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Preventing and recovering from ACL injuries by uncovering the true cause

Posted Sep 03 2010 9:46am

What causes ACL injuries?

That question has been asked and answered by thousands of people – both athletes who have had anterior cruciate ligament injuries and doctors, physical therapists, surgeons, and athletic trainers who have worked with athletes and studied these injuries. Let’s take a look at what we’ve learned from this.

A group of 21 specialists from around the country got together in 1999 in Hunt Valley Maryland with the goal of figuring out why ACL injuries occur and how to prevent them. These are some of their findings :

An estimated 80,000 ACL tears occur annually in the US.

The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports.

These injuries have an estimated cost of almost a billion dollars a year!

70% of ACL injuries occur in non-contact situations.

They said the risk factors these injuries fall into four categories: environmental, anatomic, hormonal, and biomechanical, with biomechanical being the most common factor.

Many training programs have been designed as “ACL injury risk reduction” programs, but do they really focus on the true cause and correct it?

What if they just pass the stress onto another joint structure or part of the body all together?

Here’s an example: This is a before picture of an “untrained athlete” performing a box jump. The website explains “This shows some of the predisposing problems that might lead to an ACL injury.  The 2 most notable are the upright landing position and the valgus alignment.”

Here is the same athlete following the 6 week training program. The website says “Notice the depth on landing and the more neutral position of the knees.”

But also notice that her feet are everted (turned out) severely in the “after” photo. What does that do for her ankle and foot? That position predisposes her to ankle sprains and fractures, stress fractures of the foot, and Achilles tendinitis. Is that a good thing? Is this athlete better off now?

Go back to the first photo and compare her right and left sides. What jumps out?

Her right leg is more valgus (knock-kneed) showing that hip is unstable predisposing her to injury on that side. She is also dropping her right shoulder forward and down in an attempt to help stabilize the unstable hip. This compensation could lead to a hip or low back injury or shoulder or neck issues.

Now compare her right and leg sides in the second photo. What jumps out?

Her right foot is more everted than her left meaning she still has a hip disparity and her right hip is still less stable still predisposing her to injury on that side. In the first photo her femur is internally rotating and in the second photo her femur is still internally rotated compared to her foot – same issue – same stress. And the same compensation pattern is present: she is still rotating her right shoulder forward and down.

Is this athlete better off now? I don’t think so. The same underlying dysfunctions are still present and this athlete is no more “functional” than before.

The problem with this and most training programs is that they work to improve the athletes strength, flexibility, agility and teach the athlete to focus on where their knees are and keeping them straight consciously. The problem with this is the underlying muscular and postural imbalances were never corrected. This means the athlete is no more functional and no less prone to injury than before – the injury might just show up somewhere else so it looks like the ACL prevention program worked! These training programs will end up strengthening the athletes imbalances leading to a less functional and more injury prone athlete over time. This is seen in high school, collegiate, and professional sports with the increasing number and severity of injuries even as athletes are stronger, more flexible, and increasingly agile each year.

What if we take the Egoscue approach to this athletes biomechanical issues? First, Egoscue remembers that the entire body works as a unit and must be treated as a group of interconnected load bearing joints with the bones, muscles, nerves, and ligaments linking it together. Second, Egoscue understands that any imbalances seen in posture are correctable because the body is a living organisms that responds to it’s environment. The goal is to realign the body to its original design blueprint where the athletes load joints are lined up vertically and at 90 degree angles to each other. This is done by a “menu” of Egoscue E-cises which promote functional muscle engagement without the use of drugs, surgery or manipulation. The result is an athlete who never has to think about how to move or jump and his or her body – because it is now posturally balanced – will automatically move with the correct joint alignment, muscle engagement, and proprioceptive response.

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