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ABCs of ACL injuries

With proper training, the common tear might be prevented

August 15, 2011|By TAYLOR ECKEL | taylor.eckel@herald-mail.com
  • Sterling Christy, 15, has a physical therapy session at the Tri-Stage Rehab Inc. Christy is recovering from an ACL injury that occurred during his first varsity basketball game last season.
By Chris Tilley/Staff Photographer

Sterling Christy's varsity basketball debut ended with eight seconds left in the game.

His team, Williamsport High School, was winning when he tangled with a Brunswick player.

"He grabbed me by my shoulders and twisted me down," Sterling said. "My leg got caught in his, and I felt it pop."

The "pop" Sterling felt is the hallmark of an anterior cruciate ligament (ACL) tear, an injury that is far too familiar to many high school coaches and athletes. ACL injuries can be caused by contact with an opponent or when an athlete lands from a jump, stops or changes direction with bad form.

"The (ACL) injury rate for a girl in high school athletics is one in eight, and in guys it's one in 12," said Roberta Rothen, a board certified orthopedic surgeon at The Center for Joint Surgery and Sports Medicine.

Basketball, soccer, football and skiing are all high-risk sports for ACL injuries, but they can also occur in sports such as lacrosse, volleyball and tennis.

"The anterior cruciate ligament is one of the four ligaments of the knee," said Barry Brown, a physical therapist and owner of Tri-State Rehab. "It connects the femur, which is the thigh bone, to the tibia, the bone of the lower leg. It is a very important structure in that it provides stability and prevents the knee from buckling, particularly during cutting and landing from jumping."

Fortunately for athletes, there are ways to minimize the risk of injury. Proper technique, a well-rounded strength and conditioning program, and good body mechanics can all minimize the risk of ACL injuries.

"In an ideal situation, a young athlete that's involved in these types of sports would be in a year-round conditioning program that would also be an ACL-prevention program," Brown said.

Rothen and Brown both stressed the importance of incorporating "jump training" exercises into athletes' conditioning programs.

Rothen described "jump training" as "learning how to jump and land with a bent knee. When you land, you're not landing like a clod-hopper or a Clydesdale."

Brown suggests "jump training" include jumping and hopping forward, backward, side-to-side, and diagonally. He said it is crucial that athletes make sure they are using good form — landing with their knees and hip flexed and making sure that their knees do not cave inward in a knock-kneed fashion.

"(Jump training) substantially reduces injury and increases vertical jump," said Laura Blair, a physical therapist at the Center for Joint Surgery and Sports Medicine.

Blair also emphasized the importance of core strengthening for athletes.

Les Dutko, the athletic trainer at St. James School, said it is essential that athletes have good endurance and a balance in strength between their quadriceps muscles (the front of the thigh) and the hamstring muscles (back of the thigh).

"A lot of (ACLs) are torn in the end of the game, when they're tired," he said.

Rothen agrees. "As your quads start fatiguing, you're more at risk," she said.

Brown suggests that athletes not compete in multiple leagues at a time or play competitively year-round, and said it is very important that all conditioning programs begin with a warm-up that is followed by stretching.

"It's very similar to a young developing pitcher," he explained. "Don't overuse your body. Take a break to work on strengthening and conditioning. Work on your core. Cross-training and taking a break can, in my opinion, prevent some of these unfortunate injuries."

Once an athlete has torn his ACL, surgery is generally the only option, but the prognosis for recovery is excellent.

"The overwhelming majority can't return to pivot sports without surgery," Rothen said. She said the average recovery time is six months to a year.

"Whenever a young person who has torn an ACL comes in, I let them know that it is a tremendous amount of work, but they will be back," Brown said. "There are no shortcuts."

Sterling, a rising sophomore, said he had surgery in March to reconstruct an ACL from part of his hamstring tendon and he is scheduled to return to sports sometime between October and December of this year. He said the physical therapy has been a lot harder than he expected, but he believes the experience will help him push himself when he returns to basketball.

"It will be easier to work during practices for basketball," he said.



Preventing ACL injuries

There are several low- or no-cost ACL injury prevention programs available for athletes.

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