TACKLING ACL INJURIES AND THE ROLE STRIVE PLAYS
The old anterior cruciate ligament (ACL) injury. It’s one we’ve all heard of, or personally experienced. One that’s ruined seasons for our favorite athletes or sports organizations. We’ve seen it from the top of the professional ranks, all the way down to the high school athletes fighting for a roster spot. Odell Beckham, Breece Hall, and Catarina Macario have all experienced ACL injuries that have changed the trajectory of their careers in just the past year alone.
There’s no question that these types of injuries aren’t preventable. But at STRIVE we aim to provide athletes with a revolutionary tool that can help to lower the chances of such an injury. We’ll explain further below, but first a closer look:
The Injury:
Anterior cruciate ligament (ACL) injuries are typically caused by sudden and high impact movements (i.e. change of direction, pivoting, landing awkwardly, or stopping suddenly). In contact sports, it can also be caused by direct impact to the knee (approximately 75% of ACL injuries are non-contact according to Nathan Wetters journal article).
In most sports, proper muscle function is critical. ACL injuries can happen when making cuts, landing from jumps, or even when enduring hits from opposing players. Fatigue also plays a part, as muscle groups begin to function less efficiently when fatigue sets in. This in turn creates muscle imbalances, exposing ligaments to additional stress. If those ligaments don’t have the strength to handle it, injuries are more likely to happen.
The Muscles Involved:
- The most common injury mechanism is femoral adduction, internal rotation, and knee valgus (think of the knocked knee position). This can be caused by weak abductors (gluteus medius).
- The second most common mechanism of injury is hyperextension of the knee. This can be caused by over-dominant quadricep forces especially when the knee is extended (Yohei Shimokochi, J Athl Train (2008) 43 (4): 396–408.)
- Post ACL injury worries are mostly knee-based stabilization issues. In which the glutes, quadriceps and hamstring play major roles (the exact muscle groups STRIVE assesses).
Glutes, Quadriceps, Hamstrings Relationship to ACL
STRIVE technology allows you to get an inside peek into how your glutes, hamstrings, and quadriceps are working in unison. Preventing ACL injuries can boil down to improving stabilization in these muscle groups. Now let’s attempt to break this down by muscle group so that we can get a clearer picture:
- Glutes – the glute muscles and other adductors work to stabilize the leg. This prevents femoral adduction, internal rotations, and knee valgus. Strengthening an athlete’s ability to utilize these muscles as well as increasing their capacity for force can help safeguard against the most common etiology of ACL injuries.
- Quads – your quadriceps are among the largest and strongest muscles in your body. Each quad is a group of four muscles located at the front of your thigh. These four muscles work together to help you stand, walk, run, and move around with ease. They also keep your kneecap stable (https://www.healthline.com/health/quadriceps). When the knee is near full extension, quadricep contraction induces strain on the ACL.
- Hamstrings – hamstring activation can reduce anterior tibial translation by decreasing the load on the passive restraints of the knee, increasing knee joint compression, and stabilizing the knee in response to an external varus/valgus load.
The relationship between quadriceps and hamstrings and ACL injuries has been widely covered (for example: https://pubmed.ncbi.nlm.nih.gov/19124976/). In addition, during ACL rehabilitation athletes may be hesitant to activate their quadriceps, especially when their knee is near full extension. This can lead to a reduction in quad strength as has been studied by many research teams. Hyun-Jung Kim and his team as well as Christopher Ahmad and his team have both reviewed this phenomenon.
Using STRIVE:
Addressing stabilization. Stabilization is important in preventative measures against ACL injuries and can be an important performance indicator in return from injury. STRIVE has observed lack of glute activation control in athletes that are returning from knee and ankle injuries as well as healthy athletes.
How does measuring one’s glute activity aid in return from injury and/or prevention of injury?
Building the mind-muscle connection. With STRIVE, the practitioner can do exercises with stabilization components and show the athlete their muscle activity live in real-time. Being able to see an increase in activation in a tangible fashion as athletes do in the STRIVE app empowers the practitioner and the athlete to know what is effective and what is ineffective.
STRIVE also measures quadricep activation and can inform the practitioner if the athlete is hesitant to engage their quadricep and can be used as a teaching tool, showing the athlete with real-time data when they are engaging and when they are lacking engagement in their quadricep.
ACL injuries affect one limb, which makes symmetries a very good tool in evaluating compensation patterns that may occur pre or post injury. Being able to see the movement pattern for a healthy leg and an injured leg that are performing the same task can be a great way to detect compensation patterns and inform the practitioner on how to program rehabilitation, especially looking for quadricep and glute activation balance.
Rehabilitation Practices:
ACL rehabilitation programs usually focus on exercises that require knee bending: heel slides, cycling, squats, lunges, balance activities, three-way lunges, step ups, and step downs, just to name a few.
When the practitioner feels it is appropriate, the athlete moves to sport specific activities in the controlled environment, including: jumping, cutting, pivoting. Throughout the entire rehabilitation process, STRIVE can be used to detect any hesitations the athlete may have to utilize his or her major muscle groups as they did before the injury. And then comes the uncontrolled environment. An environment that was once not able to be monitored as closely, but where the practitioner can use STRIVE to daily monitor the athlete once they return to the field or court.
Learn more on how STRIVE can become an integral part of your training and let’s tackle the ACL and related injuries together.
