ACL Series: From Rehab to Risk Reduction

Annually in the US alone there are over 80,000 ACL tears occurring primarily in athletes 15-25 years of age that participate in sports that require aggressive pivot based movements (Griffin, 2000). In the past 12 years we have had over 3000 female athletes come through our program, and in that time we have seen 11 ACL tears. Although individually tragic, we consider these numbers to be somewhat of a success.

This report will take a look into the research on ACL prevention programs and compare it to programs that we have implemented over the last 12 years. We will then propose a new program designed to parallel the rehabilitation process and return the athlete to confident athletic play.

So let’s put this topic under the microscope and learn a little more about the causes and prevention strategies currently in place to combat an injury that seems to be at the forefront of women’s sports performance training.

First, a look at our demographics:

This graph from 2007 gives a pretty clear picture of our demographics. We currently are at approximately 87% female athletes with 90% of them coming from Soccer, Volleyball and Basketball (the top 3 sports for ACL tears).  And we train between 200 and 300 girls per season, in 1-2 day a week training programs.

In 2005 we did a study that looked at the frequency of ACL tears in female soccer players in our region. We surveyed 29 High School teams and 33 Club teams to record the occurrence of ACL injuries within their teams. From 2003 to 2004 the number of ACL injuries occurring during the High School season increased to 1 in every 26 girls, and 1 in every 110 girls during the Club season.

In comparison to these statistics, athletes with a training history in our program had an ACL tear at the rate of 1 in every 272 girls. So with these statistics, our girls were 10x less likely to tear their ACL than those who played High School soccer, and did not have a training history with our program.

Here is my point. ACL injuries are going to happen, and there is no way to prevent this. We can try, and we can reduce the risk, but when you work with as many clients, in as many high-risk sports as we do, you tend to be right in the middle of the perfect storm of negative factors. One study (Nelson, 2000) outlines the risk factors for these injuries as coming from four main categories: environmental, anatomic, hormonal, and biomechanical. With this being said, we looked a little deeper at the 11 injuries we have seen.

Here are some of the initial observations that we have made on those 11 girls.

  1. 7 of the 11 injuries were contact based (difficult to prevent this situation)
  2. 3 of the non-contact injuries were on turf fields (foot caught in turf)
  3. None of them were training with us consistently at the time of the injury and more than half of them were inconsistent in training prior to injury
  4. 6 of the 11 were identified as “At Risk” (tuck jump & hop and stop tests – see video below from our plyometric eBook: Athletic Strength Foundations

It is difficult, if not impossible, prepare individuals against the environmental factors (turf, wet ground, contact, etc.), the hormonal factors and the anatomic / genetic factors (small notch, female cycle, etc.), but we have spent the last 10 years researching this injury and developing programming that reduces the risk while also improving performance by focusing on the biomechanical / neuromuscular factors. A duel-focused program like this seems to have a much higher adherence ratio than program solely focused on risk reduction.

This report is an outline of the research, the identification of neuromuscular / biomechanical risk factors associated both rehabilitation and return to sport. It also includes an outline of our training progressions and suggested integration of such a program into a sports performance-training environment.

As you will see, this epidemic is far too complex to be addressed by one or two corrective exercises placed into a warm up, or trained during a short pre-season phase. To make a lasting impact and to effectively reduce the risk of injury over time, the training must become rehabilitative and the rehabilitation must be training oriented.

This is the first post of our ACL Series on how we reduce the risk of injury and return athletes to confident play after an injury. For more information on our plyometric program CLICK HERE

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