Anterior cruciate ligament (ACL) injuries are one of the most common knee injuries suffered by young athletes (and adults!). If you completely tear your ACL (in an injury like the ones described below) you can have surgery to repair the knee but this often results in the long-term consequence of osteoarthritis of the knee that could become very debilitating (ie. say goodbye to running, jumping, skiing etc).
While prevention can sound kind of boring (especially when we figure we’ll never get hurt)…simple warm-up exercises are being taught that could minimize the risk. The program (called PEP) was designed in California and is being used by soccer teams across North America. In our region, where skiing is a popular winter activity (that also holds a fairly high rate of ACL injury) the PEP program is being introduced in hopes that it will reduce the incidence of injury.
Some interesting facts to know about ACL injuries are that girls are more susceptible, (2-8x’s more susceptible). Not fair! But WHY?!! There are anatomical differences (ie. how women are built), for example, their pelvis shape and size can create a different angle of the leg/hip. Another is the knee shape, with women having a wider notch where the femur connects. The ACL can be thinner in women. There is often more laxity (or stretchiness..)
Then, let’s not forget HORMONES! Increased relaxin (aka a relaxer) hormone is present with estrogen, therefore, there is an increase in laxity during a girl’s period, putting them at greater risk during that time of the month.
Lastly, in terms of biomechanics and neuromuscular systems, girls may move different, often tentative and with the weight behind the centre of gravity, which leads to common ACL injury mechanism.
What does the ACL do?
It helps keep the tibia (lower leg) and femur (upper leg bone) in proper alignment relative to each other.
(see the series of images on the left)
How does the ACL actually get injured? (see the image below)
- ACL injury mechanism:
- 1)Knee < 30° Flexion
- 2)Valgus (Abduction)
- 3)External / Internal Rotation
Whether on land or snow, certain movements have a greater risk of injuring the ACL, such as:
- Landing from a jump
- Cutting/ changing direction quickly
The PEP program addresses the neuromuscular and biomechanical issues surrounding the ACL injury. Over the next several months, Maggie Phillips-Scarlett will be teaching soccer teams and ski teams in the Sea To Sky Corridor this specialized warm up as an initiative to decrease the incidence of ACL’s. She will be making the rounds of many teams and organizations in the next few months. If you would like to know more about this warm-up, please contact the clinic and we can put you in touch with Maggie.
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