ACL injuries are still a feared injury for any athlete, despite the advances in rehabilitation that are helping players come back more quickly and more successfully. Recent injuries to the Michigan Wolverines have raised questions about why this is happening and whether it can be prevented, in addition to how players like Jake Ryan and Blake Countess will be able to contribute in 2013 and beyond.
Ryan tore his ACL on a simple play during the first padded practice of spring. The knee was immediately diagnosed with a significant sprain and he had surgery on March 28th. The delay was necessitated by the need to wait for the swelling to reduce and scheduling concerns.The surgery was successful and his rehab began almost immediately.
Even the most optimistic rehab schedule would make it difficult for any player to come back in season. An aggressive time line, along the lines of that followed by the NFL's Adrian Peterson or Wes Welker, would still put Ryan's return at some point in October. A more likely time line of eight to 12 months would cost him the entire season. Since Ryan already redshirted once for non-medical reasons, he is unlikely to gain a sixth year of eligibility. With some saying he was likely headed to the NFL after the season.
As a mobile linebacker, Ryan's need for quick movement, acceleration and explosion works against him in coming back to his pre-injury level. There seems to be a significant difference between the success rate of offensive players versus that of defensive players, with the thinking being that defensive players have to go backwards and have to react rather than knowing where they expect to run.
Fans tend to perceive big-name injuries such as Ryan's out of proportion. Michigan fans could be extra sensitive, after seeing cornerback Countess go down at beginning of last season. Backup quarterback Russell Bellomy also tore an ACL in spring practice.
Is Prevention Possible?
Whenever a serious injury occurs in sport, there are always questions about cause and prevention of the injury. Michigan had three known ACL injuries last season that resulted in the necessity for surgical repair, which is true for almost all ACL injuries. Putting things in perspective, those three injuries were not an unusually high number for a Division I football program. With two more ACL injuries in spring practice, those questions are arising again.
There are three factors that seem most important and are controllable by the program. Those factors are traction interface, bracing and practice time.
A major factor in some injuries is the traction interface, which is a fancy way of saying how the shoe meets the surface. Artificial surfaces such as the FieldTurf that are common in stadiums and on practice fields have had mixed reviews over the years. Some studies have shown that they may reduce the injury risk factor for injuries such as concussions.
However, these surfaces, which are a great improvement over the earlier Astroturf surfaces, do provide more traction than grass, and more is not necessarily always better. That means that when an athlete plants his foot, the foot is going to stop immediately—much like rapidly decelerating a motor vehicle by “jamming” on the brakes. The foot stops, but the leg may continue forward, placing the knee in hyperextension and stretching the anterior cruciate ligament—designed to prevent hyperextension of the knee—beyond its yield point and resulting in sprain of that ligament.
Research has shown that the use of shorter cleats on athletic shoes will cut down on these types of “traction induced” injuries. But shorter cleats accomplish this by reducing traction, meaning the athlete would not be able to stop or change directions as quickly, which might eliminate a potential advantage over his opponent.
The bottom line is that Division I football programs want playing surfaces that will be playable despite the weather, and FieldTurf accomplishes this very well. However, that increased playability may also lead to more risk of traction (non-contact) injuries. Remember that today’s athletes are bigger, stronger and faster than ever, so trying to stop or change directions rapidly puts a great deal of stress on their bodies by simple physics.
The use of bracing is also, somehow, controversial in college sports. Athletes often feel constricted or slowed by braces, but properly fitted modern braces are light and non-constricting while still offering a great deal of protection.
There has been no definitive research study that has concluded that utilizing a brace on the knee of an athlete who has no damage to his ligaments will prevent an ACL injury. This is most likely because any brace that effectively protects the ACL from injury would also limit to some degree those movements necessary to do the types of activities necessary to be successful at elite-level football.
Some studies have shown that such braces have reduced the number of ACL injuries in offensive linemen, but most of the injury risk there is from contact or from another player falling into the lineman, not traction type issues that are often seen with offensive backs, wide receivers, linebackers and defensive backs. Custom braces are very valuable for supporting the knee of an athlete who has had an ACL injury, but much less effective in preventing those injuries.
No Real Offseason, No Real Rest
Finally, we have to address the serious problem of lack of rest. The year-round demands of play, practice and conditioning is potentially the hidden cause of many athletic injuries, including ACL sprains. Elite college athletes basically are unable to give their bodies time to rest and recover from the strenuous activities of their sport. This produces the wear and tear syndrome in which it is not a single dynamic event that causes the injury, but rather constant microtrauma to the structural body part over time that eventually leads to structure failure.
Preseason practice lasts three to four weeks, then the college season lasts 12 weeks, with on-field practice, conditioning and weight training included. Then the possibility of a bowl game extends that season. Instead of a break after the season, it is off to conditioning and weight training in the “offseason,” which lasts until the next preseason practice starts. There is essentially no offseason that would allow these individuals' bodies, young and developing bodies at the college level, the opportunity to rest and repair.
With all of the above considered and the demands of high level college athletes today, it is a wonder that we do not have more debilitating injuries rather than less. So, maybe, when one is looking for the culprit in the increase of injuries in college football, one should possibly begin by looking in the mirror. Alumni and fans put pressure on coaches to win.
Athletic Directors put pressure on the football coach because money from football basically supports the entire athletic program at the university. Coaches put pressure on football players to succeed so the coach can win games and keep his job. It is a vicious circle and probably one of the major causes of injuries in elite college football.
Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and Football Outsiders. This article was written with the assistance of Dr. William Carroll, University of Mobile.