Knee Part 2: ACL How to let recovery define you

Brutal Injury

In todays article we are giving the knee a second glance since the mobility series, we are specifically looking at the anterior cruciate ligament or the ACL. The anterior cruciate ligament is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor. Meaning that when the ACL is injured, the shinbone can slide forward on the thighbone causing the knee to give way. The two ligaments in the center of the knee which forms a cross the reason for the word cruciate are the posterior cruciate ligament and the anterior cruciate ligament they work together to keep the knee stable in the front and back. The ACL provides about 90% of the stability for the knee joint. In the last few years in the NFL we have had some ACL tears to major players like Adrian Peterson,and Robert Griffin III. Approximately 70% of ACL injuries occur while playing agility sports basketball, soccer, skiing and football without contact. Leaving 30% of ACL injuries occurring as the result of direct contact . 1,2. It has been noted that 75% of surgeries done on professional football players involve ligament and cartilage tears. It is a common injury with basketball players as well accounting for approximately 42% of their injuries.  The fact of the matter is that women are four to six times more  likely to injure their ACL than men, there may be a number of different causes for that such as increased Q angles, females have a narrower femoral notch (space at the bottom of the femur the ACL runs through here), biomechanical and anatomical issues, nutritional deficiencies namely supplements that support a woman’s normal hormone cycles an reduce the changes in of elevated hormone levels. In girls soccer approximately 19% of girls playing soccer will have an ACL injury, and 13% of girls playing basketball will have an ACL injury.  All is not lost for the female athlete the American Journal of Sports Medicine in 2009 concluded that a sports injury prevention training program improved the strength and flexibility of the competitive female basketball players who were tested, and the biomechanical properties associated with ACL injury, as compared with pre and post-training parameters in the control group. The clinical revelance is that the prevention program lowered the athlete’s risk of injury.  In this article we are going to look at why Robert Griffin III injured his ACL and how Adrian Peterson made such a quick comeback. 

I was at a wedding recently talking to one of my buddies about the upcoming NFL season and who he was looking to draft for his fantasy league, who was going to be a better player this year. RG3’s name came up, the fact that he runs to much and that he will not last in the NFL. Almost on autopilot I went into a breakdown I had read from Bret Contreras

At the landing his knees come in.

about the fact his knees are valgus and that was a contributing cause for the ACL tear. A valgus knee means the knees cave in when squatting, or landing from a jump. While a varus knee means they fall outward in the same positions. You can see the evidence of valgus knees in the subway commercial when he lands and the graphic appears 39.5 inch vertical his knees are falling in, causing repeated MCL/ACL stress. Now there can be a number of different reason for valgus knees like weak hips, tight ankles, impaired quad function, and impaired hamstring function. One of the factors not mentioned is a knee that was surgically repaired and the rehab was not completed correctly and or contributing factors were not corrected. Mr. Griffin and the Redskins problem is correcting the contributing factors that have led to valgus knees this will take time most likely a multi-phase program. A couple of strategies from Bret Contreras to correct knee valgus are ankle dorsiflexion mobility drills and gastroc/soleus stretching, motor re-education with immediate video feedback, mini-band exercises and hip abductor/external rotation exercises. He has some of the top rehabilitation people and orthopedists at his disposal, lets hope they get him on the right track. 

Next up is All day Adrian Peterson, who totes the rock for the Minnesota Vikings, coming off of an ACL tear the year before he came back stronger. Last season he almost broke Eric Dickerson's record coming 9 yards short with 2,097 rushing yards.The thing about AP is his mental game, after the initial shock of the injury he went to the trainer asked what he can do to come back stronger and better. It took nine months of careful planning with Eric Sugarman a Vikings Trainer who specializes in knees. The comeback was broken down into six stages and two phases, the first three stages covered the two months after the surgery with a focus on dealing with the swelling, fighting muscle atrophy, beginning to re-establish the range of motion. In a recent article it was noted he walked in a pool at three weeks, jogged at six weeks and sprinted at eight weeks.  At week ten the started the next three stages they had him using wii-fit games that focused on balance, then moving to speed and explosiveness. The last stage was his return to the game without limitations. They also had a corrective exercise piece with a focus on the total body  working with the strength and conditioning coach Tom Kanavy they utilized upper body recovery days, total body lifts and heavy rope workouts stressing core and upper body. The key is working not only the lower extremity but the core as well. A large portion of the information in this paragraph was found in the training edge a personal trainer magazine for NASM, the breakdown of comeback of Adrian Peterson was perfect. 

What can we learn from this amazing comeback is that if we have a goal, break it down into steps and work your program stay consistent and you will see the results. The thing to remember is Adrian Peterson and RG3 are professional athletes, we are recreational athletes and we can draw inspiration from their stories.  What can we learn from RG3’s injuries and the contributing factors leading to his injury? Once you have an injury work your tail off in rehab, this is something that bothers me. I believe that you can make up the most ground in your post surgical rehab, you cannot sit there and thinking that the surgery is the be all end all. At that point the onus is on you to pick it up and move forward to get yourself into comparable if not better shape then before. Many of the therapy facilities know your insurance will run out after thirty or so sessions, ask if they have trainers they work with to take you until your at maximum improvement.  The point is to take an active role in your recovery, because if you do not care no one will.  Thanks for reading this article, as always please share it.  On friday we will be looking at different training systems, especially how and when they are best used