Understanding ACL Injuries

23rd September 2013

Serious knee ligament injuries amongst squash players aren’t as common as in other sporting populations. However, it is possible to sustain some pretty significant knee ligament damage on a squash court and the consequences can be devastating. The anterior cruciate ligament (ACL) is the most important knee ligament as far as sporting function is concerned and for most people, a ruptured ACL will require reconstructive surgery in order to return to sport.

We have dealt with hundreds of complex knee ligament injuries over the past 3 decades, primarily amongst professional footballers (or soccer players if you prefer). Whilst the basic movement patterns and physical demands of football are fundamentally different from squash, there are some similarities of knee joint loading that occur in both sports that can have a bearing on knee injury risk. Whilst football/soccer is a contact sport, the overwhelming majority of ACL injuries amongst football players are non-contact. The actual injuring movement can often be quite innocuous, such as a slightly mistimed landing or twisting movement. The same applies on the squash court.

So how can one mistimed movement cause so much ligament damage? There isn’t one simple answer to this question. However, when we consider the position of the ACL (central within the knee joint, physically connecting the thigh & shin bones), its relatively small size and the fact that it has a large number of sensory nerve endings, then it becomes apparent that the ACL doesn’t merely act as a “piece of rope” that holds two bones together.

Whilst it certainly works to physically stabilise the knee joint, the ACL has an important role in controlling the muscles that act across the joint. As forces are transmitted through the ACL, its nerve endings fire off in response to stress and via a series of reflex pathways, the knee joint is stabilised with strong muscular contractions. When high-speed sporting manoeuvres are concerned, this process usually occurs in milliseconds. The amount of force that high speed twisting & turning on court will impact on a knee, can be more than enough to rupture an ACL. The fact that this doesn’t usually happen, is down to the fact that our fast-reacting muscular system provides plenty of support to prevent the knee joint from coming apart. So all it takes to rupture an ACL is a slightly mistimed movement, that effectively beats the reflex control system. This means that the strong lower limb muscles react a fraction too late and the ACL is exposed to too much force with the result that it snaps.

ACL reconstruction postoperative results are good to excellent but the road back to full sporting fitness requires a good deal of hard work over several months. It is important to receive good postoperative rehab and to make sure that the correct physical progressions are made at the right times. At Lilleshall, we have a wealth of experience in devising and delivering this type of rehabilitation. We can provide one to one rehab with on-site hotel accommodation if required and we have access to five squash courts immediately adjacent to our clinic & rehab gym, for those patients who are in the late stages of their rehab.


Philip Newton

Want to find out more about dealing with injuries?

Then make sure to check out this series where Gary Nisbet talks through stages and expectations you might face after a serious injury and uses Peter Nicol as a case study to give his own experiences.

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