ACL injuries in team sports

Understanding ACL prevention, treatment and recovery

Just like that, the back-to-school season is here and fall sports are underway.

Sports fans are eager to get back under the Friday night lights and athletes are working overtime (and after school) to prepare for another exciting season.

But with the thrill of competition comes the risk of injury, particularly to the anterior cruciate ligament, or ACL.

ACL injuries are common in fall sports like soccer, football and field hockey, which require quick changes in direction and sudden stops.

Understanding the mechanics, prevention and treatment of ACL injuries can help athletes stay safe and maintain peak performance throughout the season.

The what-to-knows

The ACL is one of the four major ligaments in the knee, and it’s crucial for stabilizing the joint.

It connects the femur (thigh bone) to the tibia (shin bone) and is responsible for maintaining stability during activities involving pivoting, cutting or jumping.

There are three types of ACL injuries:

Grade 1: Mild damage to the ligament, slightly stretched but still functional

Grade 2: Partial tear with the ligament being looser and less stable

Grade 3: Complete tear, leading to knee instability

ACL injuries typically occur when an athlete:

• Changes directions rapidly
• Stops suddenly
• Lands awkwardly from a jump
• Experiences a direct collision or impact to the knee

These movements place significant stress on the ACL, potentially leading to a partial or complete tear.\

Female athletes are at a higher risk of ACL injuries due to anatomical, biomechanical and hormonal differences, but all athletes are susceptible.

So, why are females more susceptible?

Female athletes have wider pelvises, which can alter the alignment of the knee joint. A female’s ACL tissue is also typically thinner, so it may take less force to tear.

Women’s knees are generally looser and have more range of motion than men’s, and they often have less muscle mass around the knee, which can lead to instability.

Female athletes also tend to stand with straighter knees and less core engagement than male athletes, which can put more strain on the ACL.

The impact on athletes

The repercussions of an ACL injury can be profound, both physically and psychologically.

When an athlete tears their ACL, they can typically feel or hear that something is wrong.

Athletes often experience: 

• Pain and swelling: Immediate pain at the time of the injury, followed by swelling due to the inflammation.
• Loss of mobility: Difficulty bearing weight, moving the knee normally or a feeling of the leg giving out.
• Popping sound: Sometimes a “snap” or a “pop” sound will follow an unsafe landing or contact with another athlete, and the pain can feel like a sharp hit or kick in the knee.

If an athlete experiences any of these symptoms, they should seek immediate care.

A health care professional can order tests, such as a MRI scan, to determine the severity of the ACL tear and provide proper treatment, which usually requires surgery.

The length of the recovery program varies by person, but a typical treatment plan will include six to nine months of physical therapy following surgery as well as gap-care with an athletic trainer to get back on the court or field.

Rehabilitation following an ACL injury is a structured process that requires a sustained, dedicated effort in getting the ACL back to full function.

Some key areas of this process include:

• Early mobilization – Gentle exercises to improve range of motion and prevent stiffness. The most important goal during this time is restoring your extension, minimizing swelling and pain and restoring quad function and motor control.
• Strength training – Gradually increasing resistance exercises to rebuild quadriceps, hamstrings and calf muscles.
• Balance – Exercises to improve coordination and joint awareness, crucial for preventing re-injury.
• Sport-specific training – As recovery progresses, activities tailored to the athlete’s sport are introduced under the guidance of a physical therapist or athletic trainer.
• Psychological support – Addressing any fears or anxieties about returning to sport through reassurance and positivity from a physical therapist or athletic trainer.

By understanding the treatment options available and actively participating in physical therapy, athletes can regain confidence in their knee strength and functionality, paving the way for a return to the sport they love.

The ACL strengthening process

Studies have shown that approximately 200,000 ACL injuries occur in youth athletics every year in the U.S.

This rate continues to rise, and it’s important that we collectively shed light onto this subject to help prevent these numbers from becoming even higher.

Indeed, there are proactive steps athletes can take to minimize the risk of ACL injuries, even from the comfort of their homes, which can easily be incorporated into daily routines.

