An overwhelmingly amount of athletes will elect to have ACL reconstruction surgery in the United States. 90% of 20,000 people to be exact. The odds of them re-tearing it? 6-31% with 50% of athletes not returning to their prospective sport afterwards. Out of those who elect to have surgery, 100% of them will develop osteoarthritis in their knee.
The question we need answered is why do we keep reinjuring our knee and how can we decrease the reinjure rate?
This problem arises and continues for three main reasons:
- The athlete’s ligaments and joints are not prepared to handle the high demands of their sport or sports.
- Physical Therapy will only get the athlete’s knee working back up to its normal capacity and range of motion- not beyond.
- There is no widespread return to sport protocol in place that actually works.
Let’s dive into each main point.
- The athlete’s ligaments and joints are not prepared to handle the high demands of their sport(s).
Injuries occur because the load or demand placed on that area exceeds its capacity. Which means that our athletic programs are not making sure the athletes can handle the pressures of cutting, planting or being hit by another player. If we look at athletic programs across the United States- nothing has changed since our parents or grandparents were in school. We have done the same warmups, stretches and cool downs for years and years. With such abundant access to information, we cannot continue to have lifting and warmup protocols that are not sport specific. Are we doing what needs to be done to warm up our joints and bodies in a way that is specific to the task we are asking our bodies to do?
If we take a look into lifting programs and coaches’ qualifications- we do not see strength and conditioning coaches or coaches with any actual lifting experience teaching adolescents how to properly lift. You walk into a weight room and it’s your football or basketball coach telling you you’re going to max out at the beginning of the year so you can compare later. With no education on how to properly lift- they want the kids to risk injury by loading up whatever weight they want and don’t have the skills or bandwidth to watch 50 kids lift at the same time, let alone making sure they do it correctly. We can also add in that most lifting programs in schools are only for offseason, they are not required to lift during their season for a fear of injury. If we are afraid we are going to injure ourselves lifting weights, we can assume that the program is not well designed.
We cannot expect the re-injure rate of knee problems to decrease if we do not implement the correct lifting strategies in our schools’ programs.
- Physical Therapy will only get the athlete’s knee working back up to its normal capacity and range of motion- not beyond.
Traditional physical therapy programs have been great to keep people accountable after surgery and restoring range of motion. What happens after though? In dealing with athletes, physical therapy only address what is happening right now- not where we need to go in the future. A typical PT visit probably won’t have much ‘exercise’ in general and you will spend a lot of time on the bike and on their table.