By Briana Pina
Avoiding an ACL injury and when to return to sport if you sustain one
In my work as an athletic trainer at North Kingstown High School, I help athletes prevent ACL injuries by ensuring their muscles are strong and they’re training in the right ways. Below I explain how the ACL works and why it matters, how to prevent ACL injuries, and when to return to sport if you do sustain an ACL injury.
The ACL, how it’s injured, and why it matters
Most ACL injuries occur when movement happens too quickly, like when you suddenly stop running or change direction quickly. Jumping and landing on a straightened knee or stretching it farther than it is meant to go can also injure the ACL, as can direct blows to the knee.
The ACL, or anterior cruciate ligament, is a critically important part of the knee. Made up of three twisted bands, the ACL connects the thigh bone to the shin bone at the knee joint, running diagonally over the center of the knee. The ACL acts as a stabilizer. When it is injured, the knee joint can feel like it is giving way or cannot support your body weight. ACL injuries are often accompanied by intense, sharp pain, and swelling.
ACLs can be sprained (overstretched), partially torn or completely torn. Depending on the severity of the injury, surgery may be required. Lower-degree sprains can take about 4-6 weeks to heal, whereas injuries requiring surgery can lead to longer recovery times, from six months to a year and a half. When injured, ACLs can take a long time to heal, affect an athlete’s future in their sport, and cause lasting knee issues like knee osteoarthritis.
In the general population, men are more likely than women to have ACL injuries. But athletes are much more likely to have ACL injuries and among the athletic population, the risk of ACL injury shifts to women and girls. Athletes who play football, soccer, basketball and lacrosse are at the highest risk of ACL injuries.
Protecting your knees via the prevention methods like warming up for practice, doing specific strengthening exercises, using verbal cues, and wearing the right footwear is the best way to both avoid an initial ACL injury and the lasting damage that injury can cause.
Preventing knee injuries
MoveForwardPT.com reports that preventative physical therapy programs have proven to lower ACL injury rates by 41% for female soccer players. Preventative programs are designed to improve balance, strength and sports performance and aim to strengthen your core, thigh and leg muscles. Download a stretching and strengthening routine to protect your knees.
Use landing Instructional cues
Verbal cues have been shown to help reduce landing impact on the knee for athletes. Have someone remind you (or remind yourself) to:
- Have soft knees: Let your knees bend as you land to help absorb the impact forces.
- Load your hips: Bend at the hips a bit to help absorb the impact.
- Go toe-to-heel: Try to land on the balls of your feet and then roll onto the heel. Your arch will absorb some of the impact and will also reduce impact on the knee.
- Be quiet: When you absorb the impact with your body, you’ll make less sound. Work on making as little sound as possible on landing. More sound = more impact. Less sound = happier knees.
Wear the right cleats
If you play a sport on artificial turf, aim for a shoe with cleats that are no bigger than .5 inches. There is a decreased rate of injury on artificial turf when wearing shoes with shorter cleats, since the foot is less likely to get stuck in the ground when pivoting.
Design the right workout for your knees
Consider the strength ratio between your quadriceps and hamstrings: The hamstrings and quadriceps work together to stabilize the knee joint, so the ratio of strength between the two is important. The ideal ratio of quad to hamstring strength is 100 to 60-70. If your quads can handle squatting 100 pounds, you should be able to deadlift 60 to 70 pounds.
Work on your balance: Working on your balance is important to avoid knee injuries. Balance training helps your body learn where it is in space and how to react safely when it is thrown off.
Do a dynamic warmup before games and practices, followed by stationary stretches: Before a game or practice, make sure to get your muscles, ligaments and body ready. Warming up your body and stretching (in that order) can ensure your knee is resistant to tearing and overstretching. You’ll focus on warming up and stretching your calves, low back, quads, groin and hamstrings. Dynamic exercises and stretches would include inchworms, up-down dog, side lunges and butterfly stretching and more.
Do Plyometric training: Plyometric training, also known as “jump training,” is a type of exercising that focuses on using maximum muscle strength in specific muscles for a short period. The main goal of plyometric training is to increase power. Plyometric exercises would include: box jumps, squat jumps, jump lunges and mini hurdle jumps.
Recovery Time and Returning to Sport
Surgery, Rehab & Time: ACLs can be sprained (overstretched), partially torn or completely torn. Depending on the severity of the injury, surgery may be required. Lower-degree sprains can take about 4-6 weeks to heal, whereas injuries requiring surgery can lead to longer recovery times, from six months to a year and a half.
When can you return to play? If you have surgery, your doctor will determine when you are safe to return to play. Your physical therapist and/or athletic trainer will then help determine whether you’re able to return to full play by assessing your movement. At my school, I have athletes returning from an ACL injury go through a series of exercises: if they can cut, run, sprint, jump, do figure 8’s and speed ladders, and complete sport specific drills, all while being mentally ready and showing confidence in using their knees equally, then they can return to play without any restrictions.
If you’re injured…
Keep these tips in mind and you’ll reduce the chances that you’ll injure your ACL. But if you do injure your ACL, make sure you see a doctor, and listen to them and your physical therapist and athletic trainer. ACL tears, if not treated correctly, can lead to continuing knee instability, increased chances of re-tears, and the need for future reconstructive surgery.
Surgery and physical therapy can ensure your knee returns to fighting form and that you get back to 100% in your sport.