It’s time to revisit the ACL injury prevention approach

By Jennifer Schwartz

Editor’s note: Jennifer Schwartz is the owner of Impact Fitness DC, a professional private training company providing fitness services to female athletes, teams, individuals, and small groups in Washington, D.C. She holds a certified mastery in biomechanics with a specialization in resistance training and muscle activation techniques™, and is also a United States Soccer Federation-licensed coach with the Alexandria Soccer Association. Soccer Wire is very pleased to present Jennifer’s perspectives on biomechanics and injury prevention.

To female athletes and their families— particularly those of soccer players — ACL injuries are, unfortunately, not a novel occurrence.

Research had surged into the field of sports medicine related to the risk factors of female athletes and interventions designed to decrease the disparity of overall incidents with their male counterparts. With more and more information, it’s become increasingly clear that with the right form of intervention, these risk factors are completely modifiable while still increasing performance markers.

The sad reality in sports medicine and on our local soccer pitches is that the number of ACL injuries has not improved. Epidemiological evidence strongly suggests that many of these training approaches do not work in the real world.

There is some evidence you just can’t escape – ACL injuries are biased toward the female anatomy. However, it is my professional opinion that the causative factors are not simply physique, hormones and bone structure.

The true cause behind these widespread injuries stem from fatigue of inhibited muscles, chronic stress, soccer boots designed for marketing and not mechanics and muscular imbalances. The discrepancies between what is believed to cause ACL injuries and what actually does are why research and prevention do not reside in harmony with one another.

From a professional perspective, I find much of today’s research to be inflated: They’re asking very general questions to solve very specific problems. The research becomes irrelevant in a practical application. This Lower Extremity review from 2010 helps reveal where interventions are falling short:

• Poor program compliance by organizations.
• Coaches placing higher priority on performance-based training over injury prevention.
• Failure of athletes to adhere to intervention programming.
• Poor understanding of the behavioral aspects in implemented programs.
• Historically significant factors contributing to injury are just one small piece in a much larger puzzle.

This review hits the nail on its large, ambiguous head! We cannot treat an athlete’s overall health as a component of a program, but that should be one element in a learning and adaptive process.

It’s ludicrous to think that a six-week program completed twice a week for 15 minutes will suffice as injury prevention for the constant, uphill challenges faced by a travel or academy soccer player.

Exercise, in all its form, is a process. Exercise is not something of convenience, a check in/check out event, nor is it a teacher for muscular memory. All good things that come from exercise are a result of adaptation; they come with time, control, adequate sleep, proper nutrition, and knowing your body’s signals and thresholds.

Evidence from leading researchers will attest to muscular imbalances being the culprit of the past, and an epidemically large number of present ACL injuries. A comprehensive answer to this problem is uncertain. As both an experienced muscle function specialist and a licensed girls soccer coach, I stand with the epidemiological evidence presented in the Lower Extremity article–the programs championing jump training and dynamic warm-ups are not sufficient.

The mechanics of the muscular system are astoundingly impressive–they will operate with  muscular imbalances and under less than optimal circumstances, even with  joint compensation. But long-term imbalances in any athlete’s mechanics will expose them to acute and chronic injury.

One of the key elements of my strength training programs are isometric exercises – they are designed to strengthen weak links in the athlete’s movement through a systematic approach to physical training.

By performing these light-load, continuous activations of the muscle in its shortened range, the body will gain a sense of stability in this range that will translate into an enhanced capability to contract throughout the entire range of motion (MAT™ JumpStart).

Isometrics are a simple and effective addition to a training program by addressing muscular imbalances while the athlete is learning about their own thresholds and flexibility.

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