SOUND MIND, SOUND BODY - Ligament crucial but troublesome

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The anterior cruciate ligament, ACL, is one of four major ligaments of the knee. The ACL is also a prime candidate for victimhood when it comes to knee injuries.

While the knee is considered a "stable" joint between the mobile joints of the hip and ankle, its stability depends on muscular strength of the legs to support dynamic and highly mobile movements.

The ACL is in the center of the knee, and crosses the posterior cruciate ligament, PCL, to create an X. The ACL's main function is to prevent the tibia (shin bone) from sliding out in front of the femur (thigh bone). In addition, the ACL supports rotational dependability of the joint.

Women tend to be more susceptible to ACL injuries.

"Young middle-school and high-school female athletes are four to six times more likely to sustain a non-contact ACL tear versus a male athlete," said Mark McComas, Providence St. Mary Medical Center physical therapist. The difference is due in part to females' pelvic structure resulting in the femur curving inward.

ACL injuries are acute, and it is vital to understand the signs and symptoms to determine what kind of care is necessary.

One of the most common symptoms is the knee "giving way and a feeling of an unstable knee with pain and usually immediate swelling," McComas said.

Acute symptoms also involve a "popping" noise at the time of injury, pain in the back and outside portion of the knee and limited knee movements. Chronic deficiency of the ACL includes the buckling and giving out feeling. Like most things, the ACL weakens with age, so people over 40 are also susceptible to ACL injuries.

If an injury occurs the person should get medical help.

"The athlete or injured person should be evaluated by their medical doctor to assess the injury, order the image studies and determine the course of treatment," McComas said.

Injured people need to practice "RICE" -- rest, ice, compression and elevation -- when dealing with an ACL injury.

"Depending on the degree of injury (treatment) may be surgical repair, knee strengthening, medication or rest amongst other treatments. If surgery is required, there is a rehabilitation process that will be prescribed by the surgeon, which a physical therapist or athletic trainer will direct," McComas said.

Many people wonder if this will be a re-occurring injury. McComas said that if the athlete follows the physician's plan and the rehabilitation process, the chance of re-injury is fairly low.

Understanding the anatomy and physiology of the knee can be challenging. To learn more about strength training for ACL injury prevention ask your doctor, physical therapist or personal trainer.

Elizabeth Kovar has been working in the fitness industry since 2006 with international experience in India and Australia. She has a master's degree in recreation and tourism and is a programs coordinator at the YMCA where she trains, instructs fitness classes and assists in marketing projects. She welcomes questions and comments and can be reached at ekovar@wwymca.org.

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