What Football Players Need to Know About ACL Injuries

Football players account for 71% of all male ACL injuries in high school athletes. If you play, coach, or treat football players, there’s a lot of information you should know about ACL sprains and tears.

Key Takeaways

• The ACL is a ligament that stabilizes the knee while it moves.
• ACL injuries can occur with or without contact from another player.
• Factors like a player’s position and the field turf increase the risk of sustaining an ACL injury.
• Teaching proper maneuvering techniques and wearing knee braces are the best ways to prevent ACL injuries.

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What is Your ACL and How Does It Tear?

Two Common Causes of ACL Injuries in Football

Symptoms Associated with ACL Tears

ACL Injury Risk Factors

Positional Factors

Preventing ACL Injuries

ACL Repair Surgery

ACL Injury Recovery and Rehabilitation

What is Your ACL and How Does It Tear?

The Anterior Cruciate Ligament (ACL) is one of four cruciate ligaments located in the knee. It connects the femur to the tibia through the center of the knee. This stabilizes the knee while moving. The ACL is the main ligament used when planting and cutting, a common football maneuver to “fake out” an opponent. It is also the most commonly injured cruciate ligament.

Two Common Causes of ACL Injuries in Football

1. A player is hit in the knee causing hyperextension. The foot is usually planted in the ground leaving the knee unable to move freely, and then the knee is hit.
2. In non-contact injuries, the player is often pushing off the ground and changing direction at the same time. Hard cuts like this are a common cause of ACL tears and injuries.

ACL injuries range from mild sprains to tears and are measured on a one to three scale, one being mild instability and low severity, two being an ACL that’s been stretched and partially torn, and three requiring surgical repair. ACL injuries can take more than a year to fully recover from, but with proper rehabilitation and physiotherapy, many players can safely reduce that recovery time to under a year.

There are numerous symptoms associated with ACL tears, including:

• Severe knee pain
• A popping noise and sudden feeling of instability
• Swelling
• Inability to put weight on the knee

Many of these symptoms are also common in more mild knee injuries like strains and sprains.

ACL Injury Risk Factors

One significant risk factor is the type of turf that surfaces the playing field. FieldTurf is the predominant artificial turf from high school to professional levels, and while it has many benefits, one drawback is a slightly higher risk of ACL injury.

Another field factor is whether the playing surface is wet or dry. Dry conditions have been shown to put players at greater risk of injury than wet conditions. This is possibly due to players’ lack of cutting ability when it’s wet, meaning that they are more likely to lose footing before cutting hard enough to sustain an ACL injury.

Having a history of ACL injuries can also be another indicator of increased risk for future injuries. In professional football players, 18.3% of ACL injuries occurred in a knee that had previously been injured.

Positional Factors

Each field position has different levels of risk associated with it due to the specific movement players are required to perform. This means that some positions are putting more force on the knee and make up a large portion of the ACL injuries at a professional level.

Offense

Offensive skill players are among the most likely to suffer ACL injuries. The hard cuts and changes in direction required of tight ends and receivers make them especially susceptible to ACL injuries. On the line, tackles have a very low rate of ACL injuries, the interior linemen are at a much higher risk, and guards are the highest risk players at the professional level.

Defense

Linebackers have the highest ACL injury rates out of all defensive players. Between covering tight ends and tackling running backs, linebackers are pushing their bodies to the limit, often at the detriment of their knees. Meanwhile, defensive backs and defensive ends are both below average in incidences of ACL injuries per player.

Preventing ACL Injuries

One of the first steps in preventing ACL injuries is talking to your athletes. Trainers and physiotherapists can show players the best practices and optimal form for maintaining knee health.

Dr. Trent Nessler is a great example of the importance of athletic trainers. He tested his ACL Injury Prevention Program at Troy University in conjunction with the football team. This program, which uses wearable sensors to determine the risk of injury, led to a 58% decrease in non-contact injuries. Most schools aren’t implementing programs like Nessler’s, but an athletic trainer is the best source of accurate information for preventing injuries.

Knee braces can also be used to increase stability while playing and practicing. Dr. David Chao, who has worked with countless NFL players, recommended knee braces for all of his players. Some players prefer a brace like the Rolyan ACL Brace that offers maximum support while others choose a brace like the Cramer Diamond Knee Stabilizer that allows for a wider range of motion.

ACL Repair Surgery

ACL surgery is typically recommended to athletes or anyone who plans on putting extensive force on the ACL again after recovery. If the ligament is torn, it will be replaced with part of a similar tendon from the knee or a donated ligament from a cadaver. This is done through a small incision in the knee. Patients can typically leave on the same day as the surgery and will be on crutches for a few weeks afterward.

ACL Injury Recovery and Rehabilitation

After suffering an ACL injury, proper rehabilitation is crucial for a safe and effective recovery. A progressive system of exercises using resistance bands can be a good starting point for post-operative workouts.

As the rehabilitation progresses, athletes will slowly be able to increase the range of motion in their knee. To ensure that the knee isn’t flexed too far, try using a brace that measures and limits degrees of extension and flexion. These braces can be locked to set specific limits on the movement of the knee. As the knee is rehabbed, these limits can be extended for increased motion.

ACL injuries will often leave the knee feeling sore and weak. The pain can range from mild discomfort to severe pain. There are a number of ways to safely treat this pain without impeding the recovery process.

A brace that applies heat, such as the Hyperice Venom, can be used to relax the muscles and joints around the knee if they are feeling stiff. This is especially useful as individuals move into the rehabilitation process and are pushing the range of motion of their knee farther.

As patients begin to stretch the knee throughout the rehabilitation process, some soreness can be expected. An effective way to treat this pain is with compression and icing. Braces that apply compression and ice the knee, like the HyperIce Compression, are an easy way to get the combined pain relief of cryotherapy and compression all at once.

Simple solutions like reusable ice packs and Biofreeze gel are also great for short-term pain relief.

As a football player, ACL injuries are common, but with the right tools, you can help your athletes recover and get back on the field.

References

1. Chao, David. (2017, August). There is no increased ACL epidemic in NFL, but also no way to ensure decrease. SanDiegoUnionTribune.com. Retrieved from https://bit.ly/2xqPmrT
2. Department of Orthopaedic Surgery, Lenox Hill Hospital. (2012, September). An analysis of specific lower extremity injury rates on grass and FieldTurf. NCBI.gov. Retrieved from https://bit.ly/2Nr9qlm
3. Dodson, Christopher. (2016, March). Anterior Cruciate Ligament Injuries in National Football League Athletes From 2010 to 2013. NCBI.gov. Retrieved from https://bit.ly/2LtCDeX
4. Med Sports Systems. (1997, December). A review of selected noncontact anterior cruciate ligament injuries in the National Football League. NCBI.gov. Retrieved from https://bit.ly/2uwt88l
5. Moore, Rebecca. (2016, August). ACL Injury Prevention Kit Makes Waves in Collegiate Football. PerformanceHealth.com. Retrieved from https://bit.ly/2Nr7eKE
6. The Ohio State University, College of Medicine, (2013, November-December). A Multisport Epidemiologic Comparison of Anterior Cruciate Ligament Injuries in High School Athletics. NCBI.gov. Retrieved from https://bit.ly/2mnNufe
7. Wedro, Benjamin. (2017, November). Torn ACL. eMedicineHealth.com. Retrieved from https://bit.ly/2uInK0O

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