Preventing and Treating ACL Injuries

There are many different injuries that happen to the muscles, ligaments and tendons in the body. Some are treatable and require surgery, while others may just be injuries from overuse.

The ligaments of the knee which connect the bones to each other are the most common part of the knee injured. The main ligament that is injured is the anterior cruciate ligament. The main purpose of this ligament is to resist anterior movement of the tibia or shin bone in relation to the femur when stress is applied. Here we cover different types of exercises for both preventing and treating ACL injuries.

How do knee injuries occur

A injury to a tendon, ligament, or joint could be due to participating in a stressful activity such as a contact sport like football, extreme sports, tennis, or skiing. It could also be or just from over use and it finally giving out due to a decrease in strength. 

In skiing the injury may come from the quick movements of the hips  as well as the downward force that is put on the femur when leaning forward. The side to side motion puts strain on the  ligaments located on the left and right side, while the other forces put strain on the front and back ligaments.  The knee has four main ligiments. These include the anterior and posterior cruciate ligaments, as well as the lateral and medial collateral ligaments.  These four ligaments work together to stabalize the knee joint in place. When the joint takes a direct blow with intense force, breakage can occur. The main ligament that is often injured is the anterior ligament, but any of them are suseptable to being injured. Here is a brief discription of the four ligaments and how they work.

Cruciate ligaments:

These ligaments attach to the femur and tibia. They are named from their relation to the tibia since the anterior ligament attaches to the anterior portion of the tibia, and the posterior ligament attaches to the posterior of the tibia. They lie deep within the knee joint and cross over in the middle.

The anterior cruciate ligament  connects to the anterior of the tibia and posterior of the femur. It’s purpose is to keep the tibia from sliding too far forward in relation to the femur.The poster cruciate ligament attaches to the posterior of the tibia and anterior of the femur. Its purpose is to keep the tibia from sliding too far backwards in relation to the femur. These ligaments balance forces placed on them. It is much more common to see an injury to the ACL since the PCL is much stronger. They also assist in helping you keep your balance.

Collateral ligaments

These ligaments absorb any force that comes from the inner or outer thigh latterly or medially. The more common injury to these ligaments is the medial ligament which deals with stress coming from the outer thigh.

The medial collateral ligament connects the thigh bone to the shin on the inside of the knee. It absorbs any shock or stress which comes from the outside of the knee. This is known as valgus stress.

The lateral collateral ligament connects the thigh bone to the shin on the outside of the knee. It absorbs any shock or force which comes from the inner knee. This is known as varus stress.

Wireless, TENS, EMS, TENS Unit, TENS therapy

Factors concerning treatment

The best way to deal with injuries is to prevent them from happening. Different exercises can strengthen these ligaments. A number of studies have been done on preventive measures for knee ligament injuries. Some were on general population, but most looked at the athletic population.

One main type of training given to decrease the chances of an injury occurring is neuromuscular training (2,3). Exercises involving balance and static stretching are important to decrease the chances of injury happening again(1). Differences in gender and prevention of acl injuries concerning non contact activities have also been looked at. Focusing on training, proprioception, strength, and agility drills as well as verbal feedback come into play when training to prevent an acl injury from occurring. (4,5).

Exercises used

The types of exercises used have a impact on preventing a second injury. In one study, young rugby players were looked at concerning movement capacity treatment options to assist in preventing a knee injury. A Functional movement screen was used. Exercises like the squat, leg raises, push ups, as well as shoulder mobility exercises were used.

Groups were separated into a contact group and a non contact group. Contact and non contact injuries were reported for one season. The test lasted a total of twelve weeks. Four weeks focused on mobility, four on stability, and the other four focused on integration. Results showed the intervention group increasing their scores on the screen tests given. Their injury rate was also lower. The improvement in movement capacity indicated these exercises as effective at decreasing the chances of another injury. (10)

Training and instruction

The types of exercises performed are not the only important factors involved in training to prevent an injury. Verbal feedback and psychological factors are also important. (11)  In one study three types of feedback were used to determine which showed the greatest improvement in retention of information and performance.  This included verbal external focus, verbal internal focus, video instructions, and a control group.

This study focused on landing technique. During the first week, instructions and feedback was given.  The participants were allowed to get as much feedback as needed. One week later, the same drills were performed with no instructions or feedback. From the four groups, the external focus group and the video instruction group showed the greatest improvement in landing technique. This suggest external focus as well as video instructions as being an important part of the rehabilitation and training process (9).

Level of experience

When you have an injury like an acl injury, the time it takes to return to play is also a factor.  This involves not only returning to play,  but possibly even the length of your career. For one study, a group of soccer players that had acl surgery were looked at. Upon being cleared to return to play, the majority of players were used as backups. These players also played in a less games as well. (7) This could be due to the coaches concern of a injury happening again.

The severity of the injury  is only one factor in the rehabilitation process. Age also plays a role as well. For example, there are many other variables involved in deciding if a younger athlete should have surgery or not. Even if surgery is un avoidable other factors should be considered as well. This includes things such as skeletal age, risks of growth disturbance, another rupture occurring, stiffness, infection, and even differences in individual responses to surgery (6). These are all major factors to be consider when you are having to treat a child for any severe physical injury.

Level of treatment

Different factors are looked at concerning ones progress in rehabilitation and their ability to return to normal activities. Shock absorbtion the knee is able to take is a variable that is looked at. This concerns the area that absorbs the majority of shock and its distribution from landing. This can be assessed doing a hop test, with coorelations between the hop test and isokinetic strength. (8) The main thing that you want to see as a result of this test is a decrease in the force put on the knee, with the hip absorbing more of the force upon landing (12). Other factors needed to be considered when rehabbing from an acl injury include things such as changeable movement patterns, neuromuscular training, and plyometrics. Personal changes should also be made concerning strengths or weaknesses of the individual being treated. (13)

When looking at preventing and treating acl injuries, many variables should be considered. This includes the types of exercises performed,  the persons age, as well as level of experience. The way in which instructions are given is even a important factor in seeing a increase in performance. Each of these are important in the prevention and treatment of a injury. In order to achieve optimal performance, each should be looked at. The focus may be different depending on the needs of the individual being treated. These measures for training can be used for preventing and treating acl injuries.