Can We Prevent ACL Tears?
Yes I Think We Can!!
There he goes, sprinting down the field. The ball is passed to him, and cuts left to go get it – POP! Oh no, his right knee just buckled out from under him.
He is obviously in tremendous pain. The Medical staff is going out to check on him. A hush falls over the crowd. He is being carried off the field. This does not look good, hopefully he will not miss the rest of the season.
Unfortunately, this is an all too often repeated story for athletes in many of our stop-and-go sports, like Soccer, Basketball, Football, Field Hockey, and LaCrosse…
Why Does This Happen?
You have to ask yourself, “Why does this happen?” Why is it that the number of ACL tears increases each year? How is it possible that with all the advancements in training that this still continues to happen???
As I sit here and write up this article, I am not going to profess to have all the answers, I am not going to proclaim that I am the world’s leading expert in injury prevention, and I am not going to dazzle you with physiological terms that you will need to look up in order to understand everything.
What I am going to tell you about is what I have seen in my 10+ years working with athletes as a Strength and Conditioning Coach, and I will give you some of my thoughts and opinions as to why ACL injuries happen more and more each year and what just might be the biggest factor in preventing ACL tears.
What is the ACL?
First, let’s briefly explain what the ACL is and what its role is. ACL stands for Anterior Cruciate Ligament. The ACL attaches the femur (upper leg bone) to the tibia (lower leg bone) and prevents the tibia (shin) from moving forward when slowing down or stopping.
By controlling movement like this, the ACL helps to stabilize the knee. Understand that there are more structures and ligaments that support the knee, but we are going to focus on the ACL right now.
Types of ACL Tears
When an ACL tears, athletes will typically explain a “popping” sensation in the knee at the time of injury. There are predominately two ways the ACL gets torn: (1) through contact and (2) through non-contact.
A contact ACL tear is described as being the result of a collision or contact with someone or something violently. An example of this would be when a football lineman is involved in a pile-up and another lineman falls into his knee. When the other player falls upon the compromised player, this is the contact that causes the ACL tear.
A non-contact ACL tear is when there iss no apparent contact with anyone and the knee buckles under loading from the athlete him or herself. Many times this will occur when an athlete is sprinting and goes to cut on an angle. The knee buckles and you have the same scenario described in the first paragraph. Changing directions, landing after a jump or leap, and other types of movements that involve decelerating the body are what bring about non-contact ACL tears.
As a D-I Strength Coach, I train hundreds of athletes with weights each week, trying to strengthen the supporting muscular integrity of the body with the main goal of preventing injuries. Although we can get our athletes stronger, contact tears are almost impossible to prevent.
Changes in Reporting and Diagnosing
So why then are non-contact tears on the rise in athletics?
Well I think the obvious reason is that we have much better medical advances today for diagnosis. There are Athletic Trainers at sporting events, Doctors specializing on knees, better advancements in MRIs and surgical procedures, and more sports reporting with stats than ever before. So it would make logical sense that we would hear more about these injuries because we have more people actively looking for and diagnosing them.
Now ask someone in their forties, fifties, or sixties that played sports about how many ACL tears they saw or knew of when they played. Most of them will probably say it was not much of an issue back then or that they never knew of anyone tearing an ACL.
So why in the last 20-30 years have ACL tears become much more prevalent, particularly in the last 10 years?
One reason has to do with the increased popularity of women’s sports. There are more women competing competitively than ever before. What does this have to do with ACL Tears?
As it turns out, there are many studies which show that women are at a much higher risk for tearing an ACL than male athletes. For instance, the hip to knee angle is different for women, due to childbearing purposes. This difference in angle can lead to a higher susceptibility for knee injuries. Studies also show that hormone differences in female athletes can increase injury statistics.
Although the studies support this, I truly feel that the reason we continue to see increases in the number of athletes’ in general with ACL injuries actually has much more to do with the practices of our youth these days.
Youth Athletic Practices – Specialization
Quick question: How many 3- and 4-sport athletes are we seeing today?
There are some still, but more and more I am seeing athletes specializing in just one sport at increasingly younger ages. My daughter plays soccer, and I know many of the kids on her team now play school soccer in the fall, then go into an indoor league over the winter, then straight into an AYSO spring season, and right onto a traveling club team in the summer.
No exposure to anything else.
I recently went to a clinic and listened to a Physical Therapist talk about this very subject and he explained the detrimental effects of sport-specific over-specialization for youth. He went on to mention that kids who specialize in a sport like this get very little time off from their sport and receive too much exposure to the same types of repetitive sports movements.
Without going to deep in detail, the Physical Therapist pointed out that specialization at an early age like this can make the neurological proprioceptors in the ligaments kind of “numb.” What he meant was, these receptors need to have tensile strength when stressed, but due to over-specialization, what can result is a ligament that is slightly relaxed, becoming more susceptible to injury, such as an ACL tear.
