How to reduce the risk of Anterior Cruciate Ligament Injuries of the Knee

Just wanted to remind people to think about this type of injury. It is really important that young players and parents remember this is just as important as any soccer training you can get.

How to reduce the risk of Anterior Cruciate Ligament Injuries of the Knee

Tens of thousands of serious knee injuries occur in female collegiate and high school athletics each year. The majority of these injuries (80%) are non-contact injuries. These injuries often occur while landing from a jump or pivoting when running.



A number of studies have unequivocally demonstrated that female athletes who participate in jumping and cutting sports are about five times more likely to sustain serious knee injuries than males. The anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament all connect the femur and tibia together and keep the knee stable. The lateral collateral ligament connects the femur and fibula. The anterior cruciate ligament (ACL) controls pivoting and “sliding” motion of the knee and, along with the quadriceps and hamstrings muscles, helps stabilize the joint. Patients who tear this ligament often have an unstable knee that can collapse, causing falls and further damage to the knee. ACL tears usually require surgical reconstruction in order to resume the ability to play at a high level.


The cost of serious knee injuries in female athletes may reach $100 million at both high school and collegiate levels in the United States, where over two million females participate in high school sports. Therefore, even though high school female knee injury rates are only about one-tenth as high as for collegiate females (approximately one knee injury per 100 participants), athletic participation at the high school level is expected to account for twice as many injury occurrences yearly (over 20,000 knee injuries) as are found at the collegiate level.



WHY THE HIGHER INJURY RATES? Three theories: anatomy, hormones, training.



Some reports attribute injury rate differences to physiological differences, such as increased joint laxity among women, while others refute this claim. Several reports suggest that the hormone estrogen is directly involved in increased female injury rates. It has also been argued that anatomical differences in pelvic structure and lower extremity alignment (i.e. Q-angle) may account for differences in male and female injury rates. These have not been shown to be statistically significant factors.



The training theory: here is where we can make a difference!



A consensus group of members from the American Orthopaedic Society for Sports Medicine, Orthopaedic Research and Education Foundation, National Athletic Trainers Association Research and Education Foundation and the National Collegiate Athletic Association, concurred that while there is not presently a "clear understanding of the cause of noncontact ACL injuries…prevention programs designed to increase neuromuscular control, improve balance and teach avoidance strategies for at-risk situations appear to be effective in decreasing injury rates." Jump training programs incorporating stretching, plyometric exercises and weight lifting have been advocated to increase performance and decrease injury risk in competitive athletes in jumping sports.

Biomechanical studies have shown that decreased neuromuscular strength and coordination in the musculature that stabilizes the knee joint may be responsible for this increase in injuries. A biomechanical study showed that males activate their knee flexors at three times the level of females during landing from a jump. It also showed that the female hamstrings were significantly weaker than males prior to training. With a “jump training” program, females showed increased hamstrings strength and improved ability to control dangerous forces at the knee.

The hamstrings and calf muscles are the key to decreasing dangerous torques and impact forces. Another biomechanical study demonstrated a marked imbalance between hamstrings and quadriceps strength in female athletes prior to training. A plyometric, stretching and strength training program was demonstrated to decrease peak landing forces by decreasing varus (tendency to bow outward) and valgus (tendency to bow inward) forces at the knee. The program also significantly increased hamstrings power and strength, increased hamstrings to quadriceps peak torque ratios, and decreased hamstrings side-to-side strength imbalances. Such training, if effectively used on a widespread basis, might help to significantly decrease the number of athletes injured each year.



CHESAPEAKE ORTHOPAEDIC & SPORTS MEDICINE CENTER

Comprehensive Orthopedic Care for Your Family

Dear Coach:



I am pleased to introduce the Santa Monica Prevent Injury / Enhance Performance (PEP) program. I am working with the Santa Monica Orthopedic Group to bring this important Anterior Cruciate Ligament (ACL) Knee injury prevention program to Maryland. Over the last two years, this has been used at nine Division One college soccer programs. The Southern California Soccer Olympic Development Program has begun to use it as well. This Warm-up / Training program has been shown to help reduce the risk of ACL injuries and has the added benefit of improving athletic performance.

