ACL Injury Research Raises More Questions
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"The hurry-er I go, the behind-er I get" is
a line from the old comic strip Pogo. The academic corollary to that is
"the more I learn, the more confused I get."
Just when I think I have a pretty good
handle on the ACL injury thing, something else comes up that muddies the water
and makes it all so confusing.
Used to be that an ACL injury was
potentially a career-ending injury. If you were a junior in high school and
tore an ACL, the year rehab meant your high school career was over.
Then it turns out that a year's rehab
isnt needed. The rehab program now can start right away and progress so
quickly that a player like Rod Woodson of the Pittsburgh Steelers can tear an
ACL in the preseason and be ready for the playoffs.
OK, so the rehab can move things along real
fast. Now we see that women are tearing their ACL at a faster clip than men. So
the push is on prevention of ACL injuries in women.
But how do you prevent something when you
dont even know how it happens? So, you collect hundreds of videotapes of
knee injuries in sport and try to see what is common about the injuries. You
conduct detailed interviews of patients trying to find out how the injury
I mean, there were 11 ACL injuries in eight
players in the player pool for the womens U19 world championship
From tapes and interviews, it turns out that
cutting, stopping, and landing from jumps are risky activities for both men and
women. A long horizontal component adds to the risk. Usually the knee is near
extension and hips are pretty straight, more so in women.
Easy enough, just teach women to lower their
center of gravity. But how? There is a group out of Cincinnati that will tell
you ... for $125 per athlete. A study in California is looking at the girls in
a youth league.
Teams volunteered to participate, and those
teams had a dramatic reduction in ACL injuries. But those coaches volunteered
their teams. Maybe they were just more tuned into the problem, and by being
attentive to the potential problem, treat their players differently. Is the
reduction in injury tied to the specific exercises or the combination of ANY
exercise by a concerned coach?
A Swedish project, unpublished as yet,
taught female soccer players a series of exercises that should protect them
from ACL injury. Those players did have a reduction in injuries. So that
program works, right? More details show that only 25% of the players actually
did the program. So its not the program, but the education that went with
What about that balance training program in
Italy that showed a reduction in ACL injuries? Were you aware that some Swedes
duplicated the project and found that the players who were in the balance
training group actually had a higher rate of injury than the control group?
Now comes some information that maybe the
ACLs that tear are just small ACLs. If the ACL is below some threshold, that
player is at a greater risk of injury regardless of gender. Eighty percent of
women have an ACL below that threshold, but so do 20% of men, and those people,
male or female, are the ones who tear their ACL.
So, if that is the case, what can you really
do to prevent those injuries? You cant make your ACL bigger. (Well, you
can. If you tear a small ACL, the new graft is bigger than the native ACL. Tear
both; now the stability of the knees is really strong so go play and
dont worry about it?).
If the ligament size is an issue, then do we
focus our prevention efforts only on those with a small ligament? If so, then
we need a way to figure out the size of the ligament but an MRI is very
expensive and no one has a way to estimate ligament size without expensive
Does that mean forget about estimating the
ligament size, and just teach everyone to control these risky activities? But
what activities? That brings us back around to learning how to refine movements
the players already do
and that brings us to the compliance
If you are as confused as I am, then when
someone knocks on your door promising a program to prevent ACL injuries, I
would probably be skeptical. If a program is sold as such, then shouldnt
some players actually be tearing their ACL during the program?
I mean, the exercises are supposed to
prevent the injury by teaching one how to do these risky activities, and
sometimes someone is going to goof and tear their ligament.
As a coach, what do you do? First off, I
would accept the fact that ACL injuries are a problem. I would make sure my
players (middle, high school and college age) know which movements are
problems. Some of the best studies suggest that doing these movements in an
erect stance magnifies the risk, so stress doing things lower.
The old "ready position" needs to be
reintroduced, or in a more soccer-related description, what the Dutch refer to
as "suppleness." Will a dent be made? There is hope
Copyright © 2002 Don