How to reduce your risk of an ACL injury?
Updated: 6 days ago
ACL injuries are a huge risk in Netball with up to 22% of all injuries involving the ACL. In fact of all ACL injuries, Netball is the 5th highest in prevalence! But did you know of all the ACL injuries in netball a whopping 80% are from non-contact? Research shows that working on the leg stability, landing mechanics and leg strength helps to significantly improve the risk factors associated with ACL injuries in Netball.
As a physiotherapist I've seen a huge number of ACL injuries over the years. Its something that can cause a missed season, potentially surgery and a lot of dedication from a player to their rehabilitation. One netball player stands out in my mind from years ago. They had previously had an ACL tear a few years before, and they were so anxious of another one occurring as many of their friends had had re-ruptures after surgery. We worked hard for 6 months on strengthening, balance work, landing mechanics etc. When she completed her preseason screening she was STRONGER and FASTER than she was last season! And to this date I have not heard that she has damaged her ACL again. So whilst this article is all about injury prevention, all the exercise you'll complete can also lead to improved performance, improved reactions and improved recovery.
Table of Contents:
What is an ACL?
What does an ACL do?
Your ACL (Anterior cruciate Ligament) is a ligament within your knee that connects your thigh bone (femur) to your shin bone (tibia). It stops the shin bone from gliding forwards, keeping the knee nice and stable. It also has lots of receptors on there that feed information back to the brain. This could be about the knee's movements, any swelling, any pressure etc.
What is an ACL injury?
When we load through the knee and then twist on it, this puts huge strain through that ligament. After a period of time this load will be too great and the ACL will either partially or fully rupture (snap!).
What are the risk factors to having an ACL injury?
The main risk factors include:
Valgus movements of the knee on landing (where the knee dips inwards)
Women are more prevalent than men (between 2x and 8x more likely!)
Muscle imbalances (if your quads are very strong compared to your hamstrings it creates more shearing force through the knee)
Family history (2 genes have been found to increase the laxity of ligaments which can be associated with a higher risk of ACL rupture)
Hormonal changes throughout the cycle.
Why is netball the 5th highest sport for causing ACL injuries?
Netball requires the athlete to jump, land, pivot and quickly change direction. The knee has a huge roll to play within these movements. In fact did you know that a netballer may jump 55-60 times per game? So if the player has too strong quads, too weak gluts, not active enough hamstrings, poor foot mechanics and is menstruating...this could be a recipe for disaster!
How to reduce the risk of an ACL injury?
ACL injuries are one of the most researched topics on knee injuries. There is a huge amount of research that shows the risk factors and programmes have been put in place such as the FIFA 11+ that help to reduce these risk factors. I will caveat here - there is no exercise programme that will ever be created that will completed irradicate your risk of sustaining an ACL injury. HOWEVER there are definitely things we can do to reduce the risk.
Get your muscle strengths checked
Whenever we are looking to make changes - we need to know where we're starting from. You can do this by performing repetitions to failure and comparing each leg. Or you can come along to a clinic like The Wellbeing hub where we will analyse this for you with our specialist equipment. The muscles you need to check are:
Gluts
Hamstrings
Quads
Calves
Tibialis Posterior (helps to create the arch of the foot)
Check your landings
Set up a video recorder and video yourself from the front. As you land from a jump watch what your knees are doing. If they are squeezing together then that is a risk factor for an ACL injury. Practicing jumps and hops keeping the knee straight will be beneficial.
Check your balance
Have a practice doing a single leg balance with your eyes closed. How well do you manage? Pick yourself up a wobble cushion from our clinic or from online and practice some double leg and single leg balance on there. The stronger the connection between the brain and the ACL, in understanding how that knee is moving the better!
Conclusion
ACL injuries can cause months of rehabilitation and concern, sometimes including surgery. Lets try to reduce that risk by adding some tweaks into your weekly exercise plans. These training sessions don't need to be long and its even more fun if you can do it with a friend or team mate to keep you accountable!
If you feel you would like any extra support or a personalised assessment, why not book our Sports injury screening session with one of our physios?
References:
British Orthopaedic Association: Anterior cruciate ligament injuries in netball: the elephant in the room - Part 2. 03/08/2023
British Journal of Sports Medicine: Predisposing factors for anterior cruciate ligament injury 2020