Maryland State Youth Soccer Association Olympic Development Program coaches were given this tape to use for their practices this past spring.

As a coach of girls, and father of two soccer players, I am personally as well as professionally aware of the need to reduce injury risk as much as possible.

Over the last several years, it has become increasingly known that in soccer, basketball and other competitive sports, the incidence of ACL injuries in girls / women is two to eight times greater than that seen in men. Extensive research as been done to evaluate the reasons for this and to look for solutions.

Neuromuscular training programs that incorporate agility, plyometrics, avoidance of riskier knee / leg positions combined with overall strengthening have been shown to reduce the incidence of ACL injuries in women. This Santa Monica program is particularly well suited to youth and high school athletics. It is specific, well documented and easy to set up as a warm-up / strengthening program for practices.

For further details about ACL injury prevention and other sports medicine topics, please see the public information web site for our practice: www.orthopedicdoc.net.

Please let me know if I can be of any other assistance to you.

Best wishes for a safe and successful season.



Sincerely yours,



Jim York







The Santa Monica PEP Program: Prevent injury and Enhance Performance



This prevention program consists of a warm-up, stretching, strengthening, plyometrics, and sport specific agilities to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint. It is important to use proper technique during all of the exercises. The coaches and trainers need to emphasize correct posture, straight up and down jumps without excessive side-to-side movement, and reinforce soft landings. This program should be completed 2 to 3 times a week at a minimum.



The field should be set up 10 minutes prior to the warm-up. This will allow for a smooth and quick transition between all of the activities. A sample field set-up has been included in your packet.



This program should take approximately 15 minutes to complete. Along side each exercise you will notice a box with the approximate amount of time that should be spent on each activity. This will serve as a guideline to you in order to conduct your warm-up in a time efficient manner.



1. Warm-up: Warming up and cooling down are a crucial part of a training program. The purpose of the warm-up section is to allow the athlete to prepare for activity. By warming up your muscles first, you greatly reduce the risk of injury.



A. Jog line to line (cone to cone): Elapsed Time: 0 - 0.5 min.

Purpose: Allows the athletes to slowly prepare themselves for the training session while minimizing the risk for injury. Educate athletes on good running technique; keep the hip/knee/ankle in straight alignment without the knee caving in or the feet whipping out to the side.

Instruction: Complete a slow jog from near to far sideline



B. Shuttle Run (side to side) Elapsed Time: 0.5 to 1 min.

Purpose: engage hip muscles (inner and outer thigh). This exercise will promote increased speed. Discourage inward caving of the knee joint.Instruction: Start is an athletic stance with a slight bend at the knee.

Leading with the right foot, sidestep pushing off with the left foot (back leg). When you drive off with the back leg, be sure the hip/knee/ankle are in a straight line. Switch sides at half field.



C. Backward Running Elapsed Time: 1 -1.5 min.

Purpose: continued warm-up; engage hip extensors/hamstrings. Make sure the athlete lands on her toes. Be sure to watch for locking of the knee joint. As the athlete brings her foot back, make sure she maintains a slight bend to the knee.

Instruction: Run backwards from sideline to sideline. Land on your toes without snapping the knee back. Stay on your toes and keep the knees slightly bent at all times.



2. Stretching: It is important to incorporate a short warm-up prior to stretching. Never stretch a "cold muscle". By doing the exercises outlined here, you can improve and maintain your range of motion, reduce stiffness in your joints, reduce post exercise soreness, reduce the risk of injury and improve your overall mobility and performance.



Do a large muscle warm-up such as brisk walking for five to 10 minutes before stretching.
· Don't bounce or jerk when you stretch. Gently stretch to a point of tension and hold.

Hold the stretch for 30 seconds. Concentrate on lengthening the muscles when you're stretching.
Breathe normally. Don't hold your breath.

A. Calf stretch (30 seconds x 2 reps) Elapsed Time: 1.5 to 2.5 min.

Purpose: stretch the calf muscle of the lower leg

Instruction: Stand leading with your right leg. Bend forward at the and place your hands on the ground (V formation). Keep your right knee slightly bent and your left leg straight. Make sure your left foot is flat on the ground. Do not bounce during the stretch. Hold for 30 seconds. Switch sides and repeat.



