ACL Tears! What's going on.

[NukeLaloosh]

As it seems like it is never-ending and almost a week to week occurrence, another girl has torn an ACL again. This week McMinn Central wing Kelsey Myers is the recipient. It is just a continuing problem and one that seems has increased tremendously in the last few years. What is going on?

[etownsparky]

Knee ligament and meniscal injuries have been too common for the past 20 years. I have often wondered why these injuries appear to be more common than years ago and especially why they seem to be more prevalent in girls. Well, according to UCSF Department of Orthopaedic Surgery, "Several factors are speculated to increase risk of ACL injury in females including lower extremity alignment (wider pelvis, knee valgus, foot pronation), joint laxity, hamstring flexibility, muscle development, hormonal differences, and ACL size." (Written by Jennifer Kim Reveiwed & Updated by Joe Smith, January 2009). I believe other factors are: 1) more girls are involved in sports now than ever before and 2) basketball (and other sports) is played essentially year round - because of this the body has little to no time to recover/heal/mend.  These are only speculations on my part as I am not a physician.    Regardless, I hate to see or hear of any young athlete that suffers this type of injury.  Hopefully, this young lady will recover quickly and be back on the court playing the sport she loves.

 

[MandMMom]

It's an epidemic.  My daughter is a point guard and tore hers in summer camp between her freshman and sophomore years.  I've seen it more in guards, and of those guards I've noticed most have the same body type and muscular build - small, compact and very muscular.  The scary part is that it seems to be happening at earlier ages than in the past (early high school and even as young as middle school)

 

I'm with etownsparky - it's overuse - too many games - their bodies just break down - especially in those who play rigorous schedules beginning at age 8 or 9 (I'm guilty).  

 

ACL prevention exercises should be introduced at an early age and should be an intrical part of middle school and high school workouts.  Even with that, it's a nasty injury that isn't going to go away.

Edited December 28, 2013 by MandMMom

[MountainTroll]

Conditioning and training of our young athletes is often non-existent, inadequate, or inappropriate.  I am a firm believer that appropriate core strengthening, proprioceptive, and balance training can significantly reduce the incidence of lower extremity injuries in all athletes.  When core body strength is inadequate, higher forces are applied to the lower extremities as they try to compensate and stabilize the core.  The proprioceptive nervous system is that portion of our nervous system that allows us to determine our body's position is space and allows us to respond to forces applied to our bodies.  For example, if you close your eyes and point your finger at something, your body knows exactly where your fingers, hand, and arm are positioned.  If someone tries to move your finger, you are able to apply force to prevent that movement.  Now think about the knee.  Stand on one leg, do a partial squat, and try to maintain that position.  As you wobble, the muscles around the ankle, knee, and hip sense the movement and fire rapidly and alternately, trying to maintain the position.  It is the proprioceptive nervous system that controls all of this.  This portion of the neuromuscular system can be trained and conditioned.  When an extreme force is applied to the knee, the body more quickly and appropriately fires the appropriate muscles to counteract the force and stabilize the joint.  If the muscular response is inadequate to counteract the force, then the force will be applied to the ligaments, and they will tear.

 

Strengthen the core.

Strengthen and increase the flexibility of the muscles that stabilize the knee.

Incorporate plyometrics and balance board proprioceptive conditioning.

 

Here are some links to some additional information, but you can find more just by googling "proprioceptive training to prevent ACL injuries"

 

https://www.dropbox.com/s/90ri754jsvy7rib/AOSSM%20ACL%20Prevention.pdf

https://www.dropbox.com/s/bydq1f66c6xp7vo/ACL%20prevention.pdf

https://www.dropbox.com/s/81nraw1t37wai0x/ACLInjuryPreventioninHighSchoolAthletics.pdf

https://www.dropbox.com/s/f0u7ckuwxaga836/FUNCTIONAL_ACL_INJURY_PREVENTION_PROGRAM.pdf

[King21]

I coach girls basketball, and it is a sad reality that this is happening more and more. I also help run an AAU program. These kids do play year round. Two of ours have torn ACLs at the moment. I think it is a thing where the body doesn't rest and there's all the pressure and tension and work put on ones knee, eventually something has to give. Is there a solution? Yes. But, I don't think girls, or guys, are going to stop playing all the time when it is what they love to do. Hate to hear about all the injuries though, get healthy!

[MountainTroll]

This is NOT an overuse injury.  Trust me.

 

Many of these injuries are unavoidable, but their incidence can be decreased with appropriate training and conditioning.

