You have probably seen people walking around with a big clunky straight leg brace or a hinged knee brace. Or seen many professional athletes wearing them. They even make it now mandatory for linemen in football to wear these sports ACL braces- on BOTH legs to try to prevent this injury……..
Many of my ACL patients report how surprised they are by how often people approach them in their ACL brace, offer up their own ACL stories, advice (for better or worse) and that it seems “that everyone has this injury and surgery”.
.There are between 100,000 and 200,000 ACL ruptures per year in the United States alone. There is annual incidence in the general population approximately 1 in 3,500, although the actual incidence may be higher as these registries only report college and high school athletes. Injuries to the ACL are among the most common sports injuries. Observed most commonly in football, ACL tears also occur in baseball, soccer, basketball, volleyball, skiing, tennis…..basically all high-impact, cutting, jumping (especially single legged), fast-spaced sports.
What is and ACL?
The anterior cruciate ligament (ACL) is an important stabilizing ligament that is frequently injured by athletes(contact and non-contact injuries) and trauma victims. The primary function of the ACL is to control your tibia (shin bone) from move forward of your femur (thigh bone), it is underneath your patella (kneecap), deep inside the joint. The ACL is also a secondary restraint to control rotation of the knee joint and limit the knee from completely collapsing inward or outward. It bears most of the responsibility of holding the upper and lower leg bone against shear forces forward, sideways and rotationally.
So why is it prone to tear?
In normal straight-leg plane walking or running there is less stress on the ACL. Problems arises as we make sudden shifts in movement and how our distributed weight puts strain on our knees. It is when we make a sharp turn, change direction (cut) at high speeds, or stop suddenly from running or land a jump that our knees and ACL have to undergo this sudden intense strain. Because the ACL is simply not strong enough to hold our leg together as the leg bones twist, slide or pull away from each other under under the force of our weight and momentum it frequently tears.
Are certain people at a greater risk?
There appears to be a greater incidence of women versus men. This may be attributed to; anatomy, pelvic and knee angles, estrogen receptors in the ligament that may weaken it, the notch-angle the ligament is fixed, or poor quad- hamstring firing patterns commonly observed in women(young developing girls may be more susceptible too). Individuals that exhibit hypermobility of their joints (super bendy), or have increased angles of their knees in or out increases the strain on the ACL. Limited muscle flexibility or strength in the glutes, hip stabilizers, quads and hamstrings additionally can contribute to instability of the knee and increases the risk of an ACL injury.
Can it be avoided?
Yes, in most non-contact or traumatic cases. Individuals that have certain body morphology/physiology or engage in high risk sports(soccer, football, basketball, baseball, tennis…)that make them more prone should definitely commit to a focused strengthening, stretching and bodywork routine to protect themselves against this injury. Additionally, working with a sports specialist like a Physical Therapist is critical to address any movement patterns that are inefficient and will put you at greater risk for tearing an ACL.
The ACL is deep inside the knee and can only be repaired surgically. After the initial injury and then surgery it may involve; immobilization, braces, crutches, a long period of recovery and committed rehabilitation. The need for a longer recovery and limitations(protocol) is attributed to the poor blood supply to ligaments which lengthens the healing process. This is why so many people fear an ACL injury, because often it means missing a season, scholarship eligibility, travel and generally limits your ability to be active as you were previously for 1-1.5 years.
Do you have more questions or are you ready to assess your risk factors and avoid this potential season ending injury? This is something one of our sports specialist Physical Therapist can help you with.
We are always available for FREE Phone Consultations. Click here to schedule a time for us to call you or just give us a call, (805) 941-0125. We would be happy to talk to you about your specific questions, fears, or problem.
At Perseverance Movement Specialists & Pilates we help people aged 40+ stay fit, active and overcome mobility loss to be able to live the life they love without fear, limitation and depending on painkillers or procedures.
Yvonne A. Castillo, MSPT, DPT, CPT