B. Quadricep stretch (30 seconds x 2 reps) Elapsed Time: 2.5 to 3.5 min.



Purpose: stretch the quadricep muscle of the front of the thigh

Instruction: Place your left hand on your partner's left shoulder. Reach back with your right hand and grab the front of your right ankle. Bring your heel to buttock. Make sure your knee is pointed down toward the ground. Keep your right leg close to your left. Don't allow knee to wing out to the side and do not bend at the waist. Hold for 30 seconds and switch sides.



C. Figure Four Hamstring stretch (30 sec x 2 reps) Elapsed Time: 3.5 - 4.5 min



Purpose: To stretch the hamstring muscles of the back of the thigh.

Instruction: Sit on the ground with your right leg extended out in front of you. Bend your left knee and rest the bottom of your foot on your right inner thigh. With a straight back, try to bring your chest toward your knee. Do not round your back. If you can, reach down toward your toes and pull them up toward your head. Do not bounce. Hold for 30 seconds and repeat with the other leg.



D. Inner Thigh Stretch (20 sec x 3 reps) Elapsed Time: 4.5 - 5.5 min



Purpose: Elongate the muscles of the inner thigh (adductor group)

Instruction: Remain seated on the ground. Spread you legs evenly apart. Slowly lower yourself to the center with a straight back. You want to feel a stretch in the inner thigh. Now reach toward the right with the right arm. Bring your left arm overhead the stretch over to the right. Hold the stretch and repeat on the opposite side.



E. Hip Flexor Stretch - (30 sec x 2 reps) Elapsed Time: 5.5- 6.5 Min



Purpose: Elongate the hip flexors of the front of the thigh.

Instruction: Lunge forward leading with your right leg. Drop your left knee down to the ground. Placing your hands on top of your right thigh, lean forward with your hips. The hips should be square with your shoulders. If possible, maintain your balance and lift back for the left ankle and pull your heel to your buttocks. Hold for 30 seconds and repeat on the other side.



3. Strengthening: This portion of the program focuses on increasing leg strength. This will lead to increased leg strength and a more stable knee joint. Technique is everything; close attention must be paid to the performance of these exercises in order to avoid injury.



A. Walking Lunges (3 sets x 10 reps) Elapsed Time: 6.5 -- 7.5 min



Purpose: Strengthen the thigh (quadriceps) muscle.

Instruction. Lunge forward leading with your right leg. Push off with your right leg and lunge forward with your left leg. Drop the back knee straight down. Make sure that your keep your front knee over your ankle. Control the motion and try to avoid you front knee from caving inward. If you can't see your toes on your leading leg, you are doing the exercise incorrectly.



B. Russian Hamstring (3 sets x 10 reps) Elapsed Time: 7.5--8.5 min



Purpose: Strengthen hamstrings muscles

Instruction: Kneel on the ground with hands at your side. Have a partner hold firmly at your ankles. With a straight back, lead forward leading with your hips. Your knee, hip and shoulder should be in a straight line as you lean toward the ground. Do not bend at the waist. You should feel the hamstrings in the back of your thigh working. Repeat the exercise for 3 sets of 10, or a total of 30 reps.



C. Single Toe Raises (30 reps x 2 reps) Elapsed Time: 8.5 - 95 min



Purpose: This exercise strengthens the calf muscle and increases balance.

Instruction: Stand up with your arms at your side. Bend the left knee up and maintain your balance. Slowly rise up on your right toes with good balance. You may hold your arms out ahead of you in order to help.

Slowly repeat 30 times and switch to the other side. As you get stronger, you may need to add additional repetitions to this exercise to continue the strengthening effect of the exercise.



4. Plyometrics - These exercises are explosive and help to build, power, strength and speed. The most important element when considering performance technique is the landing. It must be soft! When you land from a jump, you want to softly accept your weight on the balls of your feet slowly rolling back to the heel with a bent knee and a straight hip. These exercises are basic, however, it is critical to perform them correctly. Please take the time to ensure safe and correct completion of these exercises.



