Why Young Athletes Tear ACL’s
March 2, 2010 by Admin: Joe Hashey, CSCS
Filed under Strength Training
=>PLEASE READ THIS POST TO THE END – I’ll be asking for a little feedback!
Anterior Crucial Ligaments (ACLs) are getting torn more often and at a younger age than ever before. Just from observation, I went to a high school where there was 1 ACL tear in the entire school – a basketball player.
Most recently I spent time at a larger school with 13 ACL and two of them double tears.
Why are these kids tearing their ACL’s so much? And just as important, what can we do as preventative measures?
Here is an alarming statistic on ACL injuries from Matthew Gammons, MD: An estimated 200,000 ACL-related injuries occur annually in the United States, with approximately 95,000 ACL ruptures. Approximately 100,000 ACL reconstructions are performed each year. The incidence of ACL injury is higher in people who participate in high-risk sports such as basketball, football, skiing, and soccer. When the frequency of participation is considered, a higher prevalence of injury is observed in females over males, at a rate 2.4-9.7 times greater for females.
The number of ACL injuries have over doubled in the last 30 years, and while perhaps some of the older cases were misdiagnosed due to less technology, it is safe to say there are many more injuries happening.
Schools of Thought On Why:
- Lack of neuromuscular training.
- Neuromuscular fatigue
- Muscle Imbalances (quad stronger than the hamstring).
Those are just a few of the theories, but cover the basics.
At the risk of oversimpfying, let me break it down in an easier way to understand.
- People do not know how to run, cut, jump, etc efficiently
- People run, cut, jump, too much and causing muscle or neurological fatigue
- People do not have the proper strength program and they are quad dominant
Here’s my personal thoughts on why young athletes are getting injured more. First, they are participating at many more organized sports at an earlier age. It is not rare to find a high school athlete playing a school sport, while playing in an off season league for another sport, and participating in travel tournaments.
All this non stop repetitive motion becomes dangerous for two reasons. One if they perform the same motion and are performing it incorrectly (running, landing, cutting) thousands of times a week, then the likely hood of an injury is increased.
Second, they will become physically and mentally fatigued. One lazy cut or jumpwithout firing your muscles correctly could lead in a serious injury.
ACL Injury Prevention
- Proper rest and consideration for young athletes
- Neuromuscular training (teaching athletes to unconsciously fire the correct muscles)
- Strengthening of the hamstrings and glutes in quad dominant athletes (dynamic stabilizers for the knee)
YOUR INPUT IS IMPORTANT
I was contacted to meet with a group researching and developing a way to quantify muscle imbalances for trainers, physical therapists, doctors, etc.
Oversimplfied, they will be hooking up my knees (or demonstrating with theirs) to a machine, perform some movements, they will measure the force output, etc, and be able to identify any imbalances.
This is new technology and I wanted to share this opportunity with everyone here!
What kind of questions do you have about ACL tears, muscle imbalances, and their way of measurement?
I am personally humbled that they want feedback from us, so let’s make it worth their time!
Post up comments!
Getting things started, my two questions:
- How will my form during the movements (squats, side lunges etc) effect the reading?
- Will glute, quad, or hamstring activiation exercises effect the read out?
– Joe Hashey, CSCS -
References:
1. About.com – Orthopedics
2. Brown University – Bio Med Dept.
PS. Your feedback is very important on this one. If I get over 20 comments, I will post a follow up with all their answers and a video! Show me you are interested, thanks.
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Joe,
I love the points you are making about this post and I agree very much with all of it but I think many people overlook certain areas when talking about keeping the knees healthy. Muscle imbalances are one thing but I am not sure that is as major of a factor as once thought. I focus more on the hips, certain training techniques for the ankles, and body weight control.
I do look at things a bit differently and attack them differently and it has paid off. I currently have 12 Division I teams that have not had an ACL tear in 8+ years and 6 teams that have only had 1 (nobody’s perfect). I speak often on these issues at conferences and I am currently writing a book on all these simple techniques to be released in the future.
I will be interested to hear what you find out and your thoughts.
Jerry
Joe, I’m looking forward to this post, actually. I’ve torn my right ACL knee twice due to football injuries. In my University, few couples of other athlete had their ACL torn too. So, post away explain us all kind of shit you could come up with and how to prevent them. However it would be nice to make a post about those who already had their ACL torn and how to make them better or whatever. God knows I will benefit lot from it, I’m already having arthritis complication right now, the doctor said my right knee looks like a 60 year old man. However it doesn’t still stop from getting me busting my ass and such. Few weeks ago, I was able to squat at 525 pounds, which is my personal record. Not bad for a guy with a bum knee!
Danny – awesome squat post surgery! I hope I can bring something valuable back for you next week!
