Alex Morgan. Megan Rapinoe. Ashlyn Harris. Ali Krieger. What do these women have in common? For one, they are all current members of the United States Women’s National Soccer Team participating in the 2019 World Cup. But for another, they are all current USWNT who have suffered an ACL injury during the course of their soccer career.
What in the ACL?!
The anterior cruciate ligament (or ACL) is one of the four major static stabilizing ligaments of the knee. The ACL, in particular, helps control the motion of the tibia (shin bone) from sliding forward on the femur (thigh bone). This ligament really is the key to keeping a knee stable while making movements such as pivoting and cutting.
Pop Heard Round the World (Cup)
So how do these injuries occur? Some ACL injuries occur through a contact mechanism–like a player slide tackling another player in the knee. That places a lot of stress on the joint and leaves a player vulnerable to potentially injuring the ACL via an external force. Despite the more traumatic look of a contact mechanism, most ACL injuries occur as a non-contact injury. This happens when an athlete makes a forceful cutting movement or lands at an awkward angle. This also puts a lot of stress on the joint, allowing for a potential injury to the ACL. Athletes will generally report a “popping” sensation in the knee when the ACL is ruptured. While the “pop” is one of the universal signs of an ACL injury, it is not always present. When the ligament is disrupted, it is extremely challenging (some may say impossible) to return back to a high level of competition comparable to a player’s prior level. Professional athletes generally need to undergo surgical intervention, followed by 6-12 months of intense physical therapy and sport-specific rehabilitation.
There have been a number of high-profile ACL injuries reported in the sports column recently (i.e. Klay Thompson, Reuben Foster). Since this injury is fairly common in men’s sports and men’s sports are far more popular than women’s sports, you may not realize that the females are 2-8 times more likely to injury their ACL. Why, you may ask? Studies outline a number of risk factors, but nearly every study has cited the female anatomy as a major factor in increasing our risk for incurring this disabling injury. As women, we have wider hips, innately putting our knees in stressed positions when we bend or land. Add that to the fact that we are seeing stronger, faster, and tougher female athletes, that stress is only increased. So what can we do about it?
- Practice GOOD landing mechanics. When doing functional exercises like squats or even plyometric exercises like box jumps, it is imperative to take note of your knees and how they track. Landing with a deeper bend in the knees, focusing on externally rotating the hips (pushing the knees away from one another), and keeping the knees over the toes, can help to reduce your risk of ACL injury.
- Get those hammies and glutes working. The muscles that comprise the posterior musculature of the lower extremity also play a huge role in stabilizing the knee joint and helping to protect the ACL. By strengthening the hamstrings and glutes, you are strengthening your dynamic stability at the knee. Those dynamic stabilizers (hamstrings and glutes) help to support the static stabilizers (ACL).
- Hydrate and eat well. This one may seem like a no brainer, but a healthy diet is so important not only to recovery, but to injury prevention, as well. When we are well-nourished and hydrated, our brain and neuromuscular system function better. Remembering good landing and running habits requires our neuromuscular system to be in tip-top shape, too.
Hopefully now when you see Megan, Alex, Ali, and Ashlyn representing the USA on the field, you will have an even greater respect for the intense work they have put in to get back to that dominating level of competition. ACL injuries are common and can be completely devastating. And while there is nothing to completely negate the risk of injury, there are some preventative strategies that can help. Call or visit exceltherapy.com to work with a physical therapist in helping prevent an ACL injury!
Brianne O'Connor, PT, DPT
Summit Clinic Director
Brianne graduated with honors from Columbia University with a Doctorate in Physical Therapy. Brianne developed an interest in physical therapy after suffering an ankle injury in college, which required extensive rehabilitation after surgery. It is this experience that drives her to encourage patients of all ages to strive for their best quality of life.