Anterior cruciate ligament (ACL) tears have become the focus of much attention across the nation as football programs on all levels have seen an increase in a knee injury that used to be pretty rare among young athletes. There are numerous theories that have been proposed to help explain the rise in ACL tears. Researchers have cited genetic reasons, neurological explanations, proprioception, the rise in artificial playing surfaces, athletic footwear, the role of fatigue, an increase in the number of adolescent participation in sports, one-sport specialization and, on the professional level, collectively bargained changes in the way football teams practice that reflect safety initiated reductions in practice time, the elimination of two-a-days and the reduction of padded practices.
This article will center on the changes in training that have occurred over the years on both the youth level and the high school level. Could it be possible that many athletes on this level are training in ways that perhaps contribute to the destabilization of the knee joint and an increased risk of future ACL injuries? One of the ways that an ACL tear can occur is when an athlete quickly stops moving and changes direction while running. Dr. Robert Litchfield, medical director of the Fowler Kennedy Sport Medicine Clinic at the University of Western Ontario, has studied videotape of ACL injuries and has found a pattern. His discovered that those who tore their ACLs all did the same thing with their legs when they were avoiding a defender or reacting to an offensive player. He explains that the injured player throws the injured limb out to the side and then tries to make an upper-body move where they move away from the side they just planted on. See Neal Gabler, The Nastiest Injury in Sports, Grantland, Dec 10, 2013, http://grantland.com/features/derrick-rose-rob-gronkowski-rise-acl-tears/.
The transitional movement pattern described by Dr. Litchfield accurately describes two of the most popular measureable movement drills that many youth level athletes start practicing in various training scenarios at a very early age. One of these drills is the three cone drill that is used to measure an athlete’s ability to change directions at a high speed.
The other drill is the shuttle run or 5-10-5 drill which is used to test an athlete’s lateral quickness and explosion in short areas. One of the biggest changes that has occurred over the last four decades has been the proliferation of football combines and showcases that allow youth level football players to display their football skills as well as their speed and agility. The ultimate goal for many of these athletes is to receive a scholarship offer that will allow them to attend college and play at the next level. The shuttle drill is also part of the testing battery conducted at the annual NFL combine that had its beginnings in 1982 and in the 21st century has become a very popular television presence. The 21st century also brought with it an increase in the number of youth level combines and showcases that have also become popular with television audiences.
The desire to post high scores in these drills can often evolve into an obsession that can consume an athlete to the point that their training becomes counterproductive and perhaps even a physical liability. On the high school level it is not uncommon for some athletes to dedicate a vast majority of their time attending summer camps, combines and training with their personal coaches. For skill position players one must also factor in the time spent participating in passing leagues. A concern for many coaches then becomes the amount of time that an athlete is absent from the team’s weight room activities.
Improving strength and flexibility within the knee joint is a critical component of ACL injury prevention. Addressing musculature imbalance is also a very important component of strength training and sacrificing the time set apart to address these two important aspects of injury prevention and comprehensive strength development could perhaps be a precursor to future ACL problems. The continuous repetition of these measureable movement drills over time may very well improve an athlete’s score but one has to wonder if these improvements might not also be accompanied by some unintended physical consequences.
Another change that might also be contributing to the increase in ACL injuries is the proliferation of the passing game that is mirrored by the number of teams that now run the spread offense and teams that run fast tempo, no huddle offenses. American Football Monthly’s State Championship Team Profile in their July 2014 issue lists the spread offense as the base offense that team’s ran the most during their championship season. Forty-two percent of 2014 state championship teams ran the spread and 58% of junior high schools and middle schools ran the same offense. These offenses have also seen a surge in popularity on the collegiate level and some professional teams have also implemented fast tempo, no huddle schemes on the offensive side of the ball. The increased popularity of these offenses combined with the fast-tempo pace that accompanies them means that an increased number of players on both sides of the line of scrimmage are now having to react in more one on one situations in space. The adoption of these offensive schemes has also changed the way that many teams practice and this increase in one on one situations in space has increased in practices also.Pittsburgh Steelers assistant team physician Robin West has noted that studies show that about 70 percent of ACL tears result from non-contact injuries. See Jenny Vrentas, 2013: The Year of the Injury, Muscle and Medicine, December 4, 2013, http://mmqb.si.com/2013/12/04/. With this in mind coaches must also account for the fact that conducting non-contact practices does not necessarily lessen the possibility that athletes will suffer an ACL tear.
Perhaps it is time for coaches to start tracking the number of repetitions that their skill position players take in practices, passing leagues, summer camps, workouts with personal coaches and combines. It might also be of benefit to limit the number of repetitions your athletes take practicing measurable movement drills such as the three cone drill and the shuttle run. This inventory combined with a weight training program that addresses any musculature imbalances will hopefully provide some positive results.