How to NOT rupture your ACL

Why is it that an athlete can perform the same change of direction and twisting type motion a thousand times during a season and then the thousand and first time they do that exact same motion, they rupture their ACL? 

Why is it that even with the best prevention programs in place in elite sports such as AFL, the incidence of ACL rupture is increasing (3 ruptures within Round 1 of the 2019 Mens AFL season)? 

Unfortunately, science does not yet have a solid answer. However, we do know that there are both modifiable and non-modifiable factors that can increase your risk of ACL rupture. Perhaps as health professionals we should be focusing our attention on how NOT to rupture your ACL instead of just rehabilitation after it has already happened. 

ACL injuries can be REDUCED by 50% with a 30-minute neuromuscular program per week (Finch et al. 2016). Even better, the 30 minutes can be broken down into 10-minute blocks before trainings and games and still have the same effect. At the end of the day what is 10 minutes compared to 12 months off? There are specific programs that have been developed for soccer, AFL and netball with free and easy to follow exercises: 

• FIFA 11+ 
• AFL Footy First 
• Netball Knee 

Neuromuscular programs are programs designed to improve the strength, flexibility, control, balance and coordination of athletes and should include agility, balance and plyometrics based exercises (Ayala et al. 2017).  

This may include exercises such as: 

• Planks and side-planks 
• Nordic Hamstring curls 
• Walking lunge with rotation
• Stationary and dynamic ball passing/catching drills at different angles standing or landing on one leg 
• Side-to-side and forwards-backwards hopping and jumping with focus on soft and controlled landings 
• Zig-zag running and side-stepping 
• Bounding 
• Unanticipated change of direction with attacker/defender drills 
• Jumping/hopping with partner push or bumps whilst in the air 
  
  

Not only do we know that these programs reduce the risk of ACL injury, they also reduce ankle injuries by 40% and all other lower limb injuries by 22% (Grimm et al. 2016). 

There are also some non-modifiable factors which place some athletes at high-risk of ACL rupture, and these individuals need to be identified during pre-season screening and be required to participate in such programs. This includes: 

• 14-18 year olds and males 19-25 year old (Sanders et al. 2016) 
• Players with a past history of ACL injury (Morgan et al. 2016) 
• Those with a family history of ACL injury (mother or father) (Smith et al. 2012) 
• Female athletes partly attributed to hormonal changes during the menstrual cycle as well as biomechanical differences due to wider hips compared to males (Park et al. 2009). 
• Athletes with current or a past history of patellofemoral joint pain (Myer et al. 2015) 

ACL injury can be a sport or career-ending injury for some players, not to mention the physical, emotional and financial costs associated. Let’s focus on preventing them before it’s too late.