The Dreaded Cruciate
While, the events of Sunday September 5th 2010 are last year’s news at this stage and a new leaf has been turned in Tipperary hurling, they will live long in the memories of Tipperary people at home and abroad. From an injury perspective, the three weeks leading up to the final brought the previously little known but widely dreaded anterior cruciate ligament (ACL) injury to centre stage. Not since Tiger Woods’ knee injury or Michael Owen’s hamstrings has an injury generated such widespread discussion and speculation across all sections of society. People who had undergone surgery and rehabilitation for six months or more had wondered why they had bothered and conspiracy theories were more plentiful than this weeks election flyers.
So what is this ligament? What’s its function? Why does it get injured? What should one do if it does get injured, and most importantly, what can we do to prevent it getting injured?
Ligaments join bone to bone and so they contribute to the stability of joints. The ACL is one of the four main ligaments of the knee and it joins the tibia (leg bone) to the femur (thigh bone). It attaches to the front part of the flat top of the leg bone and goes upwards and backwards to attach to the bottom of the thigh bone above. Where it attaches is important because how it is positioned means that it stops the leg bone sliding forwards on the thigh bone, twisting too much on the thigh bone and also stops your knee from straightening too far.
A recent study on inter-county Gaelic football and hurling players shows that 12% of all injuries sustained were knee injuries. ACL injuries were the most severe in that players missed most time from sport with this injury.
The ACL is torn most commonly in people between the ages of 14-29 years, probably because it is during these years that people are most active in sport. Several studies across several sports show that females are much more prone to sustaining ACL injury than males. The reasons for this are not fully understood.
If the ACL tears, there are two ways to manage it. The first is surgery. This is usually done in cases where the individual is younger and wants to get back to participating in sports that involve twisting and turning. The surgeon replaces the ACL with a tendon, from under the kneecap or from the hamstring muscle group, and the athlete embarks on a long road of rehabilitation which can take from six months to a year depending on the sport.
The other option is to undergo intensive physiotherapy and to try to build up the muscles around the knee, especially the hamstrings, so that they can provide extra stability around the knee and compensate for the deficient cruciate. This is usually done in more sedentary people and while it avoids costly surgery, the individual is much more likely to develop osteoarthritis in the knee due to the instability.
ACL prevention programs are increasingly important in reducing both the occurrence of the injury and the costs involved in surgical management and rehabilitation to clubs. An example is the Santa Monica ACL prevention program which has been shown to reduce the injury in female soccer players. This program is a 15 minute training program done three times each week which focuses on different aspects of training. Programs need to incorporate warm up, stretching, strengthening, agility drills, balance work, plyometrics (jump training) and cool down.
It would be a wise move for all squads to incorporate this into training sessions, especially for sports such as hurling, football, soccer and basketball, and especially for female athletes!
For further information contact the chartered physiotherapists at Sportsplus Physiotherapy and Rehabilitation Clinic, Quintin’s Way, Nenagh. 067-42837.