The ACL Injury Problem Plaguing NFL Players: Anything Being Done?

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Photo by Tim Mielke on Unsplash

Perusing the NFL injury you will find nearly 30 players are already out for the season due to ACL (Anterior Cruciate Ligament) injuries, and with several more games left in the 2020 season there is a strong likelihood of more ACL tears to occur. This number doesn’t include those players out due to various other knee injuries (torn patella tendon, MCL, etc.); just those suffering severe enough damage to the ACL to require season-ending surgery. Some of these injuries, Cincinnati quarterback Joe Burrow, e.g., were a result of another player rolling into, hitting, or tackling the player to cause the injury. For others all it took to suffer the injury was an awkward juke or an improper landing from a jump. In other words, they fell victim to an extremely unfortunate non-contact experience.

Among the risk factors for the injury listed on the Mayo Clinic website are the sports of soccer, basketball, downhill skiing, gymnastics, and football — all sports requiring sudden stops and starts, lower body twists and assorted leaps and landings. The ACL is one of the ligaments connecting the thigh bone to the shin bone (femur to tibia, if you prefer medical terms) which does make it really important if you want your legs to work the way God intended them to work. Even though those sports mentioned result a lot of stress to the knees, a lot of NFL fans tend to best recall the ACL injuries from another player directly hitting the knee. No matter the activity, it’s just not accurate.

Jumping across the pond (UK folks still say that, right?), where soccer is football and our sport is prefaced with the descriptive American, the British Journal of Sports Medicine begs to differ. A study involving 134 ACL injuries to soccer players discovered 88% of the injuries were of the indirect contact or non-contact variety. The study determined indirect contact injuries to be just as common as non-contact injuries. The report states in 44% of the indirect contact cases mechanical perturbation (basically a part of the body, other than the knees, having indirect contact with another player) caused the undue stress to the ACL, resulting in the injury. Most of this type of indirect contact involved the upper bodies of the two athletes.

Many may feel fatigue plays a major role in an athlete suffering a devastating knee injury, but this common misconception has been shattered by the UK study. The journal reports 68% of ACL injuries happened within the first 45-minutes of running onto the pitch with 25% of those occurring within the first 15-minutes of a contest. This strongly suggests there needs to be improved emphasis on neuromuscular readiness. This is a term used by athletic trainers and medical personnel to measure which steps (warm-up exercises, e.g.) best prepare an athlete for a safer peak performance. Readiness assessments are also a method trainers use to gauge the amount of fatigue resulting from previous training sessions, allowing athletes to be better prepared physically and psychologically for performances.

The Mayo Clinic’s Dr. Timothy Hewett has conducted research which has determined findings like those reported in the British Journal of Sports Medicine. Hewett states 70% of the ACL injuries in the NFL are of the non-contact variety. Back in 2015 Hewett was quoted publicly about preventative measures. “With neuromuscular training, we can reduce those risk factors,” said Hewett. Although the data to reinforce such prevention, Hewett surmised “the implementation and compliance” was undervalued by most NFL teams.

In 2012 the journal Sports Health printed a review of various programs in place to effectively curtail the number of ACL injuries among female athletes (possibly due to differences in hormones and anatomy, resulting in higher rate of ACL injuries). The review considered over 40 different ACL injury prevention programs, narrowing it down to two programs considered the most complete. The Prevent injury and Enhance Performance Program (PEP) was one of them and has grown in popularity among orthopedic and athletic training professionals.

The PEP is designed for prevention of initial ACL injuries, but is also used as a method to decrease injuries after an athlete undergoes ACL surgery. It has also been determined it isn’t just for female athletes and is being used by professional athletic trainers. What is PEP? The program consists warm-up exercises, stretching, strength and plyometrics as well as sport-specific agility training. The intent is to improve the neuromuscular conditioning and muscular motion through maintaining balance, adding power, and becoming greater at agility.

Analytics has become commonplace in all phases of training professional, collegiate and even high school athletes. Consider when Hewitt’s research from a few years ago. It consisted of using a milk crate. Hewitt had the athlete stand on the crate and drop (not jump) to the ground. High speed cameras recorded the movement of the knee and the landing. Such research by Hewett and others resulted in determining exercises to strengthen muscles of the leg which assist in knee stabilization.

Highly profitable athletic analytic companies now offer a lot more in the way of precision. The advancements in digital technology have provided improved video breakdown of athletic movements. This allows an athlete to create a muscle memory of proper form such as chest and knees over toes on jump landings, landing softly and various methods to enhance stretching of the upper and lower body. There are wearable monitors for athletes which record statistics about pressure on body parts, etc.

NFL teams are actively using these preventative refinements and are continually searching for methods to keep players healthy and on the field. However, players are human, and the human body tends to break down no matter how superior the athlete is. The NFL is no different than any other business in 2020. Even with the advances in ACL injury prevention over the last decade, a major contributor to the injury numbers may be a result of Covid-19. Not being in NFL training facilities as frequently as past off-seasons created changes in the norm. The effect of no spring and summer sessions could be a definite factor.

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