A. Lateral Hops over Cone (20 reps) Elapsed Time: 9.5 - 10min.



Purpose: Increase power/strength emphasizing neuromuscular control

Instruction: Stand with a 6" cone to your left. Hop to the left over the cone softly landing on the balls of your feet land bending at the knee. Repeat this exercise hopping to the right.



B. Forward/Backward Hops over cone (20 reps) Elapsed Time: 10 - 10.5 min

Purpose: Increase power/strength emphasizing neuromuscular control

Instruction: Hop over the cone/ball softly landing on the balls of your feet and bending at the knee. Now, hop backwards over the ball using the same landing technique. Be careful not to snap your knee back to

straighten it You want to maintain a slight bend to the knee. Repeat for 20 reps.



C. Single Leg hops over cone (20 reps) Elapsed Time: 10.5 -11 min.



Purpose: Increase power/strength emphasizing neuromuscular control.

Instruction: Hop over the cone/ball landing on the ball of your foot bending at the knee. Now, hop backwards over the ball using the same landing technique. Be careful not to snap your knee back to straighten it. You

want to maintain a slight bend to the knee. Repeat for 20 reps. Now, stand on the left leg and repeat the exercise. Increase the number of repetitions as needed.



D. Vertical Jumps with headers (20 reps) Elapsed Time: 11 -11.5 min.



Purpose: Increase height of vertical jump.

Instruction: Stand forward with hands at your side. Slightly bend the knees and push off jumping straight up. Remember the proper landing technique; accept the weight on the ball of your foot with a slight bend to the knee. Repeat 20 times and switch sides.



E. Scissors Jump (20 reps) Elapsed Time: 11.5 –12 min.



Purpose: Increase power and strength of vertical jump.

Instruction: Lunge forward leading with your right leg. Keep your knee over your ankle. Now, push off with your right foot and propel your left leg forward into a lunge position. Be sure your knee does not cave in or out. It should be stable and directly over the ankle. Remember the proper landing technique; accept the weight on the ball of your foot with a slight bend to the knee. Repeat 20 times.



5. Agilities

A. Shuttle run with forward/backward running Elapsed Time 12-13 min.

Purpose: Increase dynamic stability of the ankle/knee/hip complex

Instruction: Starting at the first cone, sprint forward to the second cone, run backward to the third cone, sprint forward to the fourth cone (etc...).



B. Diagonal runs (3 passes) Elapsed Time 13-14 min.



Purpose: To encourage proper technique/stabilization of the planted foot to deter the position from occurring.

Instruction: Face forward and run to the first cone on the left. Pivot off left foot and run to the second cone. Now pivot off the right leg and continue onto the third cone. Make sure that the outside leg does cave in. Keep a slight bend to the knee and make sure the knee over the ankle joint.



C. Bounding run (44 yds.) Elapsed Time 14 -15 min.

Purpose: To increase hip flexion strength/increase power/speed

Instruction: Starting on the near sideline, run to the far side with knees up toward chest. Bring your knees up high. Land on the ball of your foot with a slight bend at the knee and a straight hip. Increase the distance as this exercise gets easier.



6. Alternative Exercises- Warm Down and Cool Down

We all know how imperative a cool down is. Please don't skip it. It allows the muscles that have been working hard

throughout the training session to elongate and deters the onset of muscle soreness. Please emphasize the importance of adequate fluid intake (optimally water). Athletes should have a water bottle by their side during the cool down. The

cool down should take approximately 10 minutes. It should begin with a slow jog to allow the heart rate to come down before stretching. This should be followed by some light strength training exercises. We are recommending two strengthening exercises (see below). Finally, stretch the hamstrings, calves, inner thigh, quadriceps, and low back (all of these are explained in the protocol). In addition to those basic stretches, we are offering some additional stretches to target 3 muscle groups that are often forgotten.



A. Bridging with Alternating Hip Flexion (30 reps)

Purpose: Strengthen outer hip muscles (Hip abductors, flexors) and buttocks

Instruction: Lie on the ground with your knees bent with feet on the ground. Raise your buttocks up off the ground and squeeze. Now, lift your right foot off the ground and make sure that your right hip does not

dip down. Lower your right foot and now lift your left foot making sure your left hip does not dip down. Repeat 30 times on each side. As you get stronger, you will place your feet on top of a ball and repeat the

exercise.



