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70% of athletic injuries associated with sports are anterior cruciate ligament (ACL) tears. From the ages of 15-25 there are over 37,500 ACL injuries per year. Women are up to 10 times more likely to injure their ACL than men. Ligament tears at the knee occur by both impact and non-impact moves, and, if injured, the recovery and rehabilitation time that it takes to return to normal function after an ACL surgical repair is anywhere from six to nine months. After the recovery period, the risk of a second ACL injury within the first 12 months of returning to a sport is 15 times greater than that of an uninjured athlete (Porucznik, 2013). Before we explore how to prevent a tear, let's learn a little bit more about the ACL and its role in our bodies.
WHAT ROLE DOES THE ACL PLAY IN THE BODY?
The ACL is essential to normal knee stability and function. The ACL has many jobs. Simply put, the ACL keeps the tibia (shin bone) from moving too far forward or rotating too far inward under the femur, keeps the knee from entering into hyperextension and also helps protect the knee from excessive knee valgus (sideways bending of the knee inward towards the body). A stretched or torn ACL can cause great instability in the knee, as well as pain and swelling.
WHAT FACTORS CONTRIBUTE TO AN ACL TEAR / RE-TEAR?
- Improper conditioning and reconditioning programs
- Lack of mobility and stability in the foot and hip regions
- Lack of strength and power in core and lower extremities
- Laxity at the knee joint
- Anatomical differences (excessive q-angle, notch width of the knee)
- Proprioceptive control
- Improper biomechanics of specific task needed for sport
Unfortunately, improper conditioning and reconditioning programs play a large role in many of the above factors and are a big reason as to why the number of ACL tears are so high. Proper ACL conditioning programs are designed to minimize non-impact tears. During normal play, the knee is naturally moved into flexion/extension (bending and extending the knee), abduction/adduction (sideways movement) and internal/external rotation (twisting/ transverse movement). Unfortunately, traditional conditioning programs were not designed to allow the knee to move in some of these motions. Instead, programs were built to only move the knee in one plane of motion – flexion and extension (bending and extending of the knee - No side to side or transverse motion). Artificial movements like these were designed so that the knee was only allowed to track directly over the middle of the foot. Theoretically, this traditional methodology could in fact increase the chance of knee injury by creating an environment that is not authentic to sports. Further, the foot and hip are not mobilized properly in this unauthentic environment. With the knee caught in the middle of these two regions, if the foot and hip are not effectively mobilized, it will create susceptibility at the knee.
WHAT SHOULD THE PROCESS OF ACL CONDITIONING BE?
A proper ACL conditioning/reconditioning program should focus on not only how the knee operates on its own, but how the knee operates within the body as part of a whole system. Additional focus should also be placed on the mobility and stability of the hip complex and foot/ankle complex since the knee is caught in between the two. The conditioning program should also include proper strength (stability/balance) and power/reaction training of the core and lower extremities. The exercises should challenge the knee and entire body in all three planes of motion (sagittal - forward/backward, frontal - side/side, and transverse - twisting) to best prepare the knee and body for the demands of life's activities and sports. Most importantly, the program should be individualized and functional to each individual's goals, needs, and task/sport demands. Here at DHF, our ACL program does exactly those things.
- Establish the right Mindset
- Global Movement Analysis
- Joint-by-Joint Analysis to pre-determine your body's needs
- Stability & Strength Assessment utilizing biofeedback sensors
- Pre-Workout Mindset Strategies
- Pre/Post Nutrition Strategies
- Movement Conditioning Plan with Isolated to Integrated Techniques
- Recovery & Restoration Techniques
- 12 Week Conditioning Plan