ACL Injuries and Young Athletes




Young Athletes Commn Injury

Sooner or later you’re going to get hurt. That’s what happens when athletes train hard and play intensely. But thanks to professionals like Erin Perry, young athletes are returning to action better and faster than ever before. Not to mention, her tips in this article will help you avoid injuries before they happen.


Erin is a sought-after athletic therapist in Toronto, Canada, specializing in pediatric elite athletes. She has worked with the women’s national soccer teams for 8 years, as well as the national gymnastics team, and regional teams including hockey, rugby, soccer, swimming, basketball, and volleyball to name a few. Erin also runs Developing Athletics Canada and the EOS Performance Institute.


Brian: Erin, can you tell us about the young athletes you typically work with and how you got into athletic therapy?


Erin Perry: As a young person, I was athletic, I enjoyed soccer, swimming, rowing, and skiing. I experienced some injuries, but it was the concussions that caused me to ‘hang ’em up’. I figured then and there that if I couldn’t be an athlete, that I would work hard to take care of other athletes in helping them realizing their dreams. Now I specialize in pediatric elite athletes both in clinic and field situations. Their development, training and treatment are my focus. So many injuries that I treat are preventable.


Brian: One of the most common injuries in female athletes is a torn ACL. What are your experiences in treating this injury and your thoughts on injury prevention?


EP: I am so happy that you asked. Most ACL injuries are what we call non-traumatic, which simply means that it is an injury that no contact was made in. For example, a soccer player running down the line with the ball, works to move the ball inside, and suddenly falls down while hearing a pop; an ACL tear. These are all preventable! The number one cause of these types of injuries is tight hamstrings. The three hamstrings should be stretched separately, and when tested in a straight leg raise, attention must be made that the findings are made with the pelvis remaining stationary. As soon as the pelvis rotates posteriorly, the test is negated. Most females have good straight leg raise range of motion, but have poor hamstring flexibility. The difference here is crucial. Normal is 80-90degrees. Please be tested, do the tests, and tell all of your friends and teammates, so that we decrease the incidence of ACLs! The other preventable cause is a muscle imbalance between the quadriceps and hamstrings. I will say that this is crucial, that the three hamstrings need to be strengthened again individually. Closed kinetic chain strengthening should be done all of the time, unless it is a rehab program.


Brian: Is the ACL injury common among all sports?


EP: ACLs are more common in some sports like soccer, basketball, and volleyball, but I have treated athletes from badminton, hockey and gymnastics as well. The bottom line is that all women are susceptible, so if you are athletic at any level, please include prevention exercises as part of your training program.


Brian: Do female athletes come to you with other general injuries or weaknesses? Can you identify any areas in strength and conditioning that the majority of female athletes need to address?


EP: There is a large incidence of lower back pain. Here again is a preventable injury. It makes sense in the big picture that if your back hurts, it is because your abdominal muscles are weak – True and False. It is deeper than that. If you imagine the pelvic wheel in a side view the four quadrants are made up of the abdominals, hip flexors, hamstrings, and low back muscles. If the low back muscles are tight, so will be the hip flexors. This will cause the abdominals and hamstrings to go onto what we call a ‘stretch weakness’. The muscle is on stretch, so it is unable to fire in as well. This causes the pelvis to be vulnerable to an anterior rotation. If we just strengthen the abdominals, we are not treating the cause. We must first stretch the hip flexors and low back muscles to let the pelvis sit in a good postural position, then strengthen. Core training is the next step; transverse abdominus first! Learn to set the powerhouse, and get back to your training. Again – preventable if the training program addresses these issues.


Brian: Okay, let’s get into specific sports. As therapist to the Canadian Women’s National soccer team, what types of non-contact injuries do you see? What are your thoughts on injury prevention for soccer?


EP: I am glad that you asked this. When I started with the team, in 1996, there were lots of these kinds of injuries – which is hard to deal with when they don’t get great treatment at home, and depend on the National team therapist to ‘fix it’ when we have 2 training (sessions) per day. So, when I became full time in 2000, I integrated an Orthopedic Screening where I assessed the strength and length of muscles that could affect these repeating injuries. Since then, I have not seen any insidious onset injuries. We do ‘maintenance checks’, but that’s about it. Every injury that can be prevented, should be – otherwise, we have neglected athletes that are missing training, or training with poor biomechanics.


Brian: Next, for all of our runners, can you identify the most common running injuries? Are they all related to overuse, and if so, is there a certain "mileage" at which injuries seem to be more prevalent?