B. Abdominal Crunches (30 reps x 2 reps)

Purpose: Strengthen the abdominals (rectus abdominus, obliques)

Instruction: Lie on the ground with you knees bent. Place your hands behind your head with your elbows out wide. Support your neck lightly with your fingers. Take a deep breath in and slowly contract your abdominal muscles as you exhale. Repeat 30 times. Drop your legs off to the right side. Slowly crunch up with your elbows out wide. You should feel your oblique muscles working on the side of your waist. Repeat 30 times and switch to the other side.



C. Single and Double Knee to Chest (supine) (30 sec x 2 reps)

Purpose: Elongate the low back muscles

Instruction: Lie on your back. Bring your right knee toward your chest and hug firmly. Keep your left leg out straight in front of you. You should feel a stretch along your low back and into your buttocks. Hold the stretch for 30 seconds and switch sides. Now bring both knees to chest. If you feel any pain in the low back, discontinue the stretch and inform your coach/trainer.



D. Figure Four Piriformis stretch- supine (30 sec x 2 reps)

Purpose: Elongate the rotators of the hip.

Instruction: Lie on your back and bend both of your knees. Fold your left ankle over your right knee. Place your hands behind your right thigh and pull your right knee to chest. You should feel a good stretch in the left gluteals region and the side of the thigh. Hold for 30 seconds and repeat on the other side. If you experience and low back pain with this stretch, slowly lower your legs down and let your coach/trainer know.



E. Seated Butterfly stretch - seated (30 sec x 2 reps)

Purpose: Elongate the inner thigh muscles (adductors).

Instruction: Sit up bringing your feet in so that the soles of your feet are touching. Gently place your elbows on your knees and slowly push down. You should feel a good stretch of the inner thigh. Hold this for 30 seconds and repeat 2 to 3 times.

Something very simple that I am always telling the girls I train - even my young 05s - is to bend their knees while practicing their skills. Many girls run and train with their legs straight, putting stress on their knees; also, this does not help build the quad & hamstring muscels needed to protect their knees. By simply reminding them to bend their knees and stay close to the ball, these girls can develop more strength in their knees and supportive muscles.

Hope this tip helps!


Becca Moreno
Dallas Texans 00g White
Dallas Texans Academy 05g

Great read... I would add that the reason we are seeing an increase in ACL injuries in Texas is due to the amount of games that are being played on sport turf, (artificial turf).

Turf is a soccer player's worst friend.

We received the unfortunate news on yesterday that my older DD who plays for the 97 girls ODP team and is a 98 who plays for FCD tore her ACL in the President's Cup tournament a couple weeks ago. She is very active in sports. She not only plays club soccer, she also plays high-school basketball and runs track. This was very disappointing news to us as we don't know what to expect and what the future holds for her now in sports.

Have any other forum reader's experienced this? If so, how long was the recovery period? Who performed your DD's surgery? After recovery is/was the DD able to function at the same level as they did before the surgery? I have heard that with surgery, they may generally come back stronger. Is this true?

The orthopedic doctor she is seeing said she has a pretty long road ahead of her and her recovery period could be up to 9 months. She is to undergo surgery in 2 weeks but I'll like to have as much knowledge as I can from others who have gone through the same thing. The doctor said without surgery she would be done with soccer and basketball forever but may be able to still run track.

Any advice that can be offered will be most appreciated. Feel free to PM me if you do not want to post here.

Thanks.

A very concerned and scared parent.

The rehab can be long and painful (9 mo.), but in most cases, the repaired ligament will be stronger than before. Once rehabbed, gaining the confidence to actually go full blast on the knee was tougher than any stress actually put on the knee.

Our surgeon has retired, so can't recommend.

It sounds like your DD is a dedicated, strong athlete. I know it probably feels to her right now that her world is ending. Its not. Try to stay positive, work at the rehab like she's worked to get where she is as an athlete today and she'll be back better than ever.

Gunner9 wrote:The rehab can be long and painful (9 mo.), but in most cases, the repaired ligament will be stronger than before. Once rehabbed, gaining the confidence to actually go full blast on the knee was tougher than any stress actually put on the knee.

