ACL Injury: Contact vs. Non-Contact

An ACL injury happens frequently in sports such as soccer, gymnastics, skiing, football, etc. And female athletes may be 4-6 times more prone to an injury than male counterparts. Even though it happens more often in contact sports, about 75% 0f the injury happens without involving a contact with another player. It has gotten more attention because of the seriousness of the injury and many research articles regarding the issue have been published. As a result, we know more about how the injury happens, what factors are involved, who may be more prone, how to prevent it, etc.

Contact ACL Injury

A common mechanism of contact ACL injury involves falling down while being tackled in the knee or lower leg, which forces the knee into valgus motion (knee bending in). The foot usually is planted on the ground by a tackling athlete and it becomes difficult to control his lower legs and the body. It can also happen when an athlete is tackled in the front of the leg causing the knee to hyperextend.



Non-Contact ACL Injury

A non-contact ACL injury occurs more frequently than contact ACL injury. It is common in soccer, basketball, gymnastics, skiing, etc. Athletes may sustain this injury when they are try to stop and make a quick change in direction leaving the foot planted on the ground while the body is being twisted. Another mechanism of injury is landing and hyperextending the knee. It also happens when the knee collapses into valgus on landing. The athlete usually does not have a good control of the body when he/she gets hurt.



A contact ACL injury is harder to predict, however, a non-contact ACL injury can be prevented by implementing balance training, proprioception training, strengthening exercises, neuromuscular program, etc.

Sports Medicine Myth: No Pain No Gain?!

There are many people (parents, coaches, etc) say that no pain no gain. But is it true? No so much when you are injured. Pain usually is a signal that there is something not right. You have pain when you twist your ankle because you just damaged (injured) a ligament in the ankle. When doing rehab and trying to come back from an injury, it is not a good idea to keep doing what causes pain.

Soreness is difference from pain. You get sore after lifting weights and doing training that you are not used to, etc. And it goes away in a day or two. It is ok to be sore as long as it goes away. It is a natural response of your body.

But sometimes, you may have to deal with some pain during physical therapy. Let's say you had an ACL reconstructed. The first thing you do is to reduce inflammation. Then, you try to regain lost range of motions. In this phase of rehab, you will be pushed and have some (a lot of) pain to get the range of motion back quickly. Rehabilitation is not pain-free. It sometimes is painful. It can be challenging what pain is ok and what pain is not ok.

So, is it ok to play through pain when you get hurt during practice? The best thing to do is to stop doing what you are doing and take a break. In youth sports, often times there is no health care professional on site to take a look at an injured athlete right away. So, when you are in doubt, the best thing is to not do what causes pain. You do not want to keep playing when injured not knowing what is wrong and make things worse.

High Ankle Sprain: Why Is It More Difficult To Treat?

High ankle sprains are different from (lateral) ankle sprains. They happen to a different part of the ankle. Instead of happening to the outside of the ankle, this involves ligaments located right above the ankle joint that connect two bones of the lower leg (tibia and fibula). The way it happens is also different. Instead of twisting the ankle, an athlete usually lands awkwardly forcing the ankle to dorsiflex. He/she may land on someone's foot or an object. In young athletes, (growth plate) fractures or avulsion fractures may also happen, especially the mechanism of injury involves twisting motion.

But why is it more difficult to treat? The reason is that it puts stress on the ligament every time the injured ankle bears body weight. When you take a step, a ground reaction force (GRF) from the ground is transmitted through the ankle forcing tibia and fibula to separate from each other. Anterior tibiofubular ligament (the most commonly injured ligament in high ankle sprains) holds the bones together. However, in an injured ankle, this puts stress on the ligament causing the pain. Depending of the severity of the injury, the athlete may be on crutches until pain resolves, or partial weight-bearing. Also, most ankle braces are designed to prevent lateral ankle sprains and do not prevent high ankle sprains.

Especially, in sports that involve lots of jumping such as basketball, volleyball, gymnastics, etc., it may be more difficult injury than lateral ankle sprains.

Common Injuries: Ankle Sprain

Ankle is one of the most injured body parts if not the most. The most common ankle injury is ankle sprain. Sprain is an injury to ligaments which connect two(or more) bones. In the same way, athletes sprain their ankle, more serious injuries such as growth plate (physis) injuries, fractures, avulsion fractures, etc. can also happen. In growing athletes, it is important to rule out any of those injuries since it is often misdiagnosed.

