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(Part 1) Athletes better understand the ACL

With ACL injuries on the rise and multiple teams in their Spring season dealing with this devasting injury, I think that it is important to shed some light on the injury.


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Thankfully science has come a long way, but it can still take away months from an athlete's career. Sadly, there is a rise in ACL injuries since 2020 especially in youth sports which I have taken note of especially in the sport of lacrosse. With Baltimore being such a hotbed for Lax it is very unfortunate to hear about athletes suffering this injury in potentially the most important part of their high school career as they hope to be recruited f


or college athletics.

“Knowledge is power”, or something along those lines – My intent is to provide you, the reader, with more information on the ACL and how we can better understand preventing the injury from happening to those we work with.



Anatomy 101 of the Anterior Cruciate Ligament:

The ACL is an important factor in the knee joint as it resists anterior tibial translation and rotational loads (per Physiopedia). In sport we need to consider that rotation is where many injuries of the ACL can occur. This, in part, is why we need to be cautious of twisting and hyperextension in the leg/knee.


Two Quick references that offer a good review of ACL injuries and can better provide information as it relates to this conversation:


a. Delayed ACL Surgery Appears To Increase Future Injury Risk in Young Athletes

Delayed ACL Surgery Appears To Increase Future Injury Risk in Young Athletes | University Hospitals (uhhospitals.org)


b. Why Are ACL Tears So Common? 4 Ways to Help Minimize Your Risk of Injury - Athletico

In my opinion, the biggest takeaway from this pretty simple article is MOVEMENT PATTERNS. Specifically, quality movements patterns as they relate to (1) the ends of the human and (2) the needs of the athlete. Both of which are relevant in that order.



For me, the two main points on which I place emphasis for my athletes:

1. Strength

It is incredibly important to provide the knee with as much support as possible. The muscles located around the knee joint are extremely important to keep strong and balanced to provide the knee with as much stability as possible. Strengthening the hamstrings, calves, quads, and glutes will provide better stability to the knee and may prevent injuries from happening.

Most clients I have worked with can greatly benefit from progressively strengthening the muscles of the hamstrings and glutes. Further discussion on exercises will be provided in later articles.

2. Quality Movement patterns

Sometimes athletes show poor movement patterns because they have been taught incorrectly, learned incorrectly, or just plan old and don’t understand how to move their body efficiently. An example of this can be applied to the athlete drop test.




As an athlete steps down or jumps off of a 6-10 inch box, when they land they must understand that their knees should not cave in (or “knee valgus). If the knees do, whether bi-lateral or unilaterally, there is a chance of injury. Some athletes, once they have been coached, can correct this poor movement pattern, and after 1 or 2 years immediately stop valgus. Other athletes may continue to show signs of valgus and cannot correct the poor movement pattern.


This is how I explain a movement pattern problem compared to a strength issue. If the athlete can correct the mistake (in this example for instance) then they have the strength and body awareness to correct the issue. If the athlete understands what is happening but cannot keep their knees from caving in, there is a strength issue. Since we identify this, we must focus on strengthening muscles specific to this test and their poor movement patterns which typically means glute max, glute med, abductors, etc.

The more competitive the athlete the more we need to consider the risk vs reward in changing any movement patterns. If we work with an athlete to prevent them from performing certain patterns, they are accustomed to doing in competition it could extend their playing career by reducing the risk of injury. However, it can also make them slower, prevent them from performing certain techniques they are accustomed to, and more but this must be considered specific to their needs as an athlete (it's not a one size fits all approach).


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As a follow-up to this article, I will provide several exercises which I implement with my athletes to address lower extremity injury prevention. These movements provide my clients with a reduced risk of injury although it is important to understand that injuries will happen in competition, especially in contact sports.

I also note, that I am not a doctor but this article is provided to help better understand the ACL and how important it is to athletes in sports. My team of PTs and performance coaches are always available for any athletes or coaches who are concerned about potential injuries or more information.