How to Prevent ACL Tears in Young Athletes.

Young athletes know that sports injuries can quickly derail their competitive season. As kids increasingly specialize in one sport year-round—and at a younger age—the incidences of injury are rising. This is especially true for ACL tears, which are common knee injuries that occur in middle school and high school athletes. A torn ACL often requires surgery and up to a year for full recovery, which is why ACL injury prevention is important. Coaches, parents, and athletes can minimize the risk of an ACL injury by ensuring a proactive and balanced approach to training. 

What is an ACL injury?

The anterior cruciate ligament (ACL) is one of four small but important ligaments in the knee that are essential for stability, especially while playing sports. The ACL connects the shin bone (tibia) to the thigh bone (femur), working to prevent the shin bone from sliding forward and the knee from abnormal rotation. The fibrous band of tissue is what allows the body to safely run, pivot, and land a jump.

A sudden change in direction or an awkward take off or landing from a jump may cause you to plant your foot and over-rotate your knee, resulting in a torn ACL. This can be life-altering as a young athlete, as treatment typically involves surgery and recovery lasts 9 to 12 months. While the injury is physically painful, it can also take a toll on a young athlete's mental health as they feel left out from the team or worse—the injury could affect aspirations of playing at the collegiate level. Left untreated, a torn ACL can also lead to other injuries in nearby ligaments and meniscus. Long-term, individuals who suffer ACL tears are more likely to develop early-onset degenerative knee osteoarthritis, which may lead to chronic pain.

Symptoms of a torn ACL.

Many ACL injuries occur in athletes who play sports that involve sharp pivots, such as basketball, football, lacrosse, skiing, and soccer. While ACL tears are frequently sports-related injuries, they can also occur more subtly while walking. Many people with a torn ACL feel or hear a "popping" sensation in the knee at the time of the injury and feel immediate pain and swelling. Aside from discomfort, an ACL tear may limit your range of motion and stability which makes it hard to walk, run, or jump.

Female athletes are at the greatest risk of experiencing ACL injuries.

Young, female athletes are two to eight more times as likely to experience an ACL tear than their male peers. There's no one reason for this, but it may be attributed to their biology, as estrogen can loosen ligaments. Muscular imbalances are also common in girls. If an athlete's quadriceps muscles are stronger than their hamstring muscles, they may be more susceptible to injury.

Preventing ACL tears.

From 1994 to 2006, there was a 924 percent increase in ACL reconstruction in kids under 15, and the number of young athletes injuring their ACL continues to rise. It's a serious concern for kids hitting puberty who will need their knee joint to function for decades beyond their competitive season. The incidence rates are significantly higher today because we have more awareness of ACL injuries in adolescence, but it's also because there are more children playing organized, high-demand sports at an early age. 

For that reason, there is a lot of research on ACL injury prevention underway, and the good news is that we know there are proven ways to lower the risk of an ACL tear.

Proactive training programs strengthen and balance the lower body.

Specific plyometric and strengthening exercises can help athletes retrain their muscles to fire in sync, and there are a variety of free programs available. For example, FIFA 11+ is a free ACL injury prevention program designed to help players and teams reduce their risk of injury. The 20-minute warm-up program involves running, jumping, strength, and balance exercises, including exercises that help athletes practice landing skills, like landing softly. The stretching exercises are proven to be effective, as studies show 45 percent reduced injury rates in competitive soccer players.

Encourage kids to cross-train and play a variety of sports.

Athletes who play a single competitive sport year-round are at a greater risk for experiencing an ACL tear. If you only train one way, you may be neglecting other muscle groups involved in pivoting, running, and jumping. That's why it's so important to cross-train, which is a term that refers to exercising in a variety of ways outside of your main sport.

Most professional athletes were multi-sport athletes as adolescents and advanced to an elite level because they stayed injury-free. When you incorporate strength training, swimming, cycling, or other types of athletic activities into your regimen, you keep muscle groups balanced and strong which can lead to better, safer performance. 

A healthy lifestyle can lower the risk of injury.

Staying healthy is always key to preventing any injury. As a young athlete, it's important not to restrict calories because a deficit can make it hard for your muscles to recover. A well-balanced diet that incorporates a variety of fresh fruit, vegetables, protein, and carbohydrates will ensure your body has what it needs to heal after an intense practice or game. Likewise, maintaining a healthy weight and good cardiovascular health will help you to be conditioned and prevent ACL injuries.

Don't rush recovery.

ACL tears can't always be prevented, and if you need treatment, ACL reconstruction is an effective way to replace the torn ligament and get back to your sport—in time. It can be hard to sit on the sidelines after surgery, but returning to your sport too soon significantly increases the risk of a re-tear. Most adolescents need nine to twelve months to fully recover and get back into competition.

Take the time to cross-train, whether that's distance running or weight training. The work you put into your health will pay off when you return to your sport injury-free. While you can't participate in practice or a game during recovery, I encourage my patients to attend team practices and events so they can be around the team and benefit from the camaraderie.