron James, Michael Jordan, JJ Watt, and Usain Bolt, just to name a few. Playing multiple sports exposes the athlete to a variety of movements that are essential for all movements in daily life and performance.
Second, get your sleep! Lack of sleep debilitates performance and leaves the athlete more likely to suffer a serious injury. So if you are a serious athlete, stop the late Fortnite and get to bed! (Rugg, 2018)
It’s All in the Glutes:
If you know the team at Trifecta you know we are glute happy people #BunsByBoyd. And for good reason: the glutes are the workhorse of the lower body (arguably the whole body). You would be surprised how many athletes have deficient glutes and how often they are compensated for by quadriceps, hamstrings, back, and calf muscles. Your gluteus group (Maximus, Medius, Minimus) are largely responsible for moving the lower extremity and controlling the infamous knee valgus collapse. Get them on board in the right way, both in fundamental movements (squat, hinge, deadlift, jump, land etc) and the specific movements for your sport, and you will be a much better and safer athlete.
Your Ankle Mobility is Harming Your Knee
Who would have thought your stiff ankle can possibly lead to knee injuries? Well it does. Fong (et al) of the National Athletic Training Association determined a loss of ankle dorsiflexion during landing is associated with less knee-flexion displacement (less bending of the knee) and greater ground reaction forces (more forces from the ground acting on the individual), which in turn leads to greater knee-valgus displacement . This is how most ACLs are torn during sport. It is common following an ankle sprain or fracture that a loss of dorsiflexion occurs.
Address Current/Past Injuries and Limitations:
Your past ankle sprains and your previous hamstring strains all have an impact on your ACL. As we mentioned, lack of full dorsiflexion in your ankle after that sprain leads to more valgus moments and forces going through the knee during jumping and cutting, making you more susceptible to an ACL injury. How about that hamstring injury that you let rest and ice heal? The hamstring works synergistically to your ACL and helps restrict the anterior translation (moves) of the tibia (shin) during lower body movements. An ACL tear can occur when the shin excessively translates in the anterior direction. So, if you had a previous/current lower extremity injury that you have not had checked out to see if you are truly 100%, I recommend you getting checked out.
Work on Cutting, Jumping, Landing Mechanics.
ACL tears are predominately a non-contact injury, meaning that the athlete is not impacted/touched by another player when the ACL tears. This is largely preventable if the training is right! Working on neuromuscular control and mechanics with cutting/jumping/landing has been proven to reduce the likelihood of significant injuries including the ACL tear.
WARM THE HELL UP!
Why is it that we still see and hear from athletes that they barely warm up prior to performance or games? It’s 2020! Everyone should know that having a proper dynamic warm up can help mitigate the likelihood of injury! Pre-game is not the time for dilly dallying, it’s a time to be focused and preparing your body for upcoming battle ahead! Don’t know what a dynamic warm up looks like? Check out our video!
Invest into a PEP/ACL injury mitigation/Sports Performance program
As we mentioned before “An ounce of prevention, is worth a pound of treatment”. There is a ton of research on Prevent Injury, Enhance Performance (PEP) programs or similar ones such as the Knäkontroll or HarmoKnee (Arundale et al 2018) on their ability to reduce the likelihood of an ACL tear, yet we rarely see it implemented in most athletic and team practices. Based off the research, we have seen an 89% decrease in the likelihood of ACL injuries with teams that implement the PEP!
Unfortunately, due to the time constraints of most team programs (especially now in a post COVID world) most coaches have to focus on fundamentals of their sport and team building. Thus, the athlete or parent is now responsible for mitigating the risk of injuries. These programs are widely available online and would require most athletes to show up to practice a little earlier to self-implement.
However, most athletes may lack this self-discipline, and I cannot say that I had a ton of that when I was a kid. That is where a great sports performance coach comes in. Not only does a great sports performance coach help you get better at your sport by becoming stronger, faster and more powerful, but they take injury prevention into account for their clients. Integrating components of PEP programs and coordinating with the team coach, the athletic training staff, and the PT as needed will help keep the athletes healthy. Ask us about which sports performance coaches we locally recommend!
If you are interested in a PEP program for your athlete/team feel free to contact us! We would love to show you how to get it done! We have options for in person and virtual education! Ask us about our ACL Injury Mitigation Program!
References:
ARUNDALE A.J.H., BIZZINI M., GIORDANO A. et al., Exercise- Based knee and anterior cruciaiate ligament injury preven- tion, J, Orthop, Sports Phys, Ther., 2018, 48 (9), A1–A43.
Beck NA, Lawrence JT, Nordin JD, DeFor TA, Tompkins M. ACL tears in school-aged children and adolescents over 20. Pediatrics. 2017; 139(3):E20161877.
Fong CM, Blackburn JT, Norcross MF, et al. Ankle-dorsiflexion range of motion and landing biomechanics. J Athl Train. 2011;46:5–10.
Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop 2014;34:129–33.
Myer GD, Ford KR, Palumbo JP, et al. Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. J Strength Cond Res. 2005;19:51
Myer GD, Ford KR, McLean SG, et al. The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. Am J Sports Med. 2006;34:445–55.
Myer GD, Ford KR, Brent JL, et al. The effects of plyometric versus dynamic balance training on power, balance and landing force in female athletes. J Strength Cond Res. 2006;20:345–53.
Myer GD, Ford KR, Brent JL, et al. Differential neuromuscular training effects on ACL injury risk factors in “high-risk” versus “low-risk” athletes. BMC Musculoskelet Disord. 2007;8:39.
Myer GD, Brent JL, Ford KR, et al. A pilot study to determine the effect of trunk and hip focused neuromuscular training on hip and knee isokinetic strength. Br J Sports Med. 2008;42:614–19.
Myer GD, Ford KR, Di Stasi SL, et al. High knee abduction moments are common risk factors for pa- tellofemoral pain (PFP) and anterior cruciate liga- ment (ACL) injury in girls: is PFP itself a predictor for subsequent ACL injury? Br J Sports Med 2014.
Rugg C, Kadoor A, Feeley BT, Pandya NK. The effects of playing multiple high school sports on National Basketball Association players’ propensity for injury and athletic performance. Am J Sports Med. 2018;46(2):402–408pmid:29135275
Smucny M, Parikh SN, and Pandya NK. Consequences of single sport specialization in the pediatric and adolescent athlete. Orthop Clin North Am 46: 249-258, 2015
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