Research Spotlight: ACL Injuries & The Value of Injury Prevention Programs

“National Athletic Trainers’ Association Position Statement: Prevention of Anterior Cruciate Ligament Injury.” Journal of Athletic Training. January 2018

In the January 2018 issue of the Journal of Athletic Training, the NATA published their position statement on Prevention of Anterior Cruciate Ligament Injury. The intent of the publication is to provide athletic trainers, physical therapists, physicians, and fitness professionals the most accurate and up to date evidence-based recommendations for ACL injury prevention. What follows is a review of some of the key topics from this paper.

You might be wondering, “Why is this important?” Well, consider the following:

  • Lower extremity injuries make up about 66% of sports-related injuries and the most commonly injured joint is the knee.

  • >250,000 ACL tears are estimated annually in the United States alone, with approximately 100,000 reconstructions per year.

  • ACL injury is common in sports that require a lot of jumping, pivoting, and change of direction such as soccer, basketball, and volleyball.

  • ACL injury is particularly common in young, female athletes and research suggests that the rate of ACL injury in females is 3-5 times greater than that of their male counterparts.

  • Most ACL injuries are non-contact, where there is no direct trauma to the knee but instead involves uncontrolled lower extremity biomechanics.

  • It is estimated that the long-term societal costs may be close to $38,000 per patient.

Research has shown that a multi-modal preventative training program can reduce injury rates. While there is no single Holy Grail program that is shown to be better than all others, it is recommended that programs address areas of strength, agility, balance, plyometrics, and flexibility. Additionally, feedback on form and techniques are also vitally important.

An important distinction to make at this time is that we can not prevent 100% of injuries from occurring. Rather than follow suite with the use of “injury prevention” program, we generally like to use the term “injury reduction” program. It may seem like semantics, but the reality is when we look at most of the research available what is being reported on is injury rates and the ability to decrease the number of injuries that occur over a season.

I'm sure it will come as no surprise that this is a huge topic and has a lot of interrelated areas to consider and discuss. For the sake of this discussion, we are going to briefly highlight 3 questions:

  1. What are the benefits of an ACL injury prevention training program?

  2. Who would benefit from this type of injury prevention training program?

  3. What are the components of a good ACL injury prevention program?

"An inverse dose response has been shown between preventive training programs and ACL injury rates (ie, increased dosage was associated with decreased ACL injury rates). The dosage may be influenced by both the volume and intensity of training."

What Are The Benefits Of An ACL Injury Prevention Training Program?

Based on the available literature, the implementation of an ACL injury prevention program can have two potential benefits: a decreased risk of ACL & other knee injuries and improved performance.

Multi-modal training programs are recommended to reduce the number of non-contact and indirect-contract ACL injuries in sport and physical activity. They are also recommended to reduce the number of non-contact and indirect-contact knee injuries other than ACL. Improved lower extremity biomechanics, improved muscle activation, and decreased impact forces upon landing are but a few of the benefits resulting from participation in an ACL injury prevention program. ACL injury prevention programs have been reported to reduced injury by 50-75%.

Improvements in functional performance are also seen as a result of participation in an ACL injury prevention program. Studies have shown improvements in measures of vertical jump, broad jump, hop speed, sprint speed, & estimated Vo2max. Longer duration programs have also shown improvements in lower extremity strength.

Who Would Benefit From This Type Of Injury Prevention Training Program?

It is prudent to recommend that all individuals engaging in sport or physical activity should participate in a multi-modal injury prevention program. There are, however, certain sports and demographics which are more prone to ACL and other lower extremity injuries. These are the groups that should be targeted more aggressively for implementation of an injury prevention program, as they are the ones with the greatest relative risk of injury. Conversely, they are also the ones who show the greatest effectiveness of the interventions.

The following individuals are the ideal candidates for an ACL injury prevention program are:

  • Female athletes ages 12 - 18 years old: These athletes have shown a 2x - 5x greater risk of ACL injury than their male counterparts.

  • Athletes participating in high-risk sports that require jumping, landing, cutting/fast change of direction: The high school sport with the most ACL injuries for male athletes is football. The high school sports with the most ACL injuries for female athletes are soccer, basketball, softball, & volleyball. Downhill skiing also has high rate of ACL injury.

  • Individuals who have already suffered an ACL or other lower extremity injury: The greatest predictor of future injury is a history of previous injury. Individuals who have had an ACL injury or reconstructive surgery are STRONGLY encouraged to participate in such a program, particularly as they return to their sport or activity. ** It is also imperative that a full rehabilitation program has been completed with emphasis on strength & conditioning BEFORE the athlete is cleared to return to play. Too often we see athletes who have been cleared to play but are still having pain, deficits in range of motion, strength, and neuromuscular control. In some cases we are fortunate to have these athletes or their parents seek us out and work to correct these issues before an injury occurs. In some less fortunate cases, we see these athletes after they sustain a second injury or surgery and we are generally sought out because they want to get it right this time!

  • Children engaging in high-risk sports: developing a solid foundation and working to train fundamental movement patterns and neuromuscular control may aid in helping these athletes as they mature and work their way into high levels of competition.

Injury Prevention And Sports Performance Training

At Empower Fitness & Performance, we have a number of options for athletes to get the training they need to stay healthy and succeed in their sport. Our Sports Performance Training sessions incorporates these various aspects of injury prevention - strength, balance & neuromuscular control, agility, plyometrics, flexibility - into our programming for each athlete based on their specific individualize needs. In addition, we will be adding a group injury prevention class where athletes can participate in a program with increased frequency (which has been shown to improve rate of injury risk reduction), and allow those athletes who are not currently in our Sports Performance Training Program to get this vitally important training. If you would like more information on our Sports Performance Training Program or Injury Prevention class, please fill out this contact form:

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