A quick thought on 4,000 weeks…
4,000 weeks.
That’s all we get in life.
The amount of possible things we could do on earth is infinite. Our time here, however, is finite.
That means there are really cool and important things that we just will never have time to accomplish. You have to decide what’s most important to you and intentionally spend your time doing that.
Furthermore, if we only have 4,000 weeks on earth, why would you waste any moment of that time giving half-a** effort?
Go all-in on whatever you’ve decided to spend your time doing. When you’re in school, go all-in on learning. When you’re at work, go all-in being the best in the world at your field. When you’re exercising, go all-in on getting healthier and more fit. When you’re relaxing, go all-in on recovering and finding peace.
A deep dive on how to not tear your ACL.
I wrote a really dope intro story, then scrapped it when I realized I don’t need to convince people that not tearing your ACL is a good thing.
It’s the most common fear parents have during our initial conversations. The recovery time is ridiculously long. Reinjury rates (re-tearing that ACL or the opposite one) are way too high (roughly 1 out of every 4 athletes will re-injure within 2 years from surgery).
So, instead of wasting your time with a super entertaining story, let’s get straight to business.
Here are 5 ways to reduce the odds of tearing your ACL.
- Consistent strength training
There’s a pretty strong association between being (relatively) weak and tearing your ACL.
This is probably more true for females than it is for males. Girls are 2-8x more likely to tear an ACL than boys are.
In general, having stronger muscles provides support to prevent the ligament from having to do more work than it can handle.
The research isn’t definitive on what muscles exactly need to be strong to reduce injury risk. The most frequent culprit is glute med. When it comes to ACL re-injury risk (after the first tear), quadriceps weakness is highly correlated.
The truth is, it doesn’t matter that much exactly which muscles are at play, as long as you’re sufficiently training the major movement patterns (squats and hinges for the lower body).
The muscle activity that occurs during a heavy compound movement pattern is much greater than anything you get doing dinky little isolations exercises (like clamshells).
This is especially true for unilateral movements and glute med. The forces that go through the hip during a heavy split squat are astronomical.
I used to do a good bit of remote training. Oftentimes people didn’t have access to a weight room or it was too inconvenient for them to make the trek (or investment).
It’s only anecdotal evidence, but those people got hurt a lot more frequently than those who could actually load up.
Just to be on the safe side, though, I will often throw in some quad and glute med isolation exercises in the warm-ups in an effort to increase robustness.
The important part here is consistency.
Training gains aren’t like monetary gains. When you make money, you can put it in a savings account and it stays there. If you sit on the couch for 3 months straight, that money will still be there.
Training has a use it or lose it principle. If you stop training, the strength gains don’t stick around forever. They don’t go away in a week, but they for sure don’t last an entire season.
2. Progressive plyos
ACLs don’t tear slowly. They tear in roughly 0.07 seconds.
Being strong isn’t enough. You need to be able to produce that strength ridiculously quickly.
Your cousin Vinny who trains at Planet Fitness might be stupid jacked, but his body isn’t prepared to handle the speed of athletic movements.
You need to phase in plyometrics, which are movements that force you to get on and off the ground quickly. This trains your muscles and tendons to synchronize and stabilize in very short periods of time.
Our general plyo progression goes from: static to countermovement, double leg to single leg, and straight forward to multidirectional.
3. Condition
Fatigue increases injury risk.
We need to enhance your body’s overall ability to handle work.
If you’re really strong and really powerful, but you tire out in the first half, your muscles and tendons won’t be able to protect the ligaments as well late in the game.
Your conditioning needs to actually be reminiscent of the sport that you play.
4. Ramp up your field work
You don’t play your games in the weight room.
You need to strategically phase in your on-field (or on-court) work. This is an area where I see the ball dropped the most.
You see a lot of major injuries (think ACLs and achilles) early in the season. The spikes in on-field volume, where you go from very little to a whole lot, play a big role in that.
