Chances are you know someone who has experienced an anterior cruciate ligament (ACL) tear, or maybe you have experienced this injury yourself. ACL injuries have doubled in the past two decades, with about 200,000–250,000 cases annually in just the United States, with female athletes having a much higher risk than males due to physical differences.
ACL injuries have long been a concern for athletes across various sports, with research and rehabilitation practices evolving significantly over the years. The recovery process plays a crucial role in an athlete’s return to sports and activities and the approach to rehabilitation can greatly impact long-term outcomes.
An interview with Vanderbilt sophomore Emily Manuel
To gain firsthand insight into the impacts of ACL injuries and the process of rehabilitation, I interviewed Emily Manuel, a sophomore at Vanderbilt University who tore her ACL back in 2020 and underwent two surgeries. Her experience sheds light on the challenges of recovery, the importance of rehabilitation, and the psychological effects of the injury.
Manuel’s recovery process was unique in that it was during the COVID-19 pandemic. With no access to in-person physical therapy, virtual rehab introduced limitations in pushing herself effectively. The lack of in-person guidance led to problems in recovery and scar tissue buildup, ultimately requiring a second surgery. This highlights the importance of structured and closely monitored rehabilitation, particularly in the initial post-surgical phase.
The second rehabilitation experience, with in-person physical therapy, proved significantly more effective. Hands-on therapists provided the necessary guidance, progressing from basic mobility exercises to weighted strength training. This aligns with research emphasizing that ACL recovery should involve progressive loading, neuromuscular training, and proper biomechanics to restore knee stability and reduce reinjury risk. The inclusion of sports-oriented physical therapy also ensured a smoother transition back into lacrosse.
Prevention and training adjustments
Despite the known effectiveness of ACL prevention programs such as FIFA 11+ and Sportsmetrics, many athletes remain unaware of these strategies until after getting injured. Manuel’s lacrosse team only began incorporating structured warm-up and stretching routines after multiple teammates experienced ACL injuries. Studies reinforce that these kinds of neuromuscular training, including hip and core strengthening, plyometrics, and movement pattern adjustments, is key to reducing ACL injury risk.
Psychological barriers to return to play
Physical recovery is only one aspect of the rehabilitation journey; the psychological impact of ACL injuries is equally significant. Fear of reinjury often prevents athletes from performing at their full potential. Initially, Manuel found herself hesitating in games, relying heavily on a knee brace, and holding back due to anxiety. However, after her second rehabilitation, which emphasized sport-specific training, she regained confidence and was able to play without limitations. This progression underlines the need for mental resilience training and gradual exposure to higher intensity movements during rehabilitation.
The need for wider implementation of ACL prevention programs
ACL injuries often result in lengthy and frustrating recoveries, making prevention essential. Manuel believes in the importance of integrating ACL injury prevention programs into sports training, as they could significantly reduce the risk of injuries and the difficult rehabilitation process that follows.
The evolution of ACL rehabilitation has shown that hands-on, structured physical therapy, combined with proper strength training and injury prevention strategies, leads to better outcomes. Athletes, coaches, and sports organizations must prioritize injury prevention and rehabilitation advancements to ensure safer and more effective returns to play.
Future directions for ACL rehabilitation
There are many areas of improvement in terms of research for ACL injury and rehabilitation. More research is needed in sports like lacrosse and wrestling, where the risk for ACL injury is high but research is not very prevalent. There is also limited literature surrounding the differences in how men and women respond to injury prevention programs. If men and women respond differently, this would necessitate different precautions and programs to be implemented.
References
Arundale, Amelia J. H., et al. “ACL Injury Prevention: Where Have We Come from and Where
Are We Going?” Orthopaedic Research, vol. 40, no. 1, Apr. 2021,
https://doi.org/https://doi.org/10.1002/jor.25058. WILEY Online Library.
