When sports injuries become permanent

“In hindsight, I should never have gone through with my first anterior cruciate ligament (ACL) surgery,” says Stabæk's Melissa Wiik.

The former, and hopefully future, national team player, has suffered two ACL (anterior cruciate ligament) injuries to the same knee. After first injuring her ACL, she received a new ligament through reconstructive surgery.

During the rehabilitation process, she focused on exercises to stabilize and strengthen the knee joint.

When Wiik reinjured her ACL, the doctors did not believe it was torn. The knee was quite stable, indicating that 50 percent or more of the ACL remained intact. Upon having surgery on her meniscus at a later date, the doctors discovered a completely torn ACL.

“The physiological function of my knee was almost at preinjury level,” Wiik explains.

Today, she plays football at the highest level despite the ACL in her left knee being torn. Preventive training and stability exercises keep the knee in check. Another surgery would have little impact on the functionality of the knee, but would sideline Wiik for a year.

Injuries lead to more injuries

Melissa's case has been followed closely by Agnethe Nilstad, doctoral research fellow at the Norwegian School of Sports Sciences. In her study, she found that elite female footballers are nine times more likely to reinjure their knee after suffering ACL injuries, compared to those without such injury.

Expert orthopaedic surgeons and highly qualified sports physiotherapists have successfully helped injured athletes returning to their sport after ACL injury, leaving some people  taking ACL injuries less seriously.

“Seeing that ACL injuries will keep you on the sideline for a year, as well as increasing the risk of future injures, they are not to be taken lightly,” says Nilstad.

A young footballer cannot afford to be sidelined for longer periods of time through injury. It will hold them back compared to their peers, the researcher and physiotherapist explains.

“In addition, it is well documented that ACL injuries increase the risk of developing early osteoarthritis of the knee. Such injuries have therefore far reaching effects – also in the long term,” Nilstad says.

Severe injuries may be halved through preventive training

Researchers at the Oslo Sports Trauma Research Center have found that preventive training may reduce the number of injuries in football and handball by 50 percent. Still, many athletes spend too little time aiming to prevent sports injuries.

“Coaches need more knowledge about injury prevention,” says Melissa Wiik.

Youth coaches may lack a formal coaching education. At more elite levels, she believes coaches focus their limited time on football training only.

This is a major issue among elite female footballers since most of them hold a job and spend less time training than professional athletes.

“After a long day at work, they may show up tired for practice. This could lead to decreased focus and higher risk of injury,” Wiik explains.

In addition to playing football, she is a student and holds a job.

Possible to avoid?

It may seem impossible to avoid injuries, but Agnethe Nilstad introduces some measures.

“Injury recording is a simple measure to get an overview of the injury patterns,” she says.

In her doctoral project, she found text messaging to be a simple, effective and reliable method for recording injuries.

“In addition, the medical staffs would overlook 50 percent of the injuries. When the players individually reported injuries  directly, we recorded significantly higher numbers,” she says.

Nilstad agrees with Melissa Wiik on how football players should organize their training. Researchers at The Oslo Sports Trauma Research Center have developed an exercise program to prevent injuries which could be implemented in the warm-ups prior to training and matches.

“Their warm-ups will be equally effective and the coaches can include elements which are believed to prevent injuries. In addition, it is advisable for the players to have individual custom made programs. A physiotherapist can easily identify the individual player's needs.”

In her research, Nilstad studied how well the players could control their knees using the drop-jump test. In this exercise, the athlete stands on a box, drops down to a two-feet landing and immediately performs a maximal vertical jump. Nilstad and her colleagues studied the players' knee valgus; to what extent each knee moves towards the midline. In their trials, they found that the physiotherapists' assessment of knee control corresponded with an objective measurement of knee valgus using tree-dimensional motion analysis. 

The drop-jump test is a simple and inexpensive method. The clubs' physiotherapists can use it as a useful tool to identify athletes that may need to improve strength and stability of the knee joint.

“Melissa Wiik's training regimen has made her knee stable despite having a torn ACL. This is a testament as to how effective these exercises can be. In addition, it stresses the importance of preventive strength training and stability exercises. This is an important part of the rehabilitation process after an injury. Injury risk is reduced by 50 percent if the players perform injury prevention training. Through these measures, they can keep playing football and avoid being sidelined by injury,” says Nilstad.

Talent management

The injury frequency is high at the elite level. This comes at a high cost for individual careers, the teams and society. It is too late for the athletes to start preventive training when the coaching and medical staffs are at a professional level.

“Coaches and parents must initiate preventive measures for the players at an early age. The foundation for a long career as an athlete is laid in the beginning, both regarding technical ability and footballing skills, but also to prevent injuries,” says Nilstad.

Melissa Wiik wholeheartedly agrees, herself being a coach for youth players.

“Preventive training is integrated into all of my warm-ups. Just ten minutes could make a big difference. Parents and amateur coaches are not discarding the idea, they simply lack knowledge on the subject,” says Wiik. 

“We fail to grasp the severity of an injury before we suffer one ourselves. This is why preventive measures must be implemented as a part of the training programs,” Nilstad says.

“Even if you are a great player, what good will it do if you are injured and stucked on the bench?”

------------

Read the Norwegian version of this article at forskning.no