When it comes to workload, we want to see a gradual ramp, not mountainous spikes. Map out your plan and put it in a graph.
A good rule of thumb is to figure out how much you’ll run/cut/change direction in pre-season camp, then build up to that volume by increasing your volume by 10% each week for 4 weeks. That means you’ll start at 60% of the in-season volume.
5. Fuel and recover
You need to let your body recover fully between practices and games. Remember, fatigue dramatically increases injury risk.
Get 8+ hours of sleep (teens probably need more than that), eat enough calories, choose high quality foods, and find time to do things that relax you.
An extra note on knee valgus
If you look into ACL injuries, you’ll see a lot about knee valgus. I’d be remiss if I didn’t at least mention it.
Knee valgus refers to the knees caving inwards. The athlete is on the inside edge of the foot, the kneecap is inside the big toe, and the hip is turned inwards.
The basic consensus among your average healthcare professional is knee valgus = bad. It’s heavily demonized by physical therapists and physicians.
When someone tears their ACL, they almost always have a stiff landing and go into that knee valgus position. Therefore, knee valgus is bad.
So, they’ll tell you things like always have a soft landing and don’t let the knees go past the toes. Then they’ll have you do exercises where you step off a box and tell you to not let your knees cave in at all when you land.
If you talk to really good clinicians who work with high level athletes, though, it’s much more nuanced than that.
Some of the best athletes in the world are successful because of the same mechanisms that contribute to knee valgus. Allen Iverson’s crossovers and Lamar Jackson’s jukes are the result of ridiculously smooth and powerful hip internal rotation, which temporarily pulls them into some knee valgus.
Additionally, some contributory factors of knee valgus are straight up non-modifiable. If someone has an anteverted hip anatomy, they’re always going to have a lot of hip internal rotation and subsequent knee valgus. You’re not going to change their skeleton with some clamshells.
Even more so, research has shown that the drop jump tests (athlete drops off of a high box, lands quickly, and jumps again while the coach looks for knee valgus) that coaches and therapists will use to see who’s at risk for ACL injury are trash. They don’t predict ACL injuries.
Identifying knee valgus doesn’t tell us who’s going to tear their ACL. Trying to completely eliminate it is often impossible, because we can’t reshape skeletons. And it even can help athletes have elite performances sometimes.
I will concede that there is likely a correlation between knee valgus and ACL injury risk. There’s some evidence to support that, plus it passes the “common sense” test. Those who have a lot of knee valgus when they move are probably at a higher risk of tearing their ACL.
So, we seem to have conflicting research and ideologies. Is knee valgus good, bad, or indifferent? Should we seek to correct and eliminate it?
My answer is both yes and no.
What’s bad is uncontrolled knee valgus.
Athletes who are anteverted are going to enter into those valgus positions, so we want to give them the strength and neuromuscular capacity to control those positions.
Avoiding it is futile. Controlling it is not.
We do that through everything mentioned above in the article.
Dr. Steve Diaschiavi, who served as an NHL physical therapist for 10 years and is currently a professor at High Point University, wrote a good article on this topic.
An extra, extra note on injury “prevention”
You’ll see some clinicians on social media gripe about using the word injury prevention.
Their claim is that you cannot prevent all injuries from happening, so we should use the phrase “injury risk reduction” instead.
It is completely true that you cannot prevent 100% of injuries from happening. You can do every bit of training correctly and still end up tearing your ACL. Sports are complex and inherently risky.
However, in order to reduce the risk of injuries occurring, we are by definition stopping (aka preventing) some injuries from happening. That’s how probabilities and percentages work.
Injury prevention is the standard nomenclature, so we’ll continue to use it.
That’s a wrap!
Please share this newsletter with anyone you think might be interested in learning how to help their kid get faster, stronger, healthier and ready for real-word success through long-term athlete development.
It means more than you know!
Be >,
Zach
Dr. Zach Guiser, PT, DPT, CSCS