Saturday, December 21, 2013

Derrick Rose, Rob Gronkowski, and the Rise in ACL Tears - Grantland

Dr. Robert Litchfield, medical director of the Fowler Kennedy Sport Medicine Clinic at the University of Western Ontario and part of the Canadian Alpine Ski Team medical group, studied videotape of ACL injuries and found a pattern. He found that those who tore their ACLs all did the exact same thing with their legs when they were avoiding a defender or reacting to an offensive player. "They throw it [the injured limb] out to the side, and they try to make an upper-body move where they move away from the side that they've just planted," he says. "And they get to what we call a `point of no return.'" The knee misaligns, turns inward, and the athlete lands knock-kneed. That is when you hear the pop. That is why, Dr. Litchfield believes, an athlete like LeBron James will never suffer a tear. "When he comes down from a dunk, he comes down very low and powerfully versus coming down on an extended leg." In short, LeBron's legs are bowed, and athletes who bow their legs generally don't tear their ACLs.

This one is a very personal issue for me - tore my ACL in 1989.  I was going over the 8 foot wall, came down a bit awkwardly and the sand under my left foot shifted.  The "POP" they reference in the article - yeah, it's wild.  You know in a moment that something is not right.  Weirdly they did not diagnose my blown ACL right then, which resulted in several pivot shift injuries over the following years.  Then in 1992, not knowing my knee was unstable, I tried skiing.  That quickly lead to a nasty tear of the meniscus.  With the meniscus tear and no ACL, my knee was so unstable that I couldn't walk a quarter mile without knee pain.  Not good.

I finally talked the Navy into a repair in 1995, and my knee has generally improved every year since then.  In 2007, I got to a point that I could no longer run more than 3 miles or so.  Then, I began CrossFit, and the resulting gains in hamstring strength, range of motion, and movement skill (running using the POSE method, and no longer heel striking, was a big help).  POSE walking also turned out to be a huge help - when I used to walk with long strides, and a fully extended knee on each step, my knee would fill with fluid.  The resulting Baker's cyst would swell and be painful for days.  Using the POSE ideas of never extending the knee, and instead, using gravity to help one fall off of the foot that is underneath you, I can walk without fear of pain.  My latest test was a 13 miles hike in mountain of Utah with about 30 pounds of gear, up and down at ~6500 MSL.  The next day - nothing!  It was awesome.

There are several elements of knee injury.  I thought the quote above was the most telling in the article, because it points to body position as the most significant factor in ACL injury.  I think we will see athletes who are taught solid positioning through CrossFit and CrossFit Kids will see reduced incidence of ACL injury.  Additionally, since the hamstrings help the ACL position the body and the knee (tight hamstrings pull the tibia towards the hip, reinforcing the ACL's work of preventing the femur from sliding off of the back of the tibia), those who are strong in the hamstrings from skillful work with squats and deadlifts will have an advantage in injury prevention.  Athletes can do amazing things with quad dominant squats and deads, but in the end, that's a poor movement pattern and there will be a price to pay.

The other issue with ACL tears is glycation - those who continually bomb themselves with high sugar diets create weak, glycated tendon attachments which fail at lower stresses.  I think CrossFit and CrossFit Kids athletes who avoid this dietary time bomb will reap the benefit in this way also.

1 comment:

  1. Very informative post. Thanks for taking the time to share your view with us. ACL tear