Joe
Jerry
We have heard the same from many trainers, PTs and Orthos, that the hips and glutes play a big part in controlling and stabilizing the knee. The technology we will be showing to Joe tomorrow is capable of measuring those as well and we have measured the glute (maximus) during some basic movements, squat, lunge, step up, etc.
Steve Pittari
Jerry – That’s an awesome track record. I am with you on this point “and body weight control.” Not just form, but neurological and physical fatigue that effect body weight control in young athletes is a huge factor!
Thanks for the well thought out comment!
Joe
Steve – thanks for chiming in!
Joe
Steve & Joe,
I look forward to seeing the info!!!
Jerry
Jerry
If you are curious as to what we have done you can go to you tube and type in Knee Screening and a series of interviews and videos will come to the top. They are from a recent knee screening clinic we participated in here in the Binghamton area. We were attempting to replicate a study done in Denmark where the researcher test 55 female soccer and handball players and were able to identify 10 that were at risk based on the preactivation levels between their vastus lateralis and their semitendinosus. They had the girls perform a side jump or cut of 2m onto a force plate. Of the 10 they identified at risk 5 suffered non contact ACL tears over the next 2 season. If you have not seen this study I have the abstract in soft copy. I can get you a hard copy of the entire study if you would like also.
I would love to see this info. Also would like to see a comparison of readings between fatigued and non fatigued subjects.
Phil – excellent question – and thanks for being a consistent reader! Hows your son doing with his training?
Joe
My two cents? Everything you said is true about athletes participating in many off season leagues. This gives them no time to recover or rehabilitate making them too tired to move properly. This leads to greater chance of injury. Also, overuse injuries occur as too much stress can cause the ligaments to fray.
Lack of proper strength training in athletes leads to more knee injuries. Athletes are worked to death in conditioning and practices but they need to get in the weight room to help to strengthen their joints and stability muscles in order to protect their knees. Even if they don’t go in the weight room, I find that many teams are run by coaches who have no training in physical fitness or kinesiology. They work the athletes using the same conditioning movements over and over without ever teaching them proper technique.
I healed a fifteen year old’s knee pain simply by showing him proper form. His coach made him squat and lunge a hundred times but never stopped to say, you are doing it incorrectly. The poor boy had been wearing out his knees doing these exercises incorrectly all season long. This was leading to greater muscle imbalances. Simply showing proper technique saved him. He was also getting to the age where he was going to start adding weights to those squats and lunges so you could imagine what kind of damage that would do if his knees were going way over his toes like they were.
Also, many children are highly de-conditioned during the stages of development where they should be learning how to run and play. These days, they are cooped up in a house with a TV or computer for a babysitter. When I was growing up, children were playing outside in a neighborhood were everyone looked out for them and they learned how to move at the ages where they were supposed to. Children need to learn to crawl and run a round barefoot during those developmental stages or it can lead to imbalances later on. However, most children are put in front of a TV and P.E. programs are being cut. I don’t think it is a coincidence that the rate of adult onset diabetes and obesity has shot up in the past few decades along with the risk of ACL tears. A rise in processed food and lack of home cook meals has also been a problem the past few decades so children are not getting the nutrition they require to allow their muscles and bones to recover.
I think there are many factors contributing to this.
Damn rhea – well thought out two cents! Especially the part about improper form in the weight room. Unfortunately that happens more time than not.
Joe
Now this is subject that is close to me had mine redone in the early 80`s caused by a double team block one high and one low
but when u play contact sports injuries happen right.Doctor did a good job I`m in my early fifty`s and have no problems with it.But during therapy i learned the hamstrings are just as important as your quads for knee joint stability.
Joe,
This is a great article!
From my experience, unbalance between hamstring and quads is the main reason for ACL tear, espacially among female athletes.
Umproper rest is also a concern with young athletes. Here in Japan, people tend to believe that the more you do, the better you will be. So it is not rare that after a 5 hours baseball practice, players stay on the field swing, throwing and running again and again…
Will they be taking a look to see if participants have sufficient torso stability and onset of firing? It’s been noted that many with functional ankle instability have issues stabilizing the trunk and pelvis, and this likely doesn’t bode well for the knee (things that Jerry essentially touched on above when mentioning the hips and ankles.) I’ve always found the hip rotators and sufficient mobility of the ankles to be big deals with regard to limiting the occurrence of non-contact injuries.
Also, will this testing be paying any special attention to eccentric and isometric strength given that the ability to absorb force would seem to be far more critical than how much force can be produced concentrically?
That’s begging for injuries Nico! I didn’t know that – thanks for sharing.
Joe
Rolf,
Good questions, I’ll ask. I’m going to assume that the test is based on the knee and the surrounding muscles. This would provide a baseline measurement for where their are weaknesses. However, the professional would still have to identify an action plan to address the weaknesses including torso training, hip mobility etc.
But then again, that’s just my guess.
Thanks for the well thought out question Rolf!
