The Year of ACL Tears

In Injury Reduction by Chris Ritter0 Comments

This year in sports it seems as every few weeks there’s news of another athlete tearing their ACL. Whether it be during the NFL or NBA season, and it seemed to happen to a lot of talented athletes too. Just this weekend two players in the NBA suffered this injury.

After watching some playoff basketball I heard a few commentators blame the increase ACL injuries on the fact that this NBA season was shortened with so many back-to-back games. That the intensity of the schedule was just too much to take, even for a high conditioned athlete’s body.

Hearing misinformation always fires me up so I had to put together a blog post to address the truth. While the schedule density of the NBA this season may have been a contributing factor in some cases, I’m sad that most people see this as an inevitable injury with no type of protection outside of a knee brace.  For the most part this is a preventable injury, especially when it happens in a “non-contact” fashion.

An ACL injury doesn’t depend on how fit you are, or even how much you can squat. That’s why even the really “talented” athletes can experience this injury if they’re not doing the very specific but very simple training that can prevent it from happening.

This type of injury, one to your ACL, occurs when the upper leg and the lower twist in opposite directions. This results in the knee going in a pretty unnatural angle.

When looking at an injury the problem is rarely isolated to the point of actual trauma. I’m sure you’re already aware that the body is a kinetic chain. What happens in one area affects other areas of the body, even areas that aren’t close to it. Many muscles will work together to ensure quality movement and stability. One relationship of muscles is called the Lateral Sub-System, which involves muscles in the low back, hip and thigh.

On first glance it may not seem clear as to why this I would bring up this system of muscles to talk about an injury of the knee. All of these muscles are above the knee. Wouldn’t it make more sense if a group of muscles were directly above and below the knee? Actually I would argue the most important muscles in this picture that can help you prevent ACL injuries isn’t even directly responsible for the knee joint but rather the hip joint, and that’s the gluteus medius.

This small muscle is often very weak in most people due to lack of proper hip function, strength and flexibility. The gluteus medius helps to control hip movement, especially internal rotation of the hip. Another way to think of it is this muscle helps to concentrically externally rotate the hip.

If the hip internally rotates too much this causes a chain reaction down the rest of the leg. This really becomes a problem when the foot of that leg is planted into the ground. The force of the internal rotation can’t dissipate through the leg because the foot is stuck in one place. When this happens the knee is what takes the beating instead. The force of the twisting takes the knee through an abnormal range of motion and usually the ACL is ground-zero.

A lot of ACL injuries will be termed “non-contact” because the athlete simply jumped and came down, their knee rotated severely internally and the next thing you know they’re on the ground. I you’re having a hard time visualizing this injury check out the video below. Watch the girl’s knee as she makes a cut in the early part of the video and then watch how her other knee “caves in” when she plants to stop and the injury occurs. It’s clear that her hips are extremely weak and the glute medius isn’t able to properly control the internal rotation of the femur.

It’s a scary thing to watch but it happens all to often, whether it’s in the professional ranks or school-aged athletes. As I eluded to early this type of injury is preventable and I like to think that there are “warning signs” if you’re at greater risk for an ACL injury.

An obvious warning sign to everyone watching the video was that first cut and how the girl’s knee internally rotated so severely. If this happens to you or someone’s knee when you’re landing or cutting it’s an immediate sign that there’s dysfunction up the chain.

Another sign, that’s easy to miss, is having pain down the lateral part of your thigh or around the knee after running or being active. Unfortunately most people just zero in on the pain site and think it’s a problem with that immediate area. But it’s further up the chain.

I see clients all the time with this type of pain. And after taking them through an initial assessment it’s clear that their hips are weak, specifically in creating external rotation and resisting internal rotation – AKA – weak glute medius.

So now that you know what weakness to look for that may lead to an ACL injury and get started on strengthening your hips to stay injury-free. Just Google “ACL prevention programs/exercises” and you’ll see hundreds of results and many research articles as well backing up this position – that this can largely be prevented. Don’t think that because it’s happening so much this year that you can’t do something to prevent it.

Probably my favorite article on this topic is by Michael Boyle – ACL Injury Prevention Is Just Good Training. I follow a lot of what he lays out. And honestly I already slant my programs to include at least some hip work, specifically strengthening the external rotators because I know that most of the population walks into my doors with dysfunctional hips. It’s that important to me, whether you’ve had an ACL injury or not, I’m going to make sure that you’re hips get stronger.

Here are some specific exercises that I give athletes to strengthen weak hips.

X-Walk + Band – this is an activation exercise that I use to help people understand where there knee is and how to fire the right muscles to control the knee’s motion through what muscles in the hip are firing.

Assisted Single-leg Squat + Band – this exercise takes the activation further but integrating it into a more functional movement and allows you to strengthen your hips through a movement that you’ll encounter in most every sport and in life – stabilizing and moving on a single-leg.

Hop + 90 Twist – finally after you have activation and strength you can really take it to a dynamic movement. I tell people to emphasize the “sticking” part. I want you to act like a gymnast and have no movement from your hips down when you land. If it looks good then you’re on the right path to having bulletproof knees.

Try it out and remember that you now have the knowledge and power to keep your hips strong and your knees free of a non-contact ACL tear.