I had never heard it explained like that before but judging by what I have seen, it sure did make a lot of sense.
At this point, we know a couple of possible reasons why the stats on ACLs continue to increase each year. Now I would like to discuss what I think is the biggest contributing factor to this puzzling problem.
The Biggest Factor Leading to ACL Tears
When I was a kid growing up, I would go home and eat something real quick and then head out to practice (whatever sport I was doing at that time) and when I came home from practice I usually would run around and get involved in a game of kickball or capture the flag until my mother would call me in (by shouting to me, not with a cell phone) for dinner. Many times I would go right back out and play until I was called back in to shower up and go to bed.
I bet you can identify with this, if you think back to your childhood. We were always on the go and we were always doing different things.
Unfortunately I am not seeing this kind of thing anymore. What I am seeing is kids go to practice (and they give it their all), but at the end of practice coaches are telling their players to go home and recover, stretch, and take it easy to rest up for the upcoming game.
Now, I know this does not sound like a bad thing to say but I think it is being said too often. In reality, most young athletes are going to go home and do very little physical activity outside of their practices or games anyways. This is the biggest problem of today’s youth!
Our youth today sit all day at school, and then when not at practice sit down watch TV, texting, at the computer, or playing video games in all their free time. It is my belief that the increased levels of inactivity our young athletes are doing is actually de-conditioning them and setting them up for injuries down the road.
All this time in seated positions is shortening and tightening their hip flexors. Tight hip flexors often lead to inhibited and weaker glute muscles. The glutes should be some of the strongest muscles in the body, but due to lack of stimulation and inhibition, the glutes become weak and this is a huge problem when it comes to sports where landing, deceleration, and changes of directions are necessary.
Changes in Strength Levels in College Athletes
Ten years ago, my freshmen athletes were having strength deficiencies in the hamstrings in relationship to their quads. That is not what I see anymore with incoming freshmen. I am seeing a complete lack of glute firing when trying to teach any triple extension movement, knees buckling in when squatting, and the inability to straighten their legs and touch the floor without pain and discomfort.
In plain English, kids just don’t know how to use their glutes anymore! I am convinced that there is a direct relationship between shortened hip flexors and the inability to get the glute muscles to actively respond to athletic movements.
With this thought process in mind, I have designed a complete training system for re-educating the glutes and making them fire again like they are supposed to during athletic movements. Seeing that the glutes should be the strongest and most powerful muscles in the body, it just makes sense to come up with a way to neurologically get these muscles activated again.
How Athletes Move
Let’s take a look again at the example given at the beginning of this article to discuss what happens with most non-contact ACL tears.
An athlete is sprinting forward and decides to cut to the left. The athlete will plant the right foot and turn the body to the left and should push off the right foot and extend the ankle, knee, and hip (triple extension) to complete the cut and change of direction. If the athlete is not getting good gluteal activation, then he/she will be unable to properly decelerate into the plant or correctly accelerate into the cutting motion.
Because the glutes are not doing what they are supposed to be doing, the quads must take over. This situation is referred to as “quad-dominance” because the athlete is using the quads to decelerate and generate power instead of using their glutes.
The Problem with Quad Dominance
The quads are made up of 4 muscles that attach to the kneecap and run down over it and to the front of the tibia (shin bone). If the quads dominate during deceleration and acceleration, there will be forward pulling placed on the tibia and with the momentum of the forward sprint, you can easily see how this additional tension is placed on the ACL to keep the tibia pulling forward.
If the force pulling the tibia forward is excessive, then as the athlete starts to rotate, it can stretch the ACL to its breaking point. Game Over!
To the contrary, if the glutes remain the dominant muscle group when going into the change of direction, there will be less forward tension placed on the tibia and the knee will be kept in a position behind the toes. Aside from being safer for the athlete’s knee, this will also result in the athlete being able to cut more smoothly and with much more power.
The Basis of Deceleration Training
Knowing the importance of gluteal involvement in the stop-and-go sporting movements, I set out to design a way to build up the glute strength in all my athletes. I have had this Deceleration Training System in place for the past 8 years. Over that time, thousands of athletes have successfully gone through this simple but effective training progression. It is something we begin working on from the beginning with all athletes and continue to do so for many weeks.
The results have been extremely positive with a huge decrease in ACL tears at my University.
This system has worked so well for me and with my athletes, I personally believe that every coach should implement the principles of it. I know this will help many coaches and athletes.
So I go back to the title of this article. Can We Prevent ACL Tears? Yes I Think We Can! Although I don’t think we will ever be able to prevent 100% of ACL tears, especially those related to contact-scenarios, I am certain without doubt that this system has prevented knees from being damaged over the last 8 years!
To find out more about the exact System I use with my athletes, check out Deceleration Training to Prevent ACL Tears.