EP: Shin splints and low back pain – hands down. Shin splints are another preventable injury. The most common cause is a muscle imbalance between the anterior (front) and posterior (back) muscles of the shin. Their job is to stabilize the arch while it rises and falls in normal gait, which is amplified in running gait. So include a stretch for the most important calf muscle, the tibialis posterior. For this, do the normal "wall leaning calf stretch" with the addition of your back foot pointed inward, and then bend that back knee. Again, we have a muscle imbalance. Adding a few strengthening exercises to your training program is an easy way to prevent or treat shin pain: walking for 20 seconds of each of the following; on your heels, with your toes pointed out, then in, then on your toes with your toes pointed out, and then in. This is a total of 80 seconds to insure healthy shins. Shoes are key, (the right shoe for your foot and training, and getting rid of them when they wear out), as is where you run – my general rule is balance out your body – make it equal. If you run on roads or a track, alternate the route by running the opposite direction. The muscles have amazing memory – if they have pain, they will stop doing that action, if they are constantly stimulated, they will learn to adapt. The number one cause of non- traumatic running injuries is jumping of the curb to pass a passerby with a dog or a stroller. The landing hard on an extended leg causes the SI (sacro-iliac) joint to absorb (or not) the stress – so balance out by running the opposite direction next time – or by doing a self SI-joint mobilization. By putting one foot up on a 2nd stair or the bumper of a car, and leaning forward with both hands towards the opposite foot – you will be mobilizing the SI joint that is up. Hold for 20-30 seconds, and do this on both sides after your run, and refer to the above about back pain.


Brian: Any other sports or injuries that you would like to address?


EP: Growing pains is one of the main things parents bring their young athletes to me for. Knee pain is the most common. If we learn about how we grew, a lot of injuries begin to make sense. We are not born with a kneecap. It starts out as cartilage and becomes a bone by the time we are about 4 years old. The patella is called a sesamoid bone, and it grows inside the quadriceps (front of the thigh muscle) – so, any changes to the quads will cause the patella to shift. As we grow, the bones get longer, so that we get taller. If the thighbone gets longer, then the quadriceps is stretched over the new length, which pulls the patella up, which hurts. So, lots of quadriceps stretching during a growth spurt is key for treating or preventing knee pain.


Brian: Thanks Erin. Anything else you would like to mention?


EP: Stretching – everyone does it, or knows that they should – but it is not being done correctly. A long time ago, someone said that stretches should be held for 30 seconds. It depends on when, and what you are doing.


Stretching this long is for rehabilitation – it turns off the muscle. You don’t want the muscle to be off when you are about to use it, so before training, please only hold the stretch for 10 seconds, with many repetitions, and only if you need to. Dynamic flexibility is more functional, and a better way to warm-up. After your training session – then hold the muscle stretches in static positions for 30 seconds. And once a week, address the myofascia component with 90-second stretches or yoga.




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9 Responses

  1. Jerry says:

    This was a great post and an area many people say is being addressed but in reality it usually is not.

  2. Dr. Hubel, ATC, CSCS, NASM-PES says:

    Erin’s information certainly is a start for the needs of young athletes (especially females) when it comes to preventing injuries to various body parts, specifically the ACL. The ACL has been beaten to death in terms of researchers looking for the exact cause (biomechanical, anatomical, physiological, etc.). Stretching the quadriceps and the hamstring muscle groups is critical in prevention of sport specific injuries in growing athletes but we need to keep in mind the importance of PROPRIOCEPTIVE exercises for the development of the neurological aspects of athletic development. Kids tend to participate in proprioceptive activities in “play” including combinations of plyometrics and proprioceptive exercises. Complete Athletic Development does contain a number of exercises for coaches to implement into their programs to strengthen muscles, as well as to develop the proprioceptive capabilities of these developing athletes. I highly encourage coaches to explore these exercises and implement them as a part of their overall training program. Having torn an ACL as a 13-year-old basketball player as the result of a noncontact event has given me a greater appreciation for the need to develop the athlete’s entire mechanical system rather than segmented chunks. Get them off the couch/computer and into the gym or onto a field!

  3. pat elias says:

    Good over all advise. As a PA at Miami Childrens Orthopedics ,I see hundreds of kids a week with similar complaints. We are always happy to refer our patients to educated therapists around the county. But BEWARE.A therapists is not a doctor-orthopedic surgeon.Well intentioned therapists -trainers miss diagnose orthopedic conditions all the time.Growing pains can be confused for any number of conditions requiring urgent medical care( tumors , infections,etc).Parents need to rely on experts in pediatric orthopedics/sports medicine not overzealous trainers.

  4. Excellent information from both Erin Perry and Dr. Hubel. I have also found that addressing hip strength that decreases valgus stress at the knee is very beneficial to ACL prevention.
    There is some thought now that ACL injuries have a direct link to a tight fascial chain that starts at the Thoracolumbar-dorsal fascia (attarchment of the “lats”).
    Complete Athlete Development is a great way to start!


  5. Will says:

    Always a pleasure to be reminded, taught something new or affirmed in what we’re doing- many thanks to the team at IYCA!

  6. Andreas says:

    Great information.

    I was just wondering how do you stretch and strengthen individually the hamstring muscles?

    Do you just change your body position?


  7. muscle to bone says:

    muscle to bone…

    Your topic Why women should train with weights – weight training, strength … was interesting when I found it on Wednesday searching for muscle to bone…

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