Our surgeon has retired, so can't recommend.

It sounds like your DD is a dedicated, strong athlete. I know it probably feels to her right now that her world is ending. Its not. Try to stay positive, work at the rehab like she's worked to get where she is as an athlete today and she'll be back better than ever.

Gunner thanks for this feedback. It's always very hard when one doesn't know what to expect. While she is kind of down and out, I don't think the reality has really set in for her on what she is up against. I've heard stories with positive outcomes and others that weren't so positive. I think I am more depressed and scared than she is. The simple thought of surgery and the long recovery has me on pins and needles.

I can only hope and pray that everything works out for the best. She is a tough girl and amazing athlete and I hope she can keep a positive attitude and have a major comeback from this setback.

If it makes you or your daughter feel any better, Alex Morgan tore her ACL in high school, rehabbed it, and that worked out just fine.

This book by Dr. James Andrews came out a few months ago. Haven't had the chance to read it but it might have some good information.

http://www.amazon.com/Any-Given-Monday-Injuries-Athletes/dp/1451667086/ref=sr_1_1?ie=UTF8&qid=1364523697&sr=8-1&keywords=any+given+monday


Just as a forewarning, I do know he is against year-round sports specialization. All the proceeds from this book are going to the STOP (Sports Trauma-Overuse Prevention) Campaign.

Busby Babes wrote:Great read... I would add that the reason we are seeing an increase in ACL injuries in Texas is due to the amount of games that are being played on sport turf, (artificial turf).

Turf is a soccer player's worst friend.

. I could not agree more! The only game that should be played on an artificial surface is putt-putt.

Gumby wrote:

Busby Babes wrote:Great read...  I would add that the reason we are seeing an increase in ACL injuries in Texas is due to the amount of games that are being played on sport turf, (artificial turf).

Turf is a soccer player's worst friend.

.       I could not agree more!  The only game that should be played on an artificial surface is putt-putt.  

I think the turf in texas is driven by two things.... football and $$$$. It's unfortunate but it is easier on the maintenance and costs...

One contributing factor to keep in mind that's easily over looked is Overtraining.  A fatigued body is not always a strong body!!

soccer_mom_tx19 wrote:I think it's way more important to push your kids to be the absolute best they can be, both physically and mentally. Yes, stretching and warmups are necessary, but the most important thing is going 110% every second you're on the field. Injuries can and will happen, but that's no reason to play half-speed. I'd really like to see an increase in intensity on the field from some of the girls. It's just difficult when some players and parents don't take the game as seriously as others. Such is life!

jack, is that you?

soccerisfun wrote:

soccer_mom_tx19 wrote:I think it's way more important to push your kids to be the absolute best they can be, both physically and mentally. Yes, stretching and warmups are necessary, but the most important thing is going 110% every second you're on the field. Injuries can and will happen, but that's no reason to play half-speed. I'd really like to see an increase in intensity on the field from some of the girls. It's just difficult when some players and parents don't take the game as seriously as others. Such is life!

jack, is that you?

No, I'm too busy laughing. Wipe that smile off your face and give me more intensity. Soccer is not about giving your best because you enjoy it and like to compete its about being pushed harder.

If you have to push a kid at a sport or hobby then maybe just maybe they aren't doing it for themselves anymore. The joy is gone...I do it for mom.

The reason players get ACL injuries is because they are not taught how to properly run at a young age.

When you are running and change direction to your left, you should push off on your RIGHT leg, and vise versa for going to the right.

Many girls, and some boys, tend to want to push off of the same side leg when changing direction. Meaning if they want to go left they push off with their left leg causing the knee to twist. This causes torque on the knee as it twists. Also, the twisting motion is to the outside of the knee, which is an unnatural direction for the knee to move.

Where this will not injure the player at a young age (think middle school or lower) it does cause slight tearing on the connective tissue of the knee that helps stabilize the knee and help keep things together.

As the player matures and gets older and continues to run improperly they keep tearing that connective tissue. Their muscles in the leg get stronger and stronger as well.

