The Curse of the ACL Injury
One of the biggest fears of any player who plays sport is the thought of injuring their Anterior Cruciate Ligament (ACL). Whether it’s a partial tear or a complete rupture of the ligament, it’s one of the most prevalent injuries in sport and certainly of the most painful injuries that a player can endure. It can keep a player out of action for a very long time and has a long rehabilitation period. It can even end a player’s sporting career. It affects players across so many sports – Rugby, Gaelic Football, Hurling, Basketball, American Football, Tennis, Soccer etc. to name but a few.
First, it is important to understand what the ACL is, and what it does. The ACL is one of the four major ligaments in the human knee, and it runs diagonally from the femur (thigh bone) through the knee joint and attaches at the top of the tibia (shin bone). Its main functions are to assist in stabilising the knee joint and control the back and forth motions of the human knee, while also preventing the tibia from sliding out in front of the femur and providing rotational stability to the knee. The ACL forms a “X” shape with the PCL (Posterior Cruciate Ligament).
The ACL can be injured in several ways:
- Changing direction rapidly
- Stopping suddenly
- Slowing down while running
- Landing from a jump incorrectly
- Direct contact or collision, such as a football tackle
- Skiing Accidents
Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.
Most athletes claim to have heard a “popping” noise when the injury occurs, followed by intense pain for a number of minutes, while the knee swells and often is too painful or unstable to continue any activity. Frequently, surgery is required to reattach the torn ligaments, often in the form of a “graft” operation with the patellar tendon. After surgery, the recovery period usually lasts 25+ weeks, with return to sport a number of weeks after that, depending on the severity of injury. On return from rehabilitation, there can be a number of muscle imbalances, especially with hamstrings and lower back muscles.
Recent studies have shown that the numbers of ACL injuries are currently on the rise amongst the youth in sport today, along with a huge spike in ACL tears across sports such as American Football and GAA. Yet what is causing this increase?
Some reports are focusing on the footwear being used during matches, citing that the type of studs used has an impact – The idea here that “blades” are more unstable and can cause irregular knee movements during activity when compared to the traditional “studs”. Another school of thought focuses on the playing surface – With more and more artificial or “astro-turf” pitches in use, the incidence of ACL injury is on the rise. Studies found that during competition, players are more likely to suffer ACL injury due to legs not being able to “give way” as they would on grass surfaces, thereby distributing the force to the knee and causing injury. Other theorists are blaming training intensity and lack of adequate recovery time for the rise in injuries.
Some experts have attempted to devise ways of limiting these injuries, for example, Dr Eric Swart has designed a neuromuscular training programme that focuses on prehabilitation for the athlete in question. This idea of injury prevention has led to the development of similar programmes such as PEP (Prevent Injury, Enhance Performance) and FIFA11. For example, looking at the PEP programme, we can see how techniques to improve soft landings, plyometrics, agilities etc. contribute to the prevention of ACL injuries. Research has shown that programmes such as PEP has reduced the likelihood and frequency of ACL injuries.
Regardless, the increase is still obvious and these injuries could have a negative impact not only on the sporting career of an individual, but on their own personal future too.
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