By Kaysie Brittenham, PharmD Student
Are specialized training programs the solution to the alarming number of ACL (Anterior cruciate ligament) tears among young athletes? ACL tears continue to be a major issue among children and teens participating in competitive sports such as basketball, soccer, volleyball, and gymnastics. There are approximately 200,000 (1 in 1,750) ACL injuries every year, a majority of which occur in patients 15-45 years of age with young females at greatest risk.5 The ACL is one of four important ligaments in the knee. It runs through the center and provides stability when athletes are cutting, pivoting, stopping, or landing from a jump. Ligaments in the knee connect bone to bone at the joint and act like strong ropes to hold the bones together and maintain joint stability. They can tear from the force of a hit or from an awkward movement putting more force on the ligament than it can tolerate.2
ACL injuries have both immediate and long term debilitating effects. After an ACL tear, athletes are often less likely to return to athletics and tend to experience greater problems later on in life. Surgery, lengthy rehabilitation, early development of joint problems, chronic pain, and disability are all possible effects from ACL tears. Additionally, there are many financial, emotional, and psychological effects. Currently, ACL reconstruction surgery uses grafts to replace the ligament. These grafts come from tendons (strong tissues connecting muscle to bone) in the knee or in the back of the leg of either the patient or a deceased donor. The procedure typically lasts no more than a few hours. However, rehabilitation can be quite lengthy. Each person recovers differently, with some experiencing more difficulty than others. Complete recovery typically takes 9 months of rehabilitation. Muscles take a long time to regain strength and the affected knee often requires painful physical therapy to recover range of motion and stability. Sadly, some people are never the same after surgery and continue to experience problems such as a noticeable limp, joint pain, or fear of reinjuring themselves. Despite improvements in surgery and rehab, ACL injury prevention strategies are being stressed more and more. The hope is that these programs will combat the high occurrence of these detrimental injuries. Recent studies have suggested that specific training programs can lower the risk of ACL injury by as much as 70 percent.1 These training programs are believed to strengthen lower leg muscles, improve core stability, and help athletes avoid dangerous knee positions.1
Training programs are being stressed predominantly in young female athletes. “The largest numbers of ACL injuries occur in female athletes ages 15 to 20.”1 In fact, females are 4-6 times more likely than males to experience a torn ACL.3 The prevalence of ACL tears among young female athletes after puberty is thought to be a result of developmental changes. As body size increases, muscles in females do not generally develop and increase in strength as they do in males.1 Additionally, girls tend to jump and land differently than boys. Girls generally use their leg muscles unevenly, land with straight knees, and have legs that differ in strength. “These imbalances, which become more pronounced after puberty, put girls at greater risk of tearing their ACLs.”2 However, with the help of training programs, it is believed that these tendencies can be altered.
Physicians and athletic trainers are stressing the idea of ACL tear prevention. Many believe that specialized training programs, consisting of simple exercises that alter the way athletes run, jump, and land, can significantly reduce the risk of ACL injury. These programs have demonstrated numerous benefits and though they are not one hundred percent effective, initial research shows promise.2 Training programs may only take a few minutes a day to implement and could include a combination of drills such as jogging, skipping, lunging, or other bodyweight exercises.2 Consciously practicing a technique over and over causes muscle memory to kick in when the athlete cannot focus all of their attention on technique.3 One study conducted by Dr. Cynthia LaBella, showed that “a 20-minute program of specialized warm-ups, strengthening drills and plyometrics (explosive jumping exercises) cut down dramatically on ACL injuries compared to girls who did not perform the drills.”2 LaBella’s research has led to the development of KIPP (Knee Injury Prevention Program) which is now one of many ACL injury prevention programs.
Since KIPP’s development, many schools have adopted the program or others similar to it.2 Evidence has shown that multi-component programs are more successful than single-component programs in decreasing the occurrence of ACL injures. Exercises within these programs include plyometrics, balance and core control, strength training, agility training, spatial awareness, and muscle memory training.3 Many programs differ with respect to number and types of exercises and the frequency and duration of training. A pooled analysis, however, looked at all current studies on these training programs and concluded that the most effective programs combined 3 key components. These included core and lower leg muscle strengthening, plyometrics, and repeated enforcement of proper technique.4 Additionally, the most effective programs trained athletes for a minimum of twice per week for 6 weeks and included preseason and in-season training.4 Though more research needs to be done, evidence suggests there are benefits in utilizing ACL injury prevention programs.
Talk with your doctor if you have questions or are interested in learning more. They can help athletes and parents locate a qualified instructor and provide you with more information.4 Athlete’s tend to have a mindset that they’re invincible, but all it takes is one wrong movement. Is it worth being proactive and possibly preventing such a common and destructive injury? As a future health care provider, I strongly suggest that young athletes, particularly females, consider these training programs. I’ve seen first-hand the negative effects of ACL injuries and greatly support efforts to reduce their occurrence. Additionally, I would recommend that pharmacists encourage patients with possible ACL tears to have it looked at by qualified athletic trainers or sports medicine physicians. Based on their assessment an MRI may then be necessary to confirm a tear. If MRI results demonstrate a torn ACL, it is important for athletes to see a specialized orthopedic surgeon with high success rates in ACL reconstruction.
- Preidt R. Training Programs Protect Young Athletes From ACL Tears: Report. HealthDay Consumer News Service[serial online]. April 28, 2014: Available from: Consumer Health Complete – EBSCOhost, Ipswich, MA. Accessed October 26, 2014.
- Torn ACLs continue to ravage high school athletes. Record, The (Kitchener/Cambridge/Waterloo, ON)[serial online]. September 9, 2014: Available from: Points of View Reference Center, Ipswich, MA. Accessed October 26, 2014.
- Laible C, Sherman O. Risk Factors and Prevention Strategies of Non-Contact Anterior Cruciate Ligament Injuries. Bulletin Of The Hospital For Joint Diseases[serial online]. January 2014;72(1):70-75. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed October 26, 2014.
- Dharamsi A, LaBella C. Prevention of ACL Injuries in Adolescent Female Athletes. (cover story). Contemporary Pediatrics[serial online]. July 2013;30(7):12. Available from: Publisher Provided Full Text Searching File, Ipswich, MA. Accessed October 30, 2014.
- Kim, Jennifer. Anterior Cruciate Ligament Injury. Sports Medicine. http://orthosurg.ucsf.edu/patient-care/divisions/sports-medicine/conditions/knee/anterior-cruciate-ligament-injury-acl/. Last Updated January 2009. Accessed November 9, 2014.