Anterior Cruciate Ligament (ACL) Injury & Prevention Programs
Written by Ashley Gudgeon -Osteopath.
ACL injuries are one of the most common knee injuries in sport and commonly occur with damage to other structures of the knee such as meniscal tears, collateral ligament injuries or bone bruising. Interestingly, females are 3 times more likely to injure their ACL than males. ACL reconstruction is the typical standard approach to managing athletes who have suffered an ACL injury. However under 50% of those who undergo an ACL reconstruction return to their sport within 1 year and 25% of these athletes likely to suffer from a subsequent ACL injury. Given these statistics, the importance of ACL injury prevention programs is clear.
As this infographic shows, an ACL injury prevention program should be based on and include the following aspects:
- Multi-plane biomechanical components
- Double and Single leg training
- Address playing surface
- Possible bracing or tapping for prophylactic benefit
- Neuromuscular training inducing proprioception, muscle activation and inter-joint coordination exercises
- Address reaction and decision making to unanticipated focus to replicate the nature of sport
Having an understanding of the principles of Applied Functional Science allows for the utilisation of all three directional planes of motion. In addition, the adaptation of techniques as sports-specific (so replicating the movements commonly involved in a sport) ensures that patients are gaining individualised treatment to best suit their needs. Treatment that utilises the three planes of motion; Sagittal (forward and back), Frontal (side to side) and Transverse (rotational) ensures that treatment replicates the actual movements involved in an activity. Far too often people will only train in a singular plane then go and complete a sport where all three planes of motion are required and re-injure themselves.
ACL injury appears to occur most commonly without direct contact. Typically this type of injury is associated with the knee going too far, too fast, and getting into a position it couldn’t get out of with the control needed. In the past to try prevent ACL injuries, athletes have been advised to avoid allowing their knee to move anywhere except directly over their feet. Ultimately however the knee will continue to move in a range of motions whilst playing sport, not just stay over the foot. This results in people not having the capacity to allow their body to get in and out of these movements safely. Thus, the traditional approach to training has resulted in ACL injuries continuing to rise.
To best address this issue, injury prevention programs should be adapted to the specific needs of the sport and the capabilities of the athletes completing the program. The athlete needs to be able to gain as much range of motion as possible, while maintaining stability to allow for the best injury prevention to occur. Muscles need to be able to load and explode, accelerate and decelerate as required by the demands of a particular activity. Without these elements included in an injury prevention program, the knee may not have the required proprioceptive feedback or information required to safely enter these positions under large load. Therefore, an ACL injury prevention program should include teaching the knee to get in these positions safely, alongside training for the rest of the body by assisting with deceleration of these positions. An ACL injury prevention program that targets these areas ensures the best chance for an athlete to return to their sport with confidence.
This infographic have been completed by Yann Le Meur who is a sports scientist and researcher. You can follow him on twitter at @YLMSportScience where he posts new infographics on a range of topics from sport, sleep, injury and performance that is based on the latest research.