It is the start of the New Year and we all are preparing to finish our high school season strong and prepare for a return to our club soccer schedules. The first half of the season was incredibly busy for the players I work with and it doesn't get any easier or less busy from here on out.
I have noticed an unfortunate event unfolding as leagues expand, new leagues develop, more games are added and game and training schedules get longer and longer. The incidence of ACL tears has dramatically increased. The related causes are varied and can be debated for sure, but the fact that it continues to be such a highly researched topic within our sport and within the sports performance and rehabilitation industry makes it a topic of paramount importance.
Anterior cruciate ligament tears/injuries are some of the most commonly occurring injury in sports. All sports have seen a rise in occurances and these injuries can have long lasting affects on our athletes. It is up to us as coaches, sports performance specialists and physical therapists to step up and step out of our comfort zone to talk openly and honestly about what is going on and how we can minimize these types of injuries. (I say minimize and not eliminate because I believe that the very nature of many sports predisposes our athletes to risk and that risk can never be completely removed).
The ACL is a major stabilizing structure of the knee that is at risk with the sudden start-stop actions, change of direction movements and landing after jumping or hopping that all our athletes are subjected to during training and games. Research data shows us that female athletes are more at risk versus male athletes of up to 6-7 times more likely to sustain such an injury. This is based on a numbers of factors including hormonal differences, physical or structural differences, strength imbalances, overtraining, biomechanical issues and age. Believe it or not, younger athletes are more likely at risk due to the underdevelopment of strength and increasing participation levels in high level sports.
The cost to our athletes is not just financial (ranging up to $30-35,000 per injury). It is emotional, psychological and physical as well. Many of our athletes who sustain an ACL injury experience depression, detachment issues, anxiety to return to sport, fear of re-injury and long term physical impairments such as long term pain, prolonged muscle weakness, and early onset arthritis or degenerative bone disease within the knee affected. 1 in 3500 or approximately 400,000 ACL reconstruction surgeries are performed in the United States per year and on average an athlete is expected to spend 6-9 months in rehabilitation post-surgery.
Anatomical differences such as hormonal cycles, muscle imbalances (quadriceps versus hamstrings), hip width (women typically have a wider pelvis than men), overuse of the quadriceps versus the hamstrings during deceleration, landing biomechanics and difficulty in eccentric loading of the knee and hip, increased valgus stress placed on the knee during change of directions, body mass indices, smaller femoral notches for the ACL to clear, increased joint laxity and a history of previous injury all contribute to women being at an increased risk of ACL injuries.
The amount of training and number of games during a season is also quickly becoming a concern for our athletes and the influence on ACL injuries is being observed more closely. Seasons lasting almost an entire year, 3-4 practices per week, more than one game a weekend and more than one game a day in some cases, use of artificial turf/grass, lack or absence of proper recovery programs and rest time, the lack or absence of properly programmed strength and conditioning programs and improper nutrition are all areas that need to further addressed. The impact of the above stated factors cannot go unnoticed as potential contributing factors to the rising levels of ACL injuries in our athletes.
Parents and their athletes need to seek out professionals that are specialists in sports performance, have substantial knowledge in biomechanics and anatomy, are specialists in evaluating biomechanical imbalances and muscle weaknesses and can accurately assess the athlete for potential risk factors. Knowing how to evaluate an athlete prior to injury and subsequently having the experience to properly program a fitness and strength program to address the weaknesses are key. Assessment of running mechanics and the ability to properly eccentrically load or decelerate during change of direction and landing are also areas that need professional expertise.
This holds true if an injury is sustained by an athlete. Searching out a professional that has the medical and rehabilitative background and experience to guide the post-injury rehab/recovery process is paramount to successfully returning that athlete to their sport. Not everyone can or should treat or train an athlete that sustains this type of injury and choosing the right professional will definitely impact the athlete's post-surgical/injury recovery status and potential.
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