Anterior Cruciate Ligament Injury Prevention
Anterior cruciate ligament (ACL) injuries in sports are devastating events that can take an athlete out of commission anywhere between six months to a year. Although both male and female athletes are susceptible to this injury, female athletes are more prone due to a few predisposing conditions. Though ACL injuries can be surgically reconstructed, when the athlete returns to sport, there is a high risk of developing arthritis, patellofemoral knee pain, and re-injury. In many cases, there is an increased risk of injury to the contralateral uninjured side due to the athletes’ tendency to overcompensate.
Studies show that the majority of ACL injuries in females are non-contact. The reasons why many female athletes experience ACL injuries lay in their anatomy, biomechanics, and neuromuscular coordination. For example, female athletes’ narrower and smaller knee structure makes it more vulnerable to instability. Research indicates that the ACL is typically shorter in females compared to males. Additionally, from a neuromuscular perspective, female athletes often exhibit weaker gluteal and hamstring muscles. They rely more on their quadriceps to generate power and absorb ground reaction forces, placing significant strain to the knee joint. These biomechanical deficiencies become particularly evident during movements like landing and directional changes.
So, while we cannot control factors like genetics, anatomy, or external (e.g. direct blow), there are plenty within our control: biomechanics, neuromuscular imbalances, training and skill level, and even appropriate sports gear.
Proper athlete screening prior to the season can help identify athletes of high risk. Although it is not guaranteed that it can prevent ACL injuries from happening, identifying and correcting these issues can help minimize it. Strength and conditioning programs should be individualized and targeted towards improving neuromuscular imbalances, as well as landing and direction change biomechanics to help better absorb ground reaction forces. As mentioned earlier, the mechanism of the majority of ACL injuries is usually non-contact. This happens when the hip internally rotates, while the lower leg abducts and externally rotates during a direction change or landing. This mechanism overstretches the ACL beyond its tensile force causing it to tear. Faulty mechanics should be addressed and can be included in the curriculum of regular training. There are preventative programs that help athletes improve neuromuscular biomechanics and lower the risk of ACL injuries. However, according to a study published in the Journal of Athletic Training, many athletes are not aware of the existence of these preventative measures and therefore have no access to them.
I am presenting this article together with a complementary exercise program to inform and help athletes on how to be proactive to keep themselves healthy. Click on the link below to view the first phase of the ACL preventative exercise program.
This program is not meant to rehabilitate an ACL injury, only to minimize the risk of those athletes who are affected. Though this is only level 1 phase of my ACL injury prevention program, it is a good start to build a solid foundation for a more advanced level.
Click here for Level 1 ACL Injury Prevention Program
Citations
(2022) Arthroscopy [Preprint]. doi:10.5772/intechopen.94681.
Chia, L. et al. (2022) ‘Non-contact anterior cruciate ligament injury epidemiology in team-ball sports: A systematic review with meta-analysis by sex, age, sport, participation level, and exposure type’, Sports Medicine, 52(10), pp. 2447–2467. doi:10.1007/s40279-022-01697-w.
Dehcheshmeh, P.F., Gandomi, F. and Maffulli, N. (2021) Effect of lumbopelvic control on landing mechanics and lower extremity muscles’ activities in female professional athletes: Implications for injury prevention [Preprint]. doi:10.21203/rs.3.rs-250805/v1.
Fadaei Dehcheshmeh, P., Gandomi, F. and Maffulli, N. (2021) ‘Effect of lumbopelvic control on landing mechanics and lower extremity muscles’ activities in female professional athletes: Implications for injury prevention’, BMC Sports Science, Medicine and Rehabilitation, 13(1). doi:10.1186/s13102-021-00331-y.
Lucarno, S. et al. (2021) ‘Systematic video analysis of Anterior Cruciate Ligament injuries in professional female soccer players’, The American Journal of Sports Medicine, 49(7), pp. 1794–1802. doi:10.1177/03635465211008169.
Tanaka, M.J., Jones, L.C. and Forman, J.M. (2020) ‘Awareness of anterior cruciate ligament injury-preventive training programs among female collegiate athletes’, Journal of Athletic Training, 55(4), pp. 359–364. doi:10.4085/1062-6050-150-19.