Sports Knee Injuries: Prevention is Key!

By: Torey Botti, MD

Most of us practice wellness and disease prevention as a routine part of our lives.  We vaccinate our children to prevent serious infectious diseases, wear sunscreen to prevent sun damage and skin cancer, and brush our teeth to prevent gum disease and cavities.  Most youth athletes or their parents don’t spend time considering the possibility that they might sustain an injury playing their favorite sport, nor do they realize they can do something to minimize their chance of actually sustaining a devastating knee injury.

The knee is second only to the ankle in terms of its frequency to be injured in youth sports.  For boys, football players sustain the most serious knee injuries.  For girls, the culprit is soccer.  For those who have never sustained a sports-related knee injury, you might not appreciate the seriousness of an injury to this vital joint.  Many structures in the knee can be injured while playing sports, but one of the most common and serious injuries is a rupture of the Anterior Cruciate Ligament or ACL.  Athletes who tear their ACL suffer terrible pain, miss sports seasons, lose sports scholarships, and require surgery to correct the broken ligament.   Athletes with ACL tears have a greater risk of depression, poor academic performance, are often separated from their friends and teammates, and despite the advances in surgical technique and rehab, have a very real chance of not ever getting back to sports.  The damage sustained when an athlete tears their ACL is felt throughout their lives, as these athletes have up to a 90% chance of developing osteoarthritis of the injured knee.  This osteoarthritis often develops within years, with up to 50% of injured athletes developing osteoarthritis within 10 years.  And then, there are the financial costs of the injury.  When one considers the costs of the initial medical visits, ACL surgery, rehab, and medical equipment, in addition to the fact that most of these athletes will require treatment for knee osteoarthritis in the future, lifetime costs of one ACL injury can extend into the hundreds of thousands of dollars!

So, how can serious knee injuries be prevented?  Well, there is not much a young athlete can do if another player tackles, clips, or trips them during a sporting event.  But these “contact” knee injuries actually account for only ⅕  of the serious sport-related knee injuries.  Most serious knee injuries do not occur through contact, and it is these “non-contact” injuries that can be significantly improved through a technique called neuromuscular training. 

Non-contact knee injuries are usually described by injured athletes as their knee simply “buckling” or “giving out”.  They occur when an athlete is cutting, pivoting, decelerating, jumping or landing.  Utilizing sophisticated video analysis and force plate evaluation, orthopaedic researchers have learned several important things about non-contact knee injuries.  First, these injuries can occur in an instant, or roughly 40 milliseconds.  This is much too fast for an athlete to react to prevent the injury.  Second, injured athletes tend to share several neuromuscular imbalances.  Injured athletes tend to have poor upper body and core control, often land from jumps with insufficient hip and knee bend, usually rely on their quadriceps muscles rather than their hamstring muscles, and frequently favor one leg over the other.  Neuromuscular imbalances tend to be more pronounced in girls, which combined with gender-specific anatomical differences, explain why girls are 6 times more likely to sustain a non-contact knee injury than boys. 

Once the orthopaedic research community understood the mechanisms of a non-contact knee injury and the neuromuscular deficits that lead to these injuries, they then began to ask whether these deficits can be corrected, and these injuries prevented.  Since the mid-1990s, over 600 published scientific studies have addressed this question, and the answer turns out to be yes. 

This gets us back to neuromuscular training.  Neuromuscular training is a concept whereby improper body movement patterns are identified and then corrected by a certified instructor in one-on-one or in small group settings.  Athletes learn to land jumps softly, to not collapse their knees inward when landing or cutting, to keep their core and upper body aligned, and to specifically recruit hamstring and hip muscles rather than relying on the strong quad muscles.  Once the athletes learn the basics of jumping, landing, and cutting, the instructors increase the complexity of the jumps, the intensity, the height and distance, and then string together complicated sequences of jumps, cuts, and stops.  Athletes learn to avoid at-risk body positions, and the newly learned safe body positions are repeated and accelerated so these safe positions become natural.

Numerous studies have shown that athletes who complete a 6-week course of neuromuscular training have significantly lower injury rates.  For the highest risk sports like basketball and soccer, athletes who complete a neuromuscular training program have a risk reduction of roughly 200%.  On average one out of 50 girl soccer players will sustain a non-contact knee injury and tear their ACL.  A 200% risk reduction would translate to only one out of 150  girls sustaining an ACL tear.

A secondary benefit for athletes who complete a neuromuscular program is that they will significantly increase their sports performance.  Improvements in the vertical jump, sprint times, muscular strength, and endurance have been consistently demonstrated in athletes who complete these programs.

Since 2016, Flagstaff Bone and Joint has partnered with the non-profit Flagstaff Sports Institute with the goal of minimizing youth sports injuries and helping our youth achieve their athletic potential.  Flagstaff Sports Institute offers small group neuromuscular training for youth athletes ages 11 and up.  The Injury Prevention and Performance Enhancement Program, or I.P.P.E.P., is offered as a three day a week, six-week program.  The program is ideal for individual athletes or teams.  Athletes from the Flagstaff High Girls Basketball Team, NPA Wrestling Team, and F.A.S.T. Ski Team as well as numerous individual athletes have already completed the I.P.P.E.P. and have benefited from the training program. 

For more information about the I.P.P.E.P. knee injury prevention program, call (928) 856-1030 or visit: