By guest blogger Dr. Abby Baldwin, PT, DPT, OCS, SCS, COMT, ITPT, GCS, AIB-VR
THE ACL CRISIS: It’s all in your head.
New research shows that concussions could be antecedents of ACL tears in contact sports. Can it be prevented?
It’s almost a weekly headline for a women’s basketball or soccer player to announce an anterior cruciate ligament (ACL tear), and a valuable athlete is lost for the rest of a season. Women’s soccer averages at least one of these losses per club per season, and that rate is growing. Female basketball players are suffering at nearly the same rate in NCAA and professional competition. The caliber of talent in women’s sports is reaching an all-time high and with this comes more aggressive play and more jarring collisions.
Ligament injuries are one of the most common injury types in contact sports. Ligaments are the ‘ropes’ that hold bones together. Injuries occur when a muscle creates an unbalanced force on one side of a joint and pulls the bone it is attached to in a way that tears the ‘rope’ holding these bones together. As athletes speak out about the need for action in this ACL crisis, a few theories get thrown around as to the source.
Overtraining.
Seasons have become more demanding with more games and less downtime. Injuries are being traced to increased physical demand on individual athletes. Historically we know that these season-ending ACL tears happen even in preseason, prior to back-to-back games and rigorous travel schedules. So that cannot be the source. That’s just in your head.
Footwear.
Is the cleat in soccer designed for a woman’s foot? Maybe that’s what causes some kinetic predisposition to ACL tears. But women have had basketball shoes designed specifically for them. The UConn basketball program certainly has the best footwear for women in the business, but their bench is lined up with athletes comparing ACL reconstruction scars. So cleat design cannot be the problem. That’s just in your head.
Female anatomy.
Hip and knee angles contribute to ACL injuries. While this is true, it has been addressed extensively over the past decade. Watch a professional women’s team warm up and you will see them using resistance bands to engage lateral musculature in their hips to help combat this predisposition. Today’s training programs address hip and knee strength and the mechanics of how a female athlete lands with proper hip and knee alignment. Take notice, professional female track competitors and tennis players don’t struggle with ACL tears. They have high training loads and the same anatomy. So the biomechanical disadvantage of hip and knee alignment can’t be the source if it does not affect female athletes in the same way across all sports. That’s just in your head.
The defining factor.
What is the most meaningful difference between these female athletes? Tennis and track athletes don’t experience collisions in their sport. No collisions mean a significantly decreased risk of concussion.
Due to the work of researchers at Michigan State University and Henry Ford Hospital in Detroit, we know there is direct correlation between athletes cleared to return to play after a concussion and increased risk of sustaining a lower body injury within ninety days. A higher correlation of concussions and subsequent injuries with professional athletes as compared to high school athletes is prevalent. The connection is still there at every level.
According to the Australia Women’s Football Conference, held immediately prior to the Women’s World Cup last summer, 68% of all lower body injuries were non-contact injuries. Non-contact injuries are an internal processing error. The brain did not engage the muscles in the lower body with the perfect precision needed to complete the motor task.
Ohio University’s Dr. Dustin Grooms and Emory University’s Dr. Taylor M. Zuleger and their colleagues released two ground-breaking research studies over the past couple of years. The first one showed observable maladaptive patterns in the brain that relate to increased susceptibility to a lower body injury, such as an ACL tear, after an athlete suffers a concussion.
Collisions in sports come in many different varieties, impacting another player, the ball, or the ground, for example. Ironically, this often occurs when athletes try to dramatize the severity of a foul for the referee’s sake by making it look more serious, consequently impacting the ground in a more exaggerated fashion. This is a recipe for a nasty whiplash for the athlete which may or may not cause a concussion. Regardless of concussed or not, the action exposes the athletes to excessive accelerated forces of their head and cervical spine.
The second study addressed a gray area that has stumped data collectors and medical staff for decades—head impacts. Regardless of the distinction of concussed or not concussed, the University looked at the magnitude of head impact. The harder the hit to the head in sports, the more likely we see changes on a functional MRI. A higher magnitude impact to the head resulted in typical brain circuitry that controls lower body movements becoming rerouted to a less efficient pathway, showing a predisposition to lower body injury.
Most female athletes sustain lower body injuries in a non-contact situation. A muscle on one side of the joint fires when it should not, as in an ACL tear. Dr. Grooms uses a picture of an MRI image of the brain to show why this happens. The brain controls the body – every movement, nerve firing, sensation, and muscle. If the brain tries to compensate after a head impact and does not have that firing pattern executed perfectly, we can see an injury occur. For female athletes, his study population, this could result in the sport’s most common and debilitating injury, an ACL tear.
Well-executed research for over a decade and a half clearly shows we need to change how we identify and treat concussions. Studies demonstrate the benefit of strengthening the neck to help decelerate impact on the head. The ACL crisis will continue to escalate if we do not recognize what’s going on in our heads.
We have to change the way we assess and prepare athletes for contact sports by addressing how they can protect their head from outside forces. This does not mean to helmet every contact sport athlete. In fact, that might make concussions more prominent by making the head heavier for the neck to control. But it does mean we need to train the necessary muscles in the neck to decelerate the forces that can cause concussions as the head experiences whiplash through collisions in sports.
Approaches and practices in sports performance have evolved tremendously over the past two decades, but with just one serious flaw. Training programs stop at the shoulders. The neck is the critical point of integration for the muscles and nerves. It is responsible for how our brain communicates with our body and how our body communicates with our brain. We need to strengthen the neck to allow these athletes to be more resilient after impacts in collision sports. Neck strength protects their brain, and thus protects their lower body from injury.
This is an ACL crisis. It’s all in your head.
Find Out More
For more information and research related to head injuries and its correlation to ACL tears, and the opportunities to mitigate these ACL tears please contact Dr. Abby Baldwin at: GetYourHeadInTheGameInfo@gmail.com.
