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Preventing ACL Injuries

Imagine yourself on the sideline of your daughter’s soccer game. She is playing fantastic, like always, when all of a sudden she falls awkwardly. She screams in pain and is unable to put any weight on her leg. It looks like her knee is swollen. You think: How could this happen? She is having such a good year! There wasn’t even anyone around her, it doesn’t make sense!


A trip to the emergency room and multiple doctor visits later reveal that she has a torn ACL. Unfortunately, this is an all too common occurrence with young female athletes, especially those participating in sports with a lot of quick changes of direction and jumping (basketball, soccer, volleyball). It is a costly injury, both in emotional and economic terms. 


What is the ACL?  The anterior cruciate ligament (ACL) is a small ligament that connects the femur to the tibia, inside the knee. It helps to stabilize the knee during sport type movements: twisting, pivoting, and rapid change of directions.  Who tears their ACL? Girls, especially those that play sports with a lot of cutting and pivoting are at a much higher risk of tearing their ACL. While both boys and girls tear their ACLs in sports, girls are at approximately 5 times greater risk. This is due to many factors, some of which scientists are still studying. We know a lot more than we did, but there is still a lot left to know about this injury.  Can you walk if you tear your ACL?  Sometimes it will take some time for the pain and swelling to go down to make walking comfortable. Classically, an athlete will be unable to put any weight on the leg right after the injury. 

Does the ACL require surgery?  Unfortunately, the ligament will not heal on its own over time. Once it’s torn, it’s torn. If you are a young athlete that wants to return back to a high level of sports, surgery will likely be the most appropriate course of action. However, some athletes decide that they do not want to go back to sports anymore and forgo the surgery. A person can lead a normal, full life with a torn ACL, but playing sports will be really hard due to the inherent instability of the knee joint. 

Can ACL tears be prevented? YES! In fact, there is robust data that shows the risk of ACL tears can be reduced by 50-66% by completing an ACL injury prevention program. These programs entail many different workout types (plyometrics, strengthening, agility work, balance, and stretching) but the most successful will use coaches to help give feedback regarding safe body movements.

Programs should take place 2-3 times per week for at least 20 minutes. Changing the way a young female athlete moves on the field or court does not happen overnight and thus effective programs will have a duration of 4-6 weeks.  How do you strengthen your ACL? You don’t! The ACL is a ligament that does not contract, unlike muscles. A ligament is similar to a seatbelt that is engaged- it’s just there. The ACL simply connects the femur and the tibia together and cannot be strengthened like your biceps muscle. However, an athlete can complete a structured program that includes strength training, plyometrics, agility, flexibility, and balance work to enhance the muscles in the leg and make the athlete more aware of how to move properly, thereby reducing the risk of an ACL tear.  What exercises prevent ACL injury?

There is not one singular exercise that will magically prevent an ACL injury. There is no magic bullet. However, an athlete who focuses on the big muscles of her leg and hip (quadriceps, hamstrings, glutes) will have a better chance at reducing the risk of injury. This strategy, coupled with plyometrics and agility that focus on proper body mechanics will be the most successful. 

Why is it so easy to tear your ACL?

It is easy to tear your ACL because sports involve generating massive forces and then either absorbing or re-directing those forces quickly. For example, think about a basketball player sprinting down the court when the ball is suddenly turned over to the opponent. The athlete has to take all of that energy and redirect it in the opposite direction.

Or think about a volleyball player who lands after a massive spike. Her knees have to absorb the force of the landing. The forces are very large and can easily damage non-contractile tissue when not absorbed adequately. Ultimately, an athlete does these movements multiple times during each practice, thereby increasing risk over time.  Can you avoid ACL surgery?  Yes and no. If you currently have a healthy, intact ligament you can reduce the risk of you having surgery by completing a prevention program. However, if your ACL is already torn, you will likely benefit from surgery if you plan on returning back to cutting and pivoting sports.

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