Anterior Cruciate Ligament injuries (more commonly referred to as ACL) here in the 21st century they have become a very familiar site, practically in the world of sports such as Football, Skiing, Tennis, Squash, Rugby. In fact in the UK ACL injuries can account for up to 40% of all sports injuries! In the US those numbers can be even higher in certain sports!
ACL injuries in High School Athletics (2013)
So, before we go any further lets look at what is the Anterior Cruciate Ligament.
There are 3 bones in the body that meet in the knee; the Femur (thigh), the Tibia (shin) and the Patella (kneecap). These are connected by 4 ligaments – 2 Collateral ligaments to the sides of the knee (Medial – inside, Lateral – outside) and 2 cruciate ligaments inside the knee (Anterior and Posterior) these are designed to hold the bones together and to keep the knee stable.
Now what happens and causes an ACL injury?
ACL injuries occur when the ligament connecting the femur to the tibia tears (can also sprain). The symptoms that can occur are a loud ‘pop’ or ‘popping’ sensation, swelling, instability and pain when bearing any weight. The causes? Well what causes a tear is if your lower leg extends forward too much or when it is twisted such sudden stops, sudden changes in direction or landing incorrectly when jumping.
Is it happening more?
It does appear to be the case, research in the USA back in 2017 was showing a steady increase by 2% a year in children between the ages of 6 to 18 playing in sports. Looking closer to home, in the 2016-17 Premier League season there was a recorded total of 28 knee ligament injuries, 17 of which were ACL’s (the highest numbers in the previous 5 seasons).
Knee Ligament injuries over 6 seasons
What could be coursing this increase? ?
There are a few theories; the changing physiologies in players over time, footwear (softer, less supportive), modern – harder pitches. But possibly the outstanding one is overplaying and fatigue. If we looked at the teams at the very top of the game, you don’t just have 38 league games but also 2 domestic cup competitions and a European campaign which would be a minimum of 6 games in the group stage. With all this playing time players obviously need time to recover, so is there enough time spent training? More specifically is there enough strength work being done in the gym working on fundamental movements and strengthening the muscles round areas like the knee joint. I’m not talking about technical work or specific movement patterns that directly transfer to the sport! cause then we’re getting back into the same problem of muscle groups and joints being overworked and becoming fatigued and ending up resulting in a possible injury!
What can be done to prevent it?
There isn’t a fool proof way of preventing ACL injuries, landing awkwardly when jumping for a header for example can cause a rupture. As I’ve just said before solid fundamental strength work – strengthening the muscles in the quadriceps, hamstrings, hips, pelvis and abdominals, Conditioning work on proper technique when jumping and landing, pivoting and cutting movements. These fundamentals worked on properly will certainly help reduce the risk of injuries. In professional football terms just this last summer, the Football Association took action and scraped extra time being played in the rounds up to the final of the League cup and got rid of replays after the 4th round of the FA cup so to help reduce fixture congestion.
So in terms of Football clear steps are being taken in the professional game with trying to allow for good recovery time between matches, clubs themselves are hiring more Fitness or Strength and Conditioning coaches to improve players overall strength and fitness. It is an area that still needs more to happen, particularly in youth coaching as we saw with the stats in high school ACL injuries. There maybe needs a little less focus on technical work and more on the general fitness.
