Anterior cruciate ligament (ACL) injury, long the bread and butter of therapists and the bane of athletes, especially females, is undergoing scrutiny because of the high rate of repeated injuries. As many as 25% of athletes suffer a repeated ACL tear and up to 55% of those who suffer an initial tear never return to their previous level of play (1,2). Researchers debate why the high prevalence of repeat injuries. One theory is that something besides the ACL controls tibial stability. Alicia Filley explores recent thinking on the anteriolateral ligament in the first of her series on ACL injuries. The ALL is an extra capsular ligament thought to contribute to limiting tibial external rotation (see figure 1). Some theorize that the prevalence of arthroscopic surgeries means that repairs are directed into the joint at the exclusion of extra-capsular structures like the ALL. This would explain why structurally sound ACL repairs have such high rates of post-repair laxity and repeated injury.
Another theory as to the high rate of recurrence of injury is that athletes return to play too soon or without adequate rehabilitation. In the second part of her series, Filley highlights some essentials of post-ACL repair rehab as well as explores the fundamentals of conservative management. One of the challenges in the acute phase post ACL injury, is activation of the vastus medialis obliquus (VMO) and attainment of full knee extension. In a recent publication, French physicians demonstrate an exercise approach that uses fatigue to inhibit the hamstring, and then facilitates contraction of the VMO with resulting terminal knee extension (see figures 2 and 3 and video 1). See full article here (4).
Figure 2: Hamstring fatigue
Figure 3: VMO faciliation
Video 1: Novel approach to facilitation of VMO
Another study, just released ahead of print, found that poor static balance, particularly postural sway in healthy female subjects, as measured by the amount that the center of gravity of the foot moves per second, was a risk factor for non-contact ACL injuries (4). If a risk factor in healthy subjects, how much more can one assume decreased balance is a risk factor in athletes post tear or repair? Therefore, to prevent re-injury, perturbation drills and proprioceptive training, such as those recommended by ACL rehab specialist Mick Hughes, are crucial in post ACL tear rehab before returning athletes to the playing field (see figure 4).
Running for sport is just as popular among young people as it is with adults. Up to 40% of children participate in running as a sport in some parts of the world(1). For youth in the US, running is the second most popular activity(1). As the popularity of running grows, so do the numbers of... MORE
Researchers continue to try to crack the code on the best way to manage a torn anterior cruciate ligament (ACL). In the Netherlands, sports scientists again tackled the issue by randomizing 167 volunteers with a torn ACL to either an immediate surgical repair group or a conservative rehab (with the option to repair after three... MORE
In 2021 the world will celebrate St. Patrick’s day a little differently. Because of the ongoing pandemic, parades and parties are cancelled. However, you’re still in luck! We’re sharing with you a research review usually only reserved for subscribers. This research review included in the March issue followed elite youth soccer players after an ACL... MORE
It’s been a year since most of the western world went into lockdown due the novel coronavirus’s arrival. Thankfully, science has progressed at a break-neck pace to develop treatments and vaccines as novel as the virus itself. Because of the progress in this area, some of life’s normal activities have returned, including organized sports. In... MORE
Successfully returning an athlete to sport following anterior cruciate ligament reconstruction (ACLR) poses an ongoing challenge for rehabilitation professionals. Jessica Montgomery discusses the role the rate of force development plays in return to sport and injury prevention and the modifications needed for younger athletes. 2012 South West England’s Holly Molesworth in action during the rugby... MORE
Percussion massage guns are gaining popularity among professional and recreational athletes and creeping into rehab clinics. Marketers claim that they improve performance, aid in recovery, promote relaxation, break up scar tissue, speed up healing, and more. However, a literature search reveals only two articles concerning the efficacy or use of these devices. The first is... MORE