As the number of female athletes increases, so do the number of anterior cruciate ligament (ACL) tears in the knee, prompting reconstruction surgery rates to rise three times faster in women. Miho J. Tanaka, MD, MGH’s new director of Women’s Sports Medicine, says these injuries often occur without collision and can happen when the knee gives out and buckles during a sporting maneuver. “It has been proven that you can reduce the rate of ACL tears in female athletes by performing certain neuromuscular training exercises.”
Unfortunately, such information on injury prevention is not well known amongst athletes and coaches. Tanaka hopes to deter statistics by spearheading a coordinated effort among physical therapists, surgeons, athletic trainers, coaches and doctors to provide a standardized, unified way of educating the community about preventative training. Here, she shares information about the program, and answers some common questions.
Why is an ACL injury so bad?
The ACL is one of the ligaments in the knee that provides stability to the knee joint, particularly during cutting and pivoting motions. If you think of the knee as a hinge joint, the ACL prevents the knee from “coming off the hinge.” An injury of the ACL is problematic because it can cause the knee to become unstable during these twisting and pivoting motions. Although people can walk without an intact ACL, the movements needed for sporting activities, such as sudden changes in direction, are difficult with an ACL tear.
Unfortunately, this is not an injury that heals on its own, leaving surgery and a long recovery as the primary options for treatment. Athletes who have ACL tears are generally out for a season and may not return to play for up to a year, and studies show that not everyone is able to return to the same level of performance after recovering from this injury, despite having successful surgery. It also has been shown that ACL injuries can lead to increased risk of arthritis and knee disability later in life.
Tell us about your goal to implement the ACL Preventative Training Program and make it standard of care.
Female athletes are four to eight times more likely to tear their ACL than male athletes, and imbalances in the muscles that support the knee can contribute to their rate of ACL injuries. The data shows that preventative training programs to correct these muscle imbalances can reduce injury rates, but they only work when implemented and performed regularly. Even though this is common knowledge amongst surgeons and physical therapists, the purpose is not served if athletes and coaches don’t have access to this information.
The concept of having surgeons or physicians working closely with physical therapists and athletic trainers to educate the community is key. The goal is to get the same important message to as many schools and sports clubs as possible. Part of this is making sure that female athletes and parents understand the importance of preventative training. The other part is helping to implement these programs, which involves building relationships with coaches and providing the information and support needed.
Through this program, we can provide workshops for coaches to learn how to teach and monitor these exercises for their players. We can provide information on the types of exercises that are helpful, how to perform them correctly and how to modify them as needed for players of different levels. This type of program can then be incorporated into a warmup routine in the team’s practice.
Is this program immediately available for patients?
Currently, patients can make an appointment with a sports physical therapist, where the physical therapist will perform an assessment of the athlete’s movement patterns. They will look for asymmetry, muscle imbalances, and abnormal movement patterns during jumping and cutting activities, which can predict risk for ACL injury. The PT can work with an athlete on correcting the patient’s specific deficits, through exercise training, drills and feedback. This sort of neuromuscular training involves not only strengthening and stretching, but also fine tunes the process of how your body controls function and movement. This can not only reduce injury risk but can also be helpful for improving sports performance. Understanding the mechanics of the body, how the knee and hip are positioned at the landing during these cutting and pivoting movements, is an important part of this training.