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Lacrosse is one of the fastest-growing sports among young Americans, but injury can be a major setback for many players. It’s not even the body contact that’s the major problem – it’s the risk to the anterior cruciate ligament (ACL) in the knee that the sport’s organizers are concerned about. Yet with the right precautions, this can be a preventable injury.
A study published in July 2014 in The American Journal of Sports Medicine looked at injuries in high school lacrosse players and found that while ankle sprains represented a whopping 21% of all reported injuries for girls and 16% for boys. However, a US Lacrosse report from February 2014 quotes Dr. Richard Hinton, former physician for the US women’s team and a member of US Lacrosse’s Sports Science and Safety Committee, saying, “ACL injuries are the leading cause of game and practice missed time by lacrosse athletes,” There’s an explanation I’m fond of that describes the knee as “the redheaded stepchild in a nasty divorce between the hip and the foot – it did nothing wrong, yet it’s the victim”. A lightly more scientific explanation is, if the muscles of the hip don’t operate efficiently to control the femur (in the thigh), the knee suffers and will collapse in a way that stresses the anterior cruciate ligament (ACL). The ACL’s primary role is to stabilize the knee when turning or planting. “There are any number of places where the knee joint can fail when it is overstressed,” Dr. Hinton said. “There’s a greater potential for injury associated with jump, cut, twist, turn sports.”
Although studies have not yet shown any significant difference between men’s and women’s lacrosse, National Collegiate Athletic Association (NCAA) injury data show that female athletes injure the ACL more frequently than male athletes. Looking at soccer – a similar sport involving field running, planting, turning and some jumping – ACL injuries in women were twice as high as that for men. In basketball, female players are a staggering five to seven times more likely to sustain ACL injuries as men. Some studies suggest that hormonal factors may be involved – when estrogen levels are higher, the ligaments may be looser and offer less protection. Another factor may be that a woman’s ACL may be smaller than a man’s, which could make it more susceptible to fraying or becoming injured, or it could be due to anatomic alignment differences, especially the quadriceps angle. Other findings have shown a difference in neuromuscular control in women when landing jumps, as women appear to have less hip and knee flexion than men.
While more than 90% of surgical procedures on ACL injuries result in excellent clinical outcomes, research indicates less than 70% of athletes return to the same level of play. “Surgery is not a perfect solution, but it does provide the best option to return to lacrosse,” Dr. Hinton said. “Preventing these injuries is a much better answer than operating on them.” Dr. Hinton pointed out that landing techniques can be a big risk factor for knees in lacrosse. He said that athletes must be trained to “land soft and land stacked” (i.e. with weight balanced and anatomically aligned). While hip strength, core strength and coordination also affect susceptibility to injury, all the jumping and changes in direction in lacrosse make it vitally important to land with the proper mechanics and posture that will allow the body to absorb energy instead of it being passed on to the ACL.
The American Council on Exercise advises that while no single exercise can prevent ACL injury, you can give yourself a good shot at protection by developing and maintaining strength and endurance all through your hips and legs. Closed-chain strength exercises such as leg presses, squats and lunges will promote stability in the knee, but it’s also the consistency of the action that’s important – it’s much more important that you can do every rep of these actions without knee or ankle collapse and with the bodyweight balanced and hips, knees and feet aligned than it is to increase the weights. Cardio work to build endurance is also really important, because when we get tired, we get lazy with our technique and balance and are more likely to hurt ourselves. Try cardio work that takes impact off the legs but still relies on good hip-knee-foot alignment, such as using the stairclimber, stationary bike, elliptical trainer or ski machine.
US Lacrosse advocates a dynamic warm-up that features total body, explosive strengthening and ballistic stretching, and warns that static stretching prior to a game or heavy on-field training is not only “not helpful” for injury prevention, it can actually hurt athletic performance. A current pilot study funded by US Lacrosse will identify the most effective exercises to reduce ACL injuries and it will incorporate a 20-minute warm-up of dynamic exercises. Many of these exercises will help players get into the habit of bending their knees with proper mechanics for landings, planting the feet and pivoting. Examples of warm-up exercises and drills that will help are:
HURDLE WALKS FOR HIP AGILITY – walk with one knee out at right angles to your torso, thigh parallel to ground, then swing leg and knee aroundin front of you, as if lifting your leg over a hurdle.
WALKING LUNGE – take a long step, keeping knee behind toes, with chin up and behind the line of your chest.
HOPS BACK AND FORTH OVER A CENTER LINE. Hop from one leg to the other. This exercise can also be done on one leg at a time. With all hopping and bounding exercises, land softly without the ankle or knee collapsing, with the knee over the middle of the foot.
HOPS SIDE-TO-SIDE ACROSS A CENTER LINE (one leg at a time and/or hopping from one leg to the other).
DOUBLE-LEG BOUNDS – in a straight line aiming for targets, and also in a zig-zag pattern.
‘SPEED SKATER’ – bounding in a zig-zag pattern, landing and stopping on one leg, then pushing off in other direction.
ROTATIONAL JUMPS – start with both feet planted, jump and twist 180°, then land on both feet (either on the ground or a low box or step).