Building strength in the muscles around the knee and hip is essential for stability and injury prevention.

Focus on these exercises below to target the quadriceps, hamstrings, calves and glutes:

1) Bird dips

Start by standing near a supportive surface to assist with balance. Shift weight onto the leg to be exercised. 

Slowly lean forward until chest is parallel with the ground. While doing so, extend the opposite leg backward keeping it in line with the trunk. Slowly return to the starting position.

Repeat for two sets of 20 at a slow pace.

2) Standing single leg clamshell (with resistance band)

Place an exercise band above your knees with a slight bend in the knees and feet hip width apart.

Pull one knee outward without moving the other knee and return to starting position.

Repeat for two sets of 20 at a slow pace.

3) Single leg heel raise

Begin by standing in front of a stable surface on the leg you wish to exercise.

Gently lift your heel off the ground and push up onto your toe, keeping your knee straight.

When fully lifted, slowly lower your heel back to the ground.

Repeat for three sets of 15.

4) Double leg hops

Stand with legs hip width apart and knees slightly bent. Hop, traveling forward with a quick rebound into a second jump, and then hold for five seconds.

 

5) Side plank

Lying on your side with your elbow and forearm under your shoulder, lift your hips off the floor while keeping your ab muscles tight.

Make sure to keep your body as straight as possible.

Repeat for 30 seconds for eight repetitions.

6) Y touches

Before starting, place four markers in a square around you. Begin by standing in the middle of these four markers.

Stand on the leg you wish to exercise with your knee slightly bent.

Reach the other foot out and lightly tap each marker while remaining in single leg stance.

Repeat for 20 repetitions each direction.

These at-home exercises can help prevent ACL injuries from occurring and allow you to play your sport safely and at peak performance.

Physical therapy for ACL injuries

However, at-home exercises and stretches don’t guarantee ACL injury prevention.

Sometimes they’re just inevitable and happen accidently, like when a volleyball player gears up to hit a ball and lands incorrectly on their leg after spiking the ball.

An ACL injury can be a daunting setback for athletes and active individuals alike. Whether it’s a partial tear or a complete rupture, the road to recovery often involves comprehensive physical therapy.

Typically, within the first four to six weeks, an athlete will typically start the recovery process with a physical therapist or athletic trainer to restore function back into the knee.

The focus during this time is mobilization of the patellar structures, as well as restoring knee extension, all while working to reduce pain and swelling from surgery.

For the first couple of months, a physical therapist will work on patella (kneecap) movement, quad function, table exercises and other weight bearing activities (like squats) with the athlete. The goal throughout physical therapy is to keep the athlete around a 70 to 80% leg symmetry to push their body weight.

This beginning phase of passive and active range of motion exercises are prescribed to prevent stiffness and improve flexibility.

Another area of rehabilitation includes strengthening and stability with plyometric exercises, which are short, intense bursts of activity that involve explosive movements. Building strength in the muscles surrounding the knee joint is crucial to stability and preventing future injuries.

A physical therapist, using our ACL Prepare to Play program, will build a customized program for the athlete focusing on healthy movement patterns, stability and strength over time.

This program includes detailed exercise protocols and progressions to get the athlete to meet these criteria:

1. Full range of motion back into knee
2. Strength symmetry: Both legs should have similar strength levels, or 100% symmetry before return to competition.
3. Functional testing: Passing specific tests to assess readiness back into sport.
4. Psychological readiness: Confidence in the injured knee is crucial for a safe return. 

It takes about nine to 12 months of physical therapy and training after surgery to safely return to the field.

Yes, the recovery is long, but any physical therapist and athletic trainer will want to see a smooth and  gradual process with the athlete before clearing them to play.

They want to see readiness in sport-specific training and in plyometric drills, but they also want to see confidence in the athlete – someone who is ready to run or kick again without fear. 

A physical therapist will guide you through every step, physically and mentally.

Remember, each ACL injury is unique, and recovery times can vary. Always consult with a physical therapist to develop a personalized rehabilitation plan that suits your specific needs and goals.