ACL Injuries - Can't See The Wood For The Trees

As part of my regular monthly column in Sports Injury Bulletin I was asked to review three studies that looked at risk factors associated with ACL injuries. 

1. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors Knee Surgery, Sports Traumatology, Arthroscopy 2009: 17 (7) 705-729   

2. Effects of Transverse and Frontal Plane Knee Laxity on Hip and Knee Neuromechanics During Drop Landings 2009: 37 (9) 1821-1830 American Journal of Sports Medicine   

3. The anterior cruciate ligament injury controversy: is ''valgus collapse'' a sex-specific mechanism? British Journal of Sports Medicine 2009: 43 (5) 328-335   

Whilst a significant amount of research has clearly gone into establishing the intrinsic and extrinsic risk factors associated with and contributing to ACL injuries I was left wondering whether we can't see the wood for the trees. Are we focusing too much attention on specific mechanisms of injury and missing an altogether simpler solution?   

Having waded through the data I came up with my own solution to this problem. The key message from me is to 'control the controllable'. As a coach working with athletes it's unlikely that you are going to able to control all of the intrinsic and extrinsic factors (joint laxity, valgus collapse, pre- and post-landing activation patterns etc.) that are outlined in the tome offered by our 3 studies.   

Forget thinking about this a male/female issue or worrying about intrinsic/extrinsic risk factors. Start thinking about improving your athlete's gross athleticism. Isolated prevention and rehabilitation strategies have limited use and are usually a poor attempt at shutting the gate after the horse has bolted. Develop a far more structured and all encompassing conditioning programme. My good friend and colleague, Duncan French, likes to make sure his athletes are "ROBUST AND READY" and I reckon if you just keep this simple phrase in mind you will be well on the way to injury free athletes.   

ACL's blow because fundamentally the musculoskeletal system can't cope with the demands being placed upon it. Working on these four elements will go a long way to reducing ACL injuries.   

1. Adopt a long-term approach to physical preparation. I believe both female and male athletes are highly skilled in their sport but often lack the physical competencies required to withstand the demands of their sport. Start conditioning early! 

2. Ensure that females incorporate strength training into their programme. Regardless of training levels, men are naturally stronger, so rather than avoid strength training women need to embrace it and get stronger. 

3. Ditch resistance machines and start training how your body was designed to move. Use free weights, barbells dumbbells medicine balls, bands etc. Get functional! 

4. Ensure your injury reduction programme includes rotational multidimensional training exercises and include elements of CHAOS in your training. Robert Dos Remedios has coined the term CHAOS training to reflect the open skills that he uses to develop the speed, strength and control in his athletes (in 10 years he has coached thousands of collegiate athletes and has only had 3 ACL injuries - 1 male, 2 female). That's a pretty impressive record if you ask me!

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