Learn How to Prevent ACL Tears

Learning how to prevent ACL tears can minimize knee injury risk, and allow patients to avoid interventions like rehab and surgery. However, having an understanding of the underlying issues is necessary, if you don’t want to be one of the 300,000 ACL reconstruction surgeries performed each year.  Keep reading to learn about a range of different ACL tear prevention strategies.

Why Do ACL Tears Happen?

The ACL, or anterior cruciate ligament, is the most commonly injured ligament in the knee. It provides stability to the knee for everyday use by connecting the thigh bone and shin bone to prevent excessive forward shearing motion. Several factors play a role in this injury that happens so frequently.

Get a Full Overview of ACL Injuries Here

Risk factors

There are several risk factors that are more likely to lead to an ACL tear. These include:

• Participating in high impact sports such as soccer, football, basketball, and skiing.
• High-risk movements such as pivoting, running, planting and twisting, and jumping.
• Playing on artificial turf or uneven surfaces.
• Being female, due to differences in tissue mobility, hormones, and strength.
• Poor biomechanics of the knee due to genetics, poor conditioning and fitness level, and previous injuries.
• Improper footwear, poorly fitting footwear or other sports equipment that isn’t well maintained (i.e. running shoes, ski boots, etc.)

Kinesio Taping

Applying tape to the knee can help provide proprioceptive training. This will increase awareness of any biomechanical imbalances you might have that increase the risk of injury. (Keep in mind that tape should not be used solely for support.) Kinesio taping is the preferred option for the knee to provide feedback and improved coordination with the least amount of joint range restriction. While there are ways to use athletic tape, this is much less common due to the amount of hair on the legs and the amount of restriction it provides due to the inelastic qualities of the tape.

How to Apply Kinesio Tape

This is done with three strips of the pre-cut tape: one piece to go across the knee just under the kneecap, and two that will start parallel with the thigh and criss-cross each other just below the kneecap.

1. Sit with the knees bent to about 90 degrees.
2. Place the anchor of the small horizontal piece on the inside bottom of the knee and pull it across to the outside. It should be parallel to the ground.
3. Then, place one of the longer strips on the outer edge of the quadriceps muscle (mid-thigh).
4. Lay the tape in a straight line until you reach the top of the kneecap.
5. Then, start to arc the tape around the outside edge knee cap itself until it crosses to the other side of the leg, now just below the kneecap.
6. Stick the remaining tape on the inside edge of the shin.
7. Repeat this step with the other piece on the opposite side of the thigh to create an “X” under the kneecap.

Tips for Comfort

Keep these in mind to maximize the efficacy and comfort when using Kinesio tape.

• Round the edges of your strips and measure them to account for the small amount of stretch you will apply.
• Remember to never place tension at the ends to maximize tape life and decrease skin irritation.
• Start with about 10% stretch in the tape and build from there as needed. In general, less is more.
• Rub the tape vigorously when you are finished, to activate the glut and increase the stick of the tape.
• Tape can be worn for up 1-4 days, depending on your comfort and skin health (even with showers!).

Braces

Knee braces are usually recommended to prevent reinjury when there is a chronic lingering dysfunction in the knee joint following recovery from a past knee injury (such as a torn meniscus, ACL tear, or muscle strain). If needed, a medium to lightweight flexible knee brace is best for injury prevention. Occasionally, a brace will be recommended for pure prevention purposes if there are enough risk factors to cause concern.

Talk to your orthopedic doctor or physical therapist if you have concerns about your knee that could possibly be addressed with the use of a knee brace.

Prevention via Physical Activity

Focusing on good mechanics and lower body balance is the optimal prevention strategy for knee injuries. Keep these exercise tips in mind.

Plyometrics

Also known as jump training, this is a great way to prepare the knee for high-level activities associated with your sports or exercise program. A very clear risk factor for sustaining a knee injury is having excessive knee valgus (the knee collapsing inward) when landing from jumping. This move can be trained to with attention to form, coordination, and lower leg strengthening. Typically, an initial movement assessment by a physical therapist or athletic trainer can help identify any weak points and get you on track with an injury prevention program.

Warm-Up

The body moves with better coordination and agility after a period of warming up. It gets the mind ready for a higher level of activity and increases blood flow to prepare the muscles and joints. Thus, decreasing your overall risk of injury. For high-level activities, prepare the body with modified moves that mimic them (i.e. jumping and lunging prior to a game of basketball). Stretching before exercise is only necessary if you have stiff and/or sore muscles or joints.

If you participate in a particular sport, you can usually find great resources for injury prevention exercises. A well-researched sport-specific program is the FIFA 11+ warm-up for soccer players.

Strength Training

A well-balanced strengthening program can help optimize movement mechanics. A good strength program for injury prevention should focus on the core, hips, and thighs. These can be adapted to be movements that are specific for your daily activities or sports to maximize the benefits.

Exercises for an ACL Tear

Balance and Proprioception

The body’s ability to adjust to outer stimulus, no matter how high or low the impact, is one of the main determining factors in sustaining an injury. If it cannot adjust and coordinate what you're doing, it is a recipe for disaster.

Start challenging yourself with basic standing balance exercises, such as single-leg standing on various surfaces. Make it more difficult by adding coordinated movements, multi-tasking (such as throwing a ball), and more. To make sure you’re keeping good alignment, you may use a mirror or ask someone to give you feedback on your form. If you’re not sure what you should do, this is another great reason to try physical therapy.

Tips for Female Athletes

Research shows that women are at higher risk for ACL tears, especially athletes. Thus, females need to place extra attention to their injury prevention techniques. Keep these tips in mind:

• Always practice (and keep) good technique and form when exercising.
• Develop muscle groups evenly with a personalized strength program.
• Take the time to work on both strength and flexibility to keep lower body balance.
• Eat a balanced diet to minimize deficiencies that will affect tissue quality and health.
• Be aware of your menstrual cycle. Research shows that women are more likely to tear their ACLs when they are in the preovulatory stage due to hormone changes that affect tissue extensibility.

Taking Precautions to Prevent an ACL Injury

The risk of an ACL tear is an unfortunate reality of high-level movements, particularly with sports. Be extra cautious with sudden changes in position, planting the foot, or quick stopping. Injury prevention for any joint is about having self-awareness of form and how to sustain good mechanics. No matter how high or low your risk of knee injury is, a proper strength, stretching, and warm-up program will optimize your athletic performance.

If you experience sharp or severe knee pain, swelling, decreased strength, numbness, tingling, hear a pop, or cannot bear weight through the knee, seek medical advice immediately.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577417/

https://www.mayoclinic.org/diseases-conditions/acl-injury/symptoms-causes/syc-20350738

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2547857/

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