Why Are We Seeing An Increase In ACL Tears Each Year If Our Training Has Improved??
Why Are We Seeing An Increase In ACL Tears Each Year??
So what exactly is the ACL? We all have heard of it and we know it is a ligament in the knee. We know you never want to hear someone say, “You tore your ACL”. We also know that it normally requires surgery to fix and involves a long rehabilitation though physical therapy. But why does this injury occur and why are we hearing more about them every year?
First, I think we need to take a moment to get a little more understanding of knee function and what supporting structures help stabilize the knee joint. The primary function of the muscles surrounding the knee is to provide flexion and extension of the joint; it also has the capability for slight rotation, but this is very minimal and normally not discussed in most text.
Muscle is defined as a band or bundle of fibrous tissue in a human or animal body that has the ability to contract to produce a particular movement. There are 4 main muscles in the front thigh area, called the quads, which are responsible for extending the knee. They attach at the kneecap to form a tendon that then attaches to the front portion of the shin bone (tibia). A tendon is defined as a flexible but inelastic cord of strong fibrous collagen tissue attaching a muscle to a bone.
There are three main muscles called the hamstrings that flex the knee. These three muscles are located on the back of the upper leg and extend down to their tendons on the backside of the knee. There are other smaller muscles, tendons, and connective tissue that collectively surround and make up the knee joint but are not relevant for this article to discuss; just be aware of them if you would like to do more extensive research.
There are four main stabilizing ligaments in the knee joint. A ligament is defined as a short band of tough, flexible, fibrous connective tissue that connects two bones or cartilages or holds together a joint. The ACL or Anterior Cruciate Ligaments (also called the cranial cruciate ligament) main function is to stabilize the shin bone (tibia) from going forward. The PCL or Posterior Cruciate Ligaments main function is to keep the tibia from gliding backward. Both of these ligaments are found in the middle of the knee joint and form an “X”like pattern in the joint.
There is also a ligament on each side of the knee joint. The LCL or Lateral Collateral Ligament is located on the outer side of the knee joint. The MCL or Medial Collateral Ligament is located on the inner side of the knee joint. Each of these help prevent the knee from either caving in or out while performing movement. All of the ligaments, tendons, and muscles work too not only create movement but to stabilize the knee.
The bones of the knee joint are made up of the Femur (upper Thigh Bone), Tibia (Lower Shin Bone), Fibula (Lower leg bone positioned laterally to the tibia), and the patella (knee cap). Between the bones are menisci (plural for meniscus). The meniscus are small “c” shaped pieces of cartilage that act as a cushions in the knee joint. They sit between the femur and the tibia, one on the outside (lateral meniscus) and one on the inside of the knee (medial meniscus).
It is important to know and understand these structures, how they work, and their functions if you truly want to learn how to prevent injuries. I have always thought that if you do not educate yourself about the body, how can you prescribe a training regimen to prevent injuries to the various areas of the body. If you do not know, then you should always seek out the trained professionals with a proven track record for advice and guidance.
In todays training society, being as advanced as it is, with more strength coaches training athletes with weights than ever before. Why is the number of ACL tears increasing every year? Yes, there are many hypotheses for this and I really have not come across any that I would completely rule out; maybe it is combination of reasons? However there is one thought process I have had for a few years now. One I have not heard anyone discuss before as a possible contributor. As the number of ACL tears increase each year, so does the belief that my thoughts on the issue may be correct.
I truly want to share my thoughts with as many individuals as I can so we can try to change some training thoughts to turn this whole thing around and save some knees in the process!
What is the one thing we see our youth of today doing more than ever before in the history of mankind. Wow, that is a bold statement; but when I tell you, I think you will agree right away.
Our youth today SIT more than ever before!!
Our youth today SIT more than ever before. Think about it, they go to school and sit most of the day, maybe go to practice after school and then come home and sit-talking on the phone, texting, watching TV, playing video games, or face booking on the computer all night.
It is my belief that because of this we are seeing our young peoples hip flexors starting to shorten. Ten years ago, the biggest muscle weakness or imbalance I would access on incoming freshmen athletes to college was hamstring weakness compared to their quad strength. Today that is not the case. I now see more glute weaknesses or even the inability to adequately fire their glutes during exercise or movement and their hip flexors are extremely tight. Most of them cannot lie on their stomach and lift a leg off the floor without their pelvis rotating.
This is sad, because the most powerful muscles in the lower body for an athlete should be their glutes. So what does this have to do with tearing their ACL? It is my belief that if the hip flexor is shortening over time that there is a direct relationship of the glutes being inhibited resulting in less excitation or lack of stimulation during movements when the glutes should be more of a dominate or prime mover. Again, what does this have to do with ACL tears?
If the glutes are not a dominant muscle going into and out of athletic movements then the dominance will be on the quads. The majority of non-contact ACL tears occur when an athlete is sprinting forward, they go to change direction and the dreaded “POP” occurs.
Lets use this example, a lacrosse player is sprinting down the field and quickly has to head to the left, he/she will normally plant on the right foot and drive towards the left. Understand that in any movement there will be a level of deceleration to acceleration properties that take place. If the athlete is Quad dominate and we know that the quads and their tendons (patellar tendon) attach to the front of the tibia, then those quads will be firing and pulling on that tibia to continue forward as slight rotation will occur to change the direction. These two factors will place that direct stress right on the ACL to keep the tibia from gliding forward. This overload can potentially be too much causing something to give.
Now take that same scenario with an athlete who has good glute activation. If the glutes are the primary decelerator to accelerator (which they should be!) there will be minimal pull to the front of the tibia, which will result in less overload being placed directly on the ACL to manage. The forward translation (angle) of the knee will also be decreased; as a result, the athlete will be faster and move into an accelerated position much more fluidly and with greater speed.
The best way to acquire this is by re-educating the glutes to be primary movers in the lower body. The ultimate way to do this is through deceleration training. Many strength coaches will agree that in order to maximize acceleration you must first master deceleration. The key is learning how to do this systematically with the entire emphasis being placed on the glutes with the expectation that once athletes are trained properly, this firing process with the glutes will come automatically during sport.
I have spent years trying to perfect a simple solution to deceleration training techniques for coaches to implement into their teams current training programs. What I came up with is “Deceleration Training To Prevent ACL Tears.”With the help from Jedd Johnson (Diesel Crew), we were able to make this information attainable to everyone. This systematic approach has been used for 8+ years with outstanding results. I really believe this is a crucial step in reducing and many times preventing ACL tears in athletic programs.
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Hope this helps!
To your health,