[tradertwo]

I disagree with troll, conditioning is generally much better now than the distant past when there were fewer ACL,MCL, and meniscus injuries. Actually training does not strengthen ligaments, just the opposite...musculature increase just intensifies the pressure on the joint, and by default the connective tissue securing the alignment. Girls' bodies are different as far as the angle of the leg, and are less stable than in males. One other factor could be the much better performance of the shoe to floor...improvement of grip also adds to the pressures sustained when a player changes direction. FYI...it only takes 3-4 pounds of unrestrained pressure for the knee joint to fail. As for the overuse issue, I believe that it's just percentages...play more = better chance of an injury. The game has changed in the way it's played too, especially for the girls...more change of direction, stronger and faster kids, better grip, and far more playing time culminate in more frequent knee issues.

Edited December 28, 2013 by tradertwo

[MountainTroll]

I disagree with troll, conditioning is generally much better now than the distant past when there were fewer ACL,MCL, and meniscus injuries. Actually training does not strengthen ligaments, just the opposite...musculature increase just intensifies the pressure on the joint, and by default the connective tissue securing the alignment. Girls' bodies are different as far as the angle of the leg, and are less stable than in males. One other factor could be the much better performance of the shoe to floor...improvement of grip also adds to the pressures sustained when a player changes direction. FYI...it only takes 3-4 pounds of unrestrained pressure for the knee joint to fail. As for the overuse issue, I believe that it's just percentages...play more = better chance of an injury. The game has changed in the way it's played too, especially for the girls...more change of direction, stronger and faster kids, better grip, and far more playing time culminate in more frequent knee issues.

I recon I better tell the American Orthopedic Society for Sports Medicine that they'z gonna need to change their position statement on ACL injury prevention. 

 

But ... you are right that conditioning is better now, and you are right that knee injuries are more numerous and frequent now for the reasons you state.

 

As you point out, without muscular support, the knee ligaments tear easily.  That is why strength and conditioning programs should be functionally based and should include more focus on the muscles that support the knee and ankle and the proprioceptive nervous system that controls their joint stabilization function.

 

It is true that poorly designed weight training programs can lead to unbalanced, non-functional muscle development, and can place abnormal stresses on the joint.

[TheRealTruth]

I agree with troll. He has the facts. Facts can be stated but someone will always disagree.

 

It is NOT overuse. Actually, it is an underuse of training functional movement patterns correctly (ex. deceleration of a jump stop) and proprioceptive training is a major component to this.

 

Yes, kids do focus more on one sport or do play year around. More girls are also playing more sports than 20-30 years ago. This increases exposure.

 

Yes, strength and conditioning programs are more prevalent than any other time. Better for girls is arguable in this situation especially in high school. If a girl is stronger and faster than a girl 20-30 years ago, this increases risk.

 

Strength and conditioning programs for girls must address compensating for their lower extremity alignment (wider pelvis, knee valgus, foot pronation), joint laxity, hamstring flexibility, muscle development, and ACL size. While hormonal differences are a different animal, the others are not being addressed very well in most places. This is accomplished by training to correct functional movement patterns.

 

There are not enough knowledgable people involved to correct the issue at the high school level much less the middle school level where it should be implemented. FMS screening would be a good place to start. Have your team tested and begin some corrections. Talk to your local sports medicine folks. 

Edited December 28, 2013 by TheRealTruth

[tradertwo]

Thanks for correcting me on your position troll...I'll admit that I skimmed your post when I read it and figured you to be in the strength and conditioning camp...not mechanics and movement. I'll have to agree that as far as preventative maintenance, muscle memory and mechanics are the beginning and end of the conversation.

[MountainTroll]

Thanks for correcting me on your position troll...I'll admit that I skimmed your post when I read it and figured you to be in the strength and conditioning camp...not mechanics and movement. I'll have to agree that as far as preventative maintenance, muscle memory and mechanics are the beginning and end of the conversation.

I'z in the strength and conditioning for mechanics and movement camp.

Edited December 29, 2013 by MountainTroll

[EBTHER]

This was one of the deciding factors when my daughter was trying to decide whether or not to play basketball this year.  She had a very promising career in either basketball or VolleyBall.  She chose to not play Basketball in high school to lesson the risk of damaging her college volleyball career with a costly knee injury.  I have witnessed several knee injuries in Volleyball as well. I believe it happing due to the fact that competition level has risen in every sport and the demand for kids to be bigger faster stronger is pushing young bodies to and over the limit.  They are asked to preform like professional athletes at a much younger age then when i was a kid.  I guess it is the new age of the athlete.  There will come a time when you wont make it thru 4 years of high school with out some kind of a  surgery.  Not sure if that makes sports better or worse.