Saturday, September 20, 2008


ACL injury rehabilitation; conservatively or after reconstruction, is both difficult and time taking. It may take as long as a year before the athlete returns to competitive sports. For a athlete ACL injury is a shattering experience.

Anterior cruciate ligament (ACL) injuries are common in athletes participating in sports requiring jumping and pivoting maneuvers i.e. often during landing from a jump or making a lateral pivot while running where knee joint movement overcomes both the static and the dynamic constraint systems. 70% ACL injuries occur in non-contact situations. It is estimated that 80,000 anterior cruciate ligament (ACL) tears occur annually only in the United States. The highest occurrences are seen in the individuals 15 to 25 year age groups. Estimated treatment cost of treatment in ACL injuries of almost a billion dollars per year only in USA.

Few authorities have developed screening protocols for the identification of high-risk athletes. Potential risk factors such as Neuromuscular & biomechanical, hormonal, anatomic, and environmental factors have been extensively studied so that effective preventive strategies could be formulated. Studies on risk factors reveal that Interventions addressing neuromuscular factors appear particularly promising and further suggest that enhancing body control may decrease ACL injuries especially in women. Many clincians prefer dynamic neuromuscular analysis (DNA) based training as it is seen that Dynamic neuromuscular training has been shown to increase knee stability and decrease knee injury rates.

What is special about ACL injuries in females?

1. Numerous studies have found that female athletes who participate in jumping and pivoting sports are 4-6 times more likely to sustain ACL injury, than male athletes participating in the same sports.
2. Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury.

Neuromuscular & biomechanical aspects of ACL injuries:

1. Knee instability, due to ligament dominance (decreased medial-lateral neuromuscular control of the joint)
2. Quadriceps dominance (increased quadriceps recruitment and decreased hamstring recruitment and strength), and
3. Leg dominance (side-to-side differences in strength, flexibility, and coordination) are possible contributing factors to the increased incidence of knee injury in especially female athletes


Many studies conducted in USA recently results that balance and neuromuscular control play a central role in knee joint stability, protection and prevention of ACL injuries.
In a study on Croatian female athletes suggests:

Balance neuromuscular skills as measured by their balance index score using the Sport KAT 2000 testing system indicates a possible correlation between their balance index score and balance effectiveness. However training by this method may only help to develop simpler neuromuscular control.
But this method can monitor balance which can be used to estimate risk predictors in athletes who withdraw from sports due to injured or ruptured anterior cruciate ligament and to direct female athletes to more effective, targeted preventive interventions.

Formulating and executing the most reliable evidence based prophylactic training programs be introduced during athlete training, since the prevention of an initial injury will be more effective than prevention of injury recurrence. And further effort to reduce the risk of future injuries and thus prevent female athletes from withdrawing from sports prematurely.
Suggested resources:
1. Sports performance bulletin (to know the exact evidence based practical skill to prevent ACL injuries)

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