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Though basketball, soccer and football players are among the most common to injure their anterior cruciate ligaments (ACL), all athletes are at risk. Tears to the ACL can occur from contact or non-contact injuries. A strike to the side of the knee while making a football tackle can tear the ACL, as can sprinting, stopping, changing direction, pivoting, landing from a jump or overextending the knee.1
The ACL, which lies in the middle of the knee, prevents the tibia from sliding out in front of the femur. Once this ligament is torn, the athlete is advised to discontinue play until he is evaluated and treated. Before an evaluation of a serious knee injury takes place, the joint shouldn't be moved and a splint should be positioned to straighten the knee, according to The National Institutes of Health.
Rehabilitation professionals at Allegheny General Hospital (AGH) in Pittsburgh recognized that physical therapy and muscle building exercises can help to prevent ACL injury and regain joint motion and leg strength. So they designed an ACL injury prevention program to help participants improve lower-body strength, core stability, reaction times and balance.
"We hope we can turn the corner on an epidemic that has a lot of unanswered questions," says Craig Castor, ATC, supervisor of sports medicine in AGH's human motion rehabilitation program.
The Program's Progression
The ACL injury prevention program at AGH consists of sports medicine physicians, physical therapists and athletic trainers. Originally, the purpose of the program was to prevent injury. But health care providers are finding that patients who complete the program after an ACL tear leave better suited to reclaim an active lifestyle.
"Patients are also more confident to get back to participating in activities. With PT visits cut by insurance restrictions, this has become a good program for return to sport," says Castor.
Rachel Berg, PT, senior manager in AGH's Human Motion Rehabilitation program, says the program can prevent injury and promote health.
The program now includes return to sport training and functional training for people who have had ACL injuries or surgeries, with the goal of returning athletes to their sports as quickly and safely as possible, says Berg.
She notes that physical therapy and muscle-building exercises help prevent ACL injuries. Health care providers in the human motion rehab program teach patients better jump mechanics and landing techniques, along with single-leg strengthening and balance/proprioception. They also work on core and lower-extremity strengthening, especially hamstrings.
"We instruct clients in appropriate active warm-ups and do a lot of single-leg strengthening activities," she says.
Female athletes are reportedly 4 to 6 times more likely to sustain a sports-related non-contact ACL injury than male athletes.2 Berg notes several theories for this frequency.
• When jumping, girls tend to land with straighter knees than boys.
• Girls have a larger Q angle (the angle between the femur and the tibia). The average Q angle in women is 17 degrees, compared with 14 degrees in men.
• Hormonal influences in women and girls may cause increased ligamentous laxity.
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