1) Anatomy

The ankle joint consists of two lower leg bones (tibia and fibula) and talus (called ankle mortise). And there are ligaments that connect those bones on each side of the joint. They are anterior talofibular (ATF), calcanofibular (CF), and posterior talofibular (PTF) ligaments on the outside (lateral) of the ankle, There is strong deltoid ligament on the inside (medial side). It is a lot easier to roll an ankle inward than outward. This is due to the fact that fibula extends farther down the ankle and limits the motion.

There are also ligaments that connect tibia and fibula. Anterior tibiofibular (ATF) and posterior tibiofibular (PTF) ligaments are not to be confused with anterior and posterior talofibular ligaments. The muscles called peroneal brevis and longus run right behind the lateral malleolus and they may also be involved in a case of ankle sprain.

The major artery, vein, and nerve to the ankle and foot run behind the medial malleolus.

2) Mechanism Of Injury (MOI)

Ankle sprains usually happen when an athlete lands on the ankle awkwardly and twists it in. They may land on someone's foot or an object on a playing field or floor. It may also happen when he/she is trying to change directions quickly. The most ankle sprains are lateral ankle sprain.

3) Clinical Presentation

The most common symptoms of acute ankle sprain are pain and immediate swelling. Discoloration may be present in a more severe case. It is painful and tender to touch the ankle. The range of motion (ROM) may become limited due to pain and swelling. The injured athlete may or may not be able to stand on their feet right after the injury has happened.

In chronic ankle sprains, the athlete may feel like their ankle is giving away when they walk, run, etc. The ankle may not swell up.

4) Treatment

Treatment of an acute ankle sprain should include cessation of any activities, ice, compression, (and elevation). The earlier it is treated, the shorter the recovery time will be. An early attempt to keep inflammation down is important. Icing is an effective way to do so. NSAID's (non-steroidal anti-inflammatory medications) may also be useful. Once swelling and pain are controlled, the athlete may start rehabilitation, which should include regaining the range of motion and strength, balance, proprioception, strengthening of lower leg and hip musculature, core exercises, etc. It is proven that there may be a link between ankle and lower leg injuries and hip and core strength and proprioception.

Please remember that an ankle is a part of the kinetic chain and an simple injury will affect athletic performances.

When treating chronic ankle sprains, an focus is put on stabilizing the joint as well as getting rid of any symptoms that the athlete may have. In these cases, the athlete will suffer from the injury often times and they may be able to get up and stay active after getting injured. In severe cases of chronic ankle sprains, the athlete may not be able to participate in any athletic activities due to pain and/or instability. Rehabilitation of these athletes includes strengthening surrounding muscles and increasing proprioception to support the joint. If it fails, a surgical procedure to fix loose ligaments may be necessary.

How Injuries Happen

Our body can take so much stress before it breaks down. When outside stress put on the body exceeds the limit, that is when an injury happen. For example, if you fall on your arm, the arm feels some amount of force depending on how hard you fall. When the force is more than what the arm can take in a single impact, an arm bone breaks.

However, this is not the only way an injury happens. It may not happen as a result of a single impact. It may develop over a period of time such as stress fractures. Stress fractures are caused by repetitive stress put on the body. For long distance runners, a bone feels some force, when running, that is not strong enough to cause an injury right away. But that force will be accumulated over a long period of time and exceeds the limit. Bones go through cycles of bone breakdown and bone build-up. However, if they do not get enough time for re-building, they become susceptible for injury.

Our body does need some time for recovery. Balancing practice and rest is an important key to prevent injuries.

You Can't Be A Great Athlete If You Are Hurt

There is always a chance of getting hurt when you play sports. This is more true if you play competitive sports. Some injuries are unpredictable and harder to prevent. On the other hand, many chronic injuries are preventable. We hear that this athlete is hurt and out for season on TV and newspaper. Some get injured more than the others. Even great athletes can't be great unless they get on the field and show people what they can do.

So, why don't we spend a little more time to prevent injuries? It is not that hard to do so. Just adding a few more exercises and stretching to your training and practice sessions can make a huge difference.

In this blog site, we will share information related to pediatric sports medicine, injury prevention and performance enhancement, etc.