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HOW TO PREVENT ACL INJURIES

With winter sporting season in full swing, one of the most common injuries that you often hear about is a torn ACL. For sportspeople, damage to the ACL means an extended period of time off sport. Those who participate in sports that involve running, jumping, pivoting, or contact, are likely to need a surgical reconstruction to regain full function of the knee and continue playing their sport.


Playing with a torn ACL can lead to multiple episodes of knee instability which can sometimes result in further injury to the knee cartilage and meniscus. An ACL reconstruction involves months of rehabilitation before and after surgery, in order to regain full strength, stability and function of the knee.


So what can be done to avoid tearing your ACL and hence avoid having a reconstruction?


What is the ACL?

The ACL or anterior cruciate ligament is an important ligament in the knee. Its job is to prevent forward movement and control rotation of the tibia (shin bone) in relation to the femur (thigh bone). The ACL is essential for control in twisting movements.


How common are ACL injuries?

ACL injuries are common in sport, particularly soccer, football, basketball, netball and skiing. The ACL can be injured through contact or non-contact. 60-80% of injuries occur in a non-contact situation. For example, landing from a jump, cutting, twisting, changing direction or decelerating suddenly.


The overall incidence of ACL injuries is 81 per 100,000, and is between 2.5 to 10x greater in females compared to males. ACL injuries most commonly occur in combination with other injuries, such as damage to the other ligaments, meniscus and cartilage.


When the ACL is injured, the person often describes hearing a pop or crack, and the knee feeling unstable eg like it’s buckling or giving way. The knee will most likely have large amounts of swelling, and it is often extremely painful, however in some cases it can be painless. Initially the knee has full movement but this can change as the swelling increases and the muscles tighten up to protect the knee. The feelings of instability will also persist if treatment doesn’t commence early.


So how can I avoid injuring my ACL?

There are a number of things you can do at training and pre-game which can greatly reduce the incidence of ACL tears.


Specific prevention programs have been developed for various sports. Such programs have shown to reduce the number of non-contact ACL injuries by as much as 70-90%.


In soccer, the FIFA 11+ program is designed as a warm up incorporating specific exercises and drills to reduce the likelihood of injuries in soccer players. It should be performed as a standard warm-up, at the start of each training session at least twice a week. It should take around 20mins to complete.

Follow the link below to see exactly what it involves.

http://www.yrsa.ca/pdf/Fifa11/english.pdf


Netball Australia has developed the KNEE program which is an on court warm up program designed to enhance movement efficiency and prevent injury in netball players. It needs to be performed at least twice per week and should take no more than 10-12 minutes to complete.

Take a look here for more information https://knee.netball.com.au


What do prevention programs actually involve?

Prevention involves strengthening and coordinating the muscles in the core and legs, training them to keep the legs in a safe position when running and decelerating, and training good knee control. Therefore, exercises addressing jumping and landing, single leg stability, multitasking, agility and cutting are critical. These can include figure 8 running, single leg squats and shuttle runs. It is important that the exercises are completed with correct form and the correct dosage in order to get the most benefit.


Programs may involve plyometric (jumping) exercises with a focus on proper technique and body mechanics. There may also be a component of strength training, as well as neuromuscular training. This may include balance exercises, proprioceptive activities, single leg stability, dynamic joint stability, jumping and landing technique, agility drills and sports specific exercises which all aim to improve postural control and side-to-side imbalances in the leg.



References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577417/

https://knee.netball.com.au

http://www.f-marc.com/11plus-2/