You are on the sideline watching your beautiful girl shoot down the field. She seems unstoppable! Dodging past one player and cutting past another. You see an opponent downfield starting to take an angled approach. In your mind you see it happen in slow motion. Your confident soccer player doesn’t notice the other player! She keeps pushing forward with the goal in mind. The other player goes low and strikes in at your girl. Then time freezes; they collide. Her knee is in a strange position. Time catches up and your little girl is on the field clutching her knee.
This is a story that happens all too often and it could end up in many different ways. Unfortunately, research is starting to demonstrate that our young athletes are ending this story with more and more serious knee injuries. The most common being ACL tears! It may not be preventable, but if your child participates in sports there is important information you need to know.
The ACL, or anterior cruciate ligament, is one of the important supportive ligaments on the inside of everyone’s knee. It prevents the lower leg bone (tibia) from sliding forward too far on the upper leg bone (femur). It also prevents too much extension and rotation of the knee. This is important as it protects the cushioning structures of the knee (menisci) from wear and tear. Alarmingly, the numbers of torn ACLs has increased steadily over the past 20 years in adolescents. These numbers have increased right alongside increased youth participation in organized sports. Youth risk for ACL injury increases sharply at the age of 12-13 in girls and 14-15 in boys. Girls can be 6 times more likely to injure their ACL than boys.
So why is this important? Typically, once torn, the ACL cannot repair itself. If it goes unrepaired then that person will have a significant loss of stability in their knee. Often times to the point of inability to participate in organized sports. The current solution for this is to have it repaired surgically. With surgery and rehabilitation, costs can be expensive ($20,000+) not including time lost from school, sports, and friends. Another sad consequence is that knees that have had an ACL injury, reguardless of surgery, are up to 10 times more likely to develop early arthritis as an adult.
The deck is not stacked well for adolescents in general for knee injuries. They are growing quickly and coordination is often behind the growth curve. Current body types are changing as our youth generally have higher BMIs than in years past. Many mechanical changes are occurring during puberty, and these are often more pronounced in girls earlier on. Pushing a changing body through more and more strenuous cutting, pivoting and jumping sports is taking its toll. The sports most commonly associated with ACL injury, especially in girls, are basketball, soccer and gymnastics; for boys it is football, lacrosse and soccer.
A true diagnosis requires specialized imaging with a Magnetic Resonance Image (MRI). The ACL cannot be seen on an Xray. There are some tests that can help point the medical professional in the direction of scanning for a torn ACL.
So the big question is, can anything be done to prevent your teen from tearing their ACL? Just stopping sports is usually not a good idea and can lead to overweight and depressed teens. However, being judicious about which and how many sports may not be a bad idea to reduce increased risk and exposure to injury (please remember that all sports, no matter how prepared, will put your youth at risk of injury). One other option that is showing some promise is Neuromuscular Training. Basically, specific drill type exercise that help to improve the body’s ability to react as well as learn safer movement patterns. This typically involves training with specific knee positioning in controlled environments. These also usually involve strengthening of specific muscle groups that protect the knee and leg in general. The current scientific evidence indicates that the most successful injury reduction programs are those that utilize movement pattern and strength training for both pre-season and in-season training. Some girl soccer player groups have shown risk reductions as much as 72% (for ages below 18 years).
Where can you find these kinds of services? Look to your local physical therapists! Especially those that work specifically with sports minded individuals and youth. Not all physical therapists are experts at everything. So just like looking for a house or car, choose the one that fits your needs, your style and your teen! Be sure to ask them about specific knee protection programs for your teen’s specific sport!
As always, if you have more questions, please comment below or use my “Ask A PT” forum. I would love to help your youth be as safe as possible on and off the field. Thanks for reading.