Am I at risk for an ACL tear?

The ACL tear, it seems like every teenager that plays sports has had one. It is a season-ending injury and sometimes it can be career ending. The ACL tear, or anterior cruciate ligament tear, can happen to any athlete, in any sport, at any time. And while there are no full proof methods of identifying and treating who may be at risk for such an injury, there are many red flags to look out for as well as ways to help minimize your risk.

The ACL is a ligament that connects your tibia (which is the large bone in your lower leg) to the femur which is the large thigh bone. It is one of four ligaments that provide stability to the knee, and helps limit the rotation of the bottom shin bone, the tibia. Tearing can happen by either contact, meaning someone forcefully tackles or runs into your leg or by non-contact meaning you plant your foot and the knee rotates excessively and the ACL tears. It is for the non-contact tears that we can evaluate certain movement patterns and anatomical structures to see if there is an increased risk for an ACL tear, and from there do some exercises that are able to create a stronger knee and minimize the risk.

For a nontraumatic tear there are things that we are able to look at to determine your possible risk for a tear. It is best that you see a medical professional, such as a physical therapist, if you think it is possible that you are at risk so they can accurately assess the situation. One of the things that you can look at is knee angles. The best way to do this is to jump. Do a double foot vertical jump and have someone watch how you land. If your knees go in and almost touch each other, this is a red flag that you could possibly be headed for an ACL tear. This usually indicates weakness in some areas that needs to be corrected. Also the biomechanics of jumping are not correct, so instituting a beginning jumping program will also help.

Another thing we consider in your risk is muscle imbalances. Many athletes have quads (the muscles in the front of the leg) that are highly developed but lack hip, core and hamstring strength in order to provide balance to the leg. This pulling of the quads can lead to a stiffer landing or the knee being pulled more forward, which if the hamstrings are not strong enough to balance out, can lead to injury. Strengthening, foam rolling and balance activities can all help to minimize muscle imbalances.

Decreased muscle functioning caused by fatigue can also lead to increased risk of injury, in any body part not just the ACL. Many children play their sport year round, not giving their body any breaks, often playing multiple games in one day. This type of muscle fatigue leads to increased susceptibility to an ACL tear. If the muscles are not working properly or are too tired to work properly then the ligaments are at greater risk. Allowing yourself to rest can help the muscles recover and be able to help protect the ACL.

What can be done if you feel you are at risk?  The first thing you want to do is seek help from a physical therapist who can appropriately evaluate you and determine what factors we can change to put you less at risk. There are many intrinsic and extrinsic factors that must be considered. While what is written above is just a simple overview of some things that we can look at, having an in-depth understanding and evaluation will help determine if you are in fact at risk.

With the information gained in the evaluation there can be a program developed that will focus on the risk factors that could possibly cause an ACL tear. From strengthening, to balance, to plyometrics, to jump programs and so on, all can be incorporated in order to help reduce your chances of an ACL tear. The added bonus is that once you focus on improving the deficiencies that were determined to possibly put you at risk for an ACL tear you become an overall better athlete. Increasing strength and balance and plyometrics will improve your entire body, making you stronger, better, faster.

One thing is for certain: when you identify that you are in fact at risk for an ACL tear, you must change how you train. Continuing to do the same thing will only feed into the poor patterns and the muscle imbalances that currently exist. That it is why it is important to seek the help of a professional so you can incorporate your training for your sport but also incorporate the training that is necessary to minimize your risk.

For more information on this topic please come to a free seminar at Total Performance Physical Therapy on Monday September 22, at 7 PM at the Bucksmont Indoor Sports Center on exactly this topic, "Am I at risk for an ACL tear?"

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