Joe
Yogi, I’m glad the doctor did a good job and things have been going well.
Interesting to me, through some of the studies I read when writing this article approximately 80% of acl tears happen in NON CONTACT activities. Weird, right? Well I guess it does it comes down to running, landing, cutting, etc correctly.
Thanks for the comments,
Joe
Steve,
I will checkout those videos-thanks and I would love to get a copy of that literature. How would I go about obtaining that?
Thanks,
Jerry
My guess is that kids these days(shit that makes me sound old) spend their formative years on their duff staring at the tv and playstation instead of vigorous playing. Playing, I’m sure helps develop athletic qualities like strength, balance, endurance, power, HOW TO ABSORB FORCE, and THE STRENGTHENING OF LIGAMENTS AND TENDONS. Im sure everyone here knows the body adapts to its environment and the stresses put upon it- the basis of training. Connective tissue takes time to adapt so if these kids were spending years on their duff and all the sudden, in one year decide to play sports, will their ligaments and tendons be able to adapt so quickly? Im guessing not, even with youth on their side.
I think there is a price to pay for using the ‘dvd babysitter’ and lack of physical education in American public schools.
I would totaly agree with the quad dominate issue. I also think the foot ware they are wearing is not doing them any favors. But their needs to be a simple universal formula of correction that can be put to use. Better yet a preinjury guide line protocal for training in the first place.
Jerry
Send me an email at spittari@sonostics.com and I will forward the material
Steve
Gabe – good point about the decline of actual physical movements in many PE classes.
Chances are that nearly everything mentioned plays a roll, imbalances, fatigue, lack of training, etc etc. PE class is one I didnt consider, but it does make some sense and adds value to that list!
Thanks Gabe,
Joe
Mike, that would be awesome. I will start doing more research and see if I can’t develop a prehabilitation protocol in the next few months.
Joe
Among the other factors listed, I think another thing to think about is the rotation angle of the femur. Namely too much internal rotation leading to adverse and unbalanced forces on the knees.
We pay a lot of attention to shoulder internal/external rotation and probably not enough to hip internal/external rotation. Most people I’ve worked with on squatting technique readily display this.
PL squatting and DLing always make my poor bum knee feel better for a reason.
i hate to say it but this theory is wrong. simply look at one episode of sportscenter. you think 30 years ago athletes were as explosive and fast as kobe-lebron-adrian peterson-randy moss and those of alike…? simply put, todays athletes are bigger faster stronger than EVER IN HISTORY, and there is no way to strengthen your ACL……theres no exercise for that!! im not saying posterior chain, hamstrings and deceleration wont help prevent knee stabilization. you put bigger faster stronger athletes in crazy out of control movements theres going to be a obvious increase % of ACL tears….
Matt
Matt – very good point. I’m not sure if I would consider the reasoning of neurological fatigue, muscle imbalances / weaknesses, and insufficient neurological training with these bigger faster bodies as ‘wrong’ – but you do add a good thought to the discussion.
Thanks for reading and commenting!
Joe
No way to strengthen your ACLs?
So I guess that giants like Andy Bolton have exactly the same ACL strength as I do. Or that they were just genetically born with stronger ACLs.
Your point is somewhat valid. But only indirectly. Tendons and ligaments DO in fact heal and get stronger. Or no one would have ever recovered from tendonosis let alone a partial ACL tear.
But they also have a diminished capacity and rate at which they do so when compared to muscles.
Perhaps it would be more accurate to say that ligament and tendon strength lags behind muscle strength. This situation can lead to irritation/degradation and/or rupture if the connective tissues are not given adequate time to get stronger or are stressed beyond their capacity to regenerate.
Matt,
interesting thought but I don’t see those guys tearing their ACL’s like the teenage (and younger) girls. No data though, just anecdotal
phil
Well I know this might bring some heat towards me but football is a sport where most players look forward to injuring their opponents. It’s no surprise to me that there are so many injuries. Now looking at it from the training perspective and from what I’ve seen at the H.S. I’m working, coaches feel that training their athletes “to death” in over 100 degree weather 4-5 days a week is a way to make them “tougher”. I can only watch in horror as the athletes perform circuit after circuit with bad technique while the coaches chit chat. And to make matters worse the attitude is that the Head Coach knows best even if he has no clue of what physical training is. As long as the “old ways” maintain the status quo at the weight rooms ACL and other career and life treatening injuries will remain in high numbers.
trust me as a highly trained athlete i tore my acl, at 6’4, 292lbs runnin in the 4.6′s i tore my acl playing fball 3 years ago. and there were no imbalances as i did GHR’s, squat 650, posterior chain work…etc…i did it all and had all aspects of “training” down pat. just simple physics as the bigger and faster a object moves, the more force it takes to stop that force and injuries come into play.
I should make sure to emphasize the fact that the majority of ACL tears are non contact.
JOe