Can some ACL injuries be prevented?

semerson@macon.comNovember 25, 2013 

UGAKentucky

Georgia quarterback Aaron Murray (11) acknowledges the crowd after being introduced before their game against Kentucky Saturday night.

JASON VORHEES — jvorhees@macon.com Buy Photo

ATHENS -- Back in September, Georgia star receiver Malcolm Mitchell was trying to cope with having torn the anterior cruciate ligament in his knee.

So Mitchell tweeted out a request: “If you ever tore your ACL I would like to hear your story. Could you e-mail me.”

By now, however, Mitchell has plenty of stories to hear on his own team. Georgia has had four offensive players tear their ACLs this year, with star quarterback Aaron Murray the latest, on Saturday night, ending his career.

It has been an injury-ravaged season for Georgia, with several other key players either tearing their knee meniscus or spraining their ankles. But the ACLs stand out because they end seasons right away, and four in one year is unusual.

So on Sunday head coach Mark Richt was asked if he thought his staff was doing something wrong. Predictably, Richt said the coaches weren’t, pointing out that three of the ACLs happened on non-contact plays, from Mitchell celebrating a teammate’s touchdown, to Justin Scott-Wesley covering a punt, to Murray running the ball.

“I don’t think there’s anything you can do or anything we’ve done that would cause that type of thing,” Richt said. “If there’s scientific research out there that has been a form of training that would attribute to that, I’m sure it would already have been written by now. It’s just unfortunate. It happens. It’s a fairly common injury. It happens when you’re changing direction.”

Then Richt added another point.

“And I think the No. 1 sport for ACL injuries, from what I understand, is girls soccer,” he said. “It’s not really a high-contact sport but a lot of change in direction. And that happens a lot.”

Richt is correct about girls soccer, but one man believes that’s changing, and that it offers a lesson for football.

Bert Mandelbaum, an orthopedic surgeron in California, has been studying knee injuries in sports since the 1990s. He has worked with U.S. Soccer for more than a decade and was retained by Major League Baseball last year as its director of research.

Mandelbaum’s interest in knee injuries sprung from the high amount of ACL tears seen in girls and women’s soccer. He and his associates studied it and decided that it wasn’t genetics. It was athletes moving in space without enough muscle and hip control, increasing the risk. In fact, boys and men’s soccer had a high rate, as well.

Soccer players were cutting, landing and pivoting in an awkward manner. It wasn’t about what shoe they were wearing, for instance.

During the next decade, more soccer teams and trainers instituted prevention exercises: plyometrics, hip strengthening and more stretching. The result, according to a 2009 study by Mandelbaum, was a 72 percent drop in ACL injuries in women’s soccer. He says a similar study set to be published soon saw a 67 percent drop in men’s soccer ACL injuries.

But now football is seeing a gradual increase, according to Mandelbaum, and he has a theory why: the proliferation of spread offenses and the general opening up of the game so that players are making the same kind of movements as in soccer.

“It’s repeating history here,” Mandelbaum said in an interview Monday. “I would say football players are playing football like soccer players now.”

In other words, they’re in space a lot more than they used to be.

Georgia has had six players suffer injuries during a practice or a game the past two years. All were offensive skill players. Four of them were non-contact injuries. The exceptions were Keith Marshall this year (hit at the knees during the Tennessee game) and Marlon Brown (also hit in the knees during last year’s Mississippi game.)

Mandelbaum has not viewed any of the Georgia injuries. But he is collecting videos of every football ACL injury he can find, especially in the NFL. He pointed to Indianapolis Colts receiver Reggie Wayne, who tore his ACL this year as he was running back on a down-and-out. He was not hit. Wayne just couldn’t control his hip, and his knee went out.

“Strength doesn’t equal control,” Mandelbaum said. “Yes you have to be strong, but it doesn’t equal control. ... These guys have very strong hamstrings and very strong quadriceps. But that’s not what the issue is. It’s about controlling the hamstrings and the quadriceps and controlling the hip.”

He doesn’t think strength and conditioning has much to do with it. It’s just a matter of football training -- everywhere, not just at Georgia -- not adapting yet to the fact that so much of the game is played in space, rather than purely at the line of scrimmage.

“I think the next step is to develop programs for football to adapt to the change in the game,” Mandelbaum said.

And to be clear, that doesn’t mean eradicating ACL injuries, but hopefully decreasing their amount.

Dr. James Andrews, a renowned surgeon who oversaw Robert Griffin III’s return from ACL surgery this year, told Sports Illustrated earlier this year that Mandelbaum’s ideas have promise. Andrews predicted that “prevention programs will become more sophisticated, especially for younger athletes.”

Such as college football players.

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