Practical Ways to Prevent an ACL Injury
October 9, 2019
The Anterior Cruciate Ligament (ACL) injury can have a detrimental effect on individuals. A rupture (or full thickness tear) will usually result in a 9-12 month absence from your chosen sport or other recreational activity and a period of regular rehabilitation exercises during that period.
Long term, you can also be faced with an increased risk of further complications including osteoarthritis or other chronic knee conditions. With the wonderful increase in participation rates of female athlete in recent years, we have also seen a significant increase in occurrence of ACL related injuries. A key contributor has been Australian Rules Football, but historically sports such as netball and soccer have always had high incidence of ACL injury.
Nowadays, there are two different schools of thought regarding the management of an ACL rupture. The first, and the historically favoured choice has been surgical repair of the injured ligament. This involves taking a portion of your hamstring or patellar tendon and making it into a replacement for the torn ligament. Over time, and with strengthening, this tendon takes on ligament type properties and can serve well as a functioning ligament.
New research is now suggesting that return to play timelines, plus long term outcomes can be achieved well with conservative management approaches. A conservative management approach involves getting exceptionally strong through your quadriceps, hamstrings, glute and calf muscles to assist in the external stability of your knee. The conversation around which approach is most appropriate for you should be between you, your physiotherapist and a surgeon for their opinions. Ultimately the decision will be yours if you have suffered an ACL rupture but recommendations will vary depending on any other injuries you may have sustained at the time.
So what is your ACL? Your ACL one of four key ligaments inside the knee that helps to stabilise your knee joint and connects your femur (thigh bone) to your tibia (shin bone). The ACL’s major role is to prevent hyper-extension, and limits the rotational force of the knee and provides key stability when changing direction if running or landing.
Most commonly your ACL is injured either via a non-contact mechanism, including pivoting, rapid decelerating, change of direction, or a contact mechanism such as a receiving a tackle in football. Whilst a contact injury is generally unavoidable, intervention programs can help reduce your risk of sustaining a non contact injury.
On current research’s statistics, females are 2-8 times more likely to sustain an ACL injury when compared to their male counterparts. There are a multitude of reasons as to why this is the case, but some of these include:
- The difference in anatomy between males and females – females have a wider pelvic, which then means that the thigh bones are on an increased angle relative to the knee than males
- Males and females have different biomechanics when jumping and landing (again related to their anatomical differences
- Hormonal differences – there is some research to suggest that the stage of a woman’s cycle may impact on the “forgiveness” of ligaments and therefore place them at greater risk at different phases of their menstrual cycle
- Experience in particular sports, and therefore strength. Particularly with the rise of the AFLW, women are entering into the sports without the long preseasons and therefore strengthening programs that their male counterparts have been through. This is changing with women staying involved in football but there is still work to be done
So how do we prevent these injuries from occurring?
There are a host of programs out there to ultimately try and prevent ACL injury. The premise of many of these programs is fundamentally around improving strength of the quads, hamstrings and glutes. There is also a focus on landing technique, running or gait education and retraining (when required). A good quality program should also address explosive or powerful movements. and an extension of these would be dynamic balance exercises that include using the brain (ie throwing or catching a ball) while focussing on single leg standing or hopping or jumping.
If you’ve sustained an ACL injury and aren’t completing some of these processes, you should be! If you play competitive sport and also aren’t completing these exercises, you should be too! Get in contact with one of our physiotherapists and get your strength and balance exercises part of each and every one of your club’s warm ups!
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