Anterior Cruciate Ligament (ACL) Injury Prevention
By Stephen Woollard, Certified Athletic Therapist
You have likely heard of an athlete sustaining an ACL injury in the news. Maybe an athlete sustained one and the report is that they are out for the season, or maybe even a career ending injury. But what is the ACL, how do they get injured, and what can we do about it?
What is the ACL?
First off, the ACL is the Anterior Cruciate Ligament. What are ligaments? Ligaments are tough, fibrous bands of connective tissue that join bones to other bones. They help stabilize joints, particularly in a passive range of motion (meaning when no muscular force is involved). The ligaments of the knee include the lateral and medial collateral ligaments, as well as the deeper anterior cruciate ligament and posterior cruciate ligament. The ACL resists anterior (forward) translation, tibial rotation, varus and valgus knee position, and hyperextension.
Why is this important?
Unfortunately, ligaments can be sprained when the force placed on them exceeds their ability to resist. This can range from a minor stretching of the ligament (grade 1) to a partial tear (grade 2), or a full rupture (grade 3). The ACL itself can be injured either through contact or non-contact injuries. Contact injuries typically involve a blow to the outside of the knee, which can also injure the MCL and medial meniscus. Non-contact injuries involve planting the foot and twisting the knee, or a rapid deceleration with a change of direction.
The knee is the second most commonly injured joint in the body (the ankle is first), and the leading cause of sport related surgeries. Unfortunately, ACL injuries account for 50% of all knee injuries. And 76.6% of those ACLs required surgery. Women are 4-6 times more likely to suffer an ACL injury. And rehab following an ACL injury or surgery can be a long process, lasting up to or over a year.
Even after surgery and rehab there are things to consider. Many people will not return to their sport or activity, or not to the same level, there is an elevated risk of re-injury, and an increased risk of osteoarthritis later in life. But a good rehab program can help mitigate these issues. And Athletic Therapists can help with that too! That will have to be a whole other post. Stay tuned.
The good news is that prevention programs work! Studies show that implementing a program can help reduce the risk of ACL injury by 53-88% (depending on the source). These programs can also help improve athletic performance and reduce the risk of other injuries (hello ankles). Ideally these programs should last around 15 minutes, 2-3 times per week for 14 months. That being said, doing something is always better than doing nothing. So, any time you can dedicate to an injury prevention program will help. And even if you have already rehabbed a previous ACL injury it is important to implement a prevention program to help prevent re-injury.
A program should have at least three out of the five of the following categories:
Good technique and feedback on technique are also crucial components of the program’s success. It is important to progress and change the program periodically to keep it interesting and continually challenge you and your body.
There are existing programs like FIFA 11+ for soccer, Activate from World Rugby, and Sportsmetrics targeted specifically towards women. However, the demands of sports and activities can vary greatly. So, it may be more appropriate to have a program designed and tailored to you and your specific needs. And that is where an Athletic Therapist can help you. Injury prevention is the first step of an AT’s scope of practice. If we can help and intervene at the prevention stage, it will save a lot of time, effort, and pain at the emergency care, rehab, and reconditioning stages.