The combination of added muscular strength and weakened connective tissue in the knee is a recipe for disaster. With more muscular strength the muscles are able to apply more power and force to the twisting action to the knee. With damaged connective tissue to help stabilize the knee all the torque is put on the ACL and/or the MCL. Ligaments can only take so much before they snap, and too much torque causes the ligament to snap.

What's sad is that this could all be corrected if coaches teach players how to run and change direction properly at a young age.

2ddsinsoccer wrote:We received the unfortunate news on yesterday that my older DD who plays for the 97 girls ODP team and is a 98 who plays for FCD tore her ACL in the President's Cup tournament a couple weeks ago.  She is very active in sports.  She not only plays club soccer, she also plays high-school basketball and runs track.  This was very disappointing news to us as we don't know what to expect and what the future holds for her now in sports.

Have any other forum reader's experienced this?  If so, how long was the recovery period?  Who performed your DD's surgery?  After recovery is/was the DD able to function at the same level as they did before the surgery?  I have heard that with surgery, they may generally come back stronger.  Is this true?  

The orthopedic doctor she is seeing said she has a pretty long road ahead of her and her recovery period could be up to 9 months.  She is to undergo surgery in 2 weeks but I'll like to have as much knowledge as I can from others who have gone through the same thing.  The doctor said without surgery she would be done with soccer and basketball forever but may be able to still run track.  

Any advice that can be offered will be most appreciated.  Feel free to PM me if you do not want to post here.  

Thanks.

A very concerned and scared parent.      

I did not tear my 100%, but had partial tearing and really strained my ACL playing indoor soccer a few years ago.

The road to recovery was tough, and I did not tear my clean through.

The recovery period including surgery can take close to a year before they can come back. I will say, if the Physical Therapist tells you do something a certain way... DO IT. If they tell you to do 1000 squats before bed... do it no questions. They know what's best for the recovery.

It will be very frustrating at first. Your daughter will want to run and play, but physically won't be able to. Don't allow her to do things she is not ready for until the PT clears her. You don't want to hurt the knee again and start all over from square 1 again.

The toughest thing is going to be the mental aspect of recovery. Your daughter will not trust the knee anymore. This is something you will have to encourage her to get through. She won't fully get over her distrust till she's back out playing on it, but just keep telling her that it will be fine and that the knee is just as good as it used to be.

Biggest thing is STAY POSITIVE throughout the whole process!

BESS Protocol has taught us over the past 15 years that poor balance denotes an increase in lower orthopedic injury risk. This is easily measured objectively and improved through Physical Therapy or Core Stabilization Strength/Balance exercises. Prevention is key so learn this when the athlete is younger if they have poor balance.

I tore my first ACL at 13. recovery took a year due to growth plate issues postponing surgery. I played for one year before tearing my other one (this is also a common theme, just FYI). Its a tough road to recovery, the new ACL's have held up incredibly well (I went on to play D1 soccer on a full ride) . That being said, I have also had five scopes since then as well. Anytime you go under the knife you have to deal with scar tissue. That and a combination of playing at a high level for many years post surgery and I am left with two fairly bummed knees. The price you pay for playing the game you love. I wouldn't change it and would make the same decisions, but my ortho surgeon said that i can expect to be back in every five years or so until a knee replacement. Find a doctor you trust, as there's a chance (just being real) you will be seeing him again. I have had the same one for 20 years. Would recommend but I imagine he'll be retiring soon.

soccer1182 wrote:I tore my first ACL at 13. recovery took a year due to growth plate issues postponing surgery.

I'm convinced athletes are more prone to injury during those growth spurts.

It seems like most of these coaches know soccer, but lack an understanding of general fitness and recovery. All training should be a sweet spot of frequency, volume, and intensity. As one goes up, the others need to go down. No offense intended with the proceding statement. Parents need to consider the specific athlete. The more explosive (intense) an athlete, the more likely they are to get injured. As previously stated, if intensity is very high, volume and/or frequency need to be dialed down. If an athlete is dealing with an injury, they probably can't do intensity or volume, but maybe they can do frequency.

My apologies if this isn't the best place for training/recovery advice. Well-wishes to all those dealing with injury!

Injury, pain, bone broken: These factor finish player to play.

Best recommendation: Play Safe, Do training from best academy.