It goes without saying that sports are a big part of the high school experience. And for many student athletes, their sport may be the vehicle that carries them to college and beyond. The lessons these young athletes learn will be immense and last them a lifetime.
Unfortunately, some lessons are learned the hard way through injury. Recently we’ve been seeing an increase in ACL tears, so I thought it would be beneficial to athletes, coaches and parents to take a look at this escalating injury. So I called on Chris Phillips, founder and owner of Compete Sports Performance and Rehab in South Orange County.
Chris is a certified athletic trainer and strength conditioning coach with over 20 years experience working in pro sports, including 15 years as a player in the NHL. Chris is currently the trainer for the OC Blues FC of the USL Pro soccer league and also served as a trainer for the LA Sol (formerly of Women’s Professional Soccer league).
Soccer was on my mind when I talked to Chris recently and most of my questions to him reflect that. But make no mistake, ACL injuries are affecting almost every student athlete from football to tennis players, so what Chris says is relevant for just about every sport.
Q: So what exactly is an ACL and what is its function?
Chris Phillips: The ACL is one of four ligaments in the knee. It’s the most predominant one and the one that you kind of need the most. And what it does is it stops the translation of the tibia or the shin bone from moving forward on the femur or your upper leg.
The ACL is a ligament that holds two bones together so when it tears it really causes more instability in that knee. So when you stand on it, it doesn't give you a good stable force.
Q: So when it tears, is it like a muscle-tear or does it actually snap in two? What happens to it?
CP: It could happen many different ways. Typically it snaps firmly in the middle of it. Occasionally it will tear at the bone were it attaches but it doesn't typically tear off the bone. It will typically break in the middle.
And because they have a very poor blood supply, they don't heal on their own. And you can't sew it back together like you would do with a muscle (where it might regenerate a little better) because of that lack of blood flow – again they don't heal very well. So when these things get torn they really need to be replaced.
Q: So that's why it takes so long to recover – because when athletes go down, they’re down for a year.
CP: Yes, typically it's between 6 to 12 months recovery time. In my opinion I think it's better if they wait until about 7 to 8 months before they really start to return and then they can continue to recover and do better and still progress until they get to about a year.
The most common surgery technique performed is called a tendon graft, where they're cutting the tendon out, chipping the bone out of the patellar tibia and then drilling holes and tapping that bone back into where the ACL would've been. So you start to look at all the bone growth that has to go on, as well as the patellar tendon starting to feel like itself. It does take 6 to 12 months to fully heal.
Q: So what are some of the things you do to help athletes come back post-surgery?
CP: I think the big thing is to get them to different stages so they know what to expect. For most of the athletes we see, this might be their first ACL injury and it’s a big blow to their life. Some of these kids, whether they’re 15 or 16-year-old soccer players or pro soccer players, that's all they've done, that's all they know and all of a sudden their world stops.
So first off we tell them that these are unfortunately common, the recovery is very good, and their options are very good as long as they do the things they're supposed to do and that they'll recover. To be honest, most of them come back stronger and do better after they tore their ACL then before they tore their ACL.
So a lot of it is to just give them that confidence and tell them that they're going to be all right but there's a lot of work ahead of them and then we start to work with them.
The big thing for us is working on proper mechanics and single leg strength. For most sports is spent on one leg and soccer is a good example – whether you are going to kick a ball, sprint up to a ball, or cut your opponent. A lot of that is spent on one leg.
Most people train or rehab both legs at a time, so we try to get away from that and start to train their legs on single leg stances – whether its single leg squats or single leg straight leg lifts. We also work on proper positioning and that teaches them different techniques – like how to stop, how to decelerate or how to accelerate.
When you look at 10 to 15 years ago when ACL tears weren't as prevalent, most of them were direct contact – somebody getting run into, a football player getting run into or getting chop-blocked. But today, most of them are non-contact.
A soccer player cuts in and the ACL just doesn't hold on and it tears. Why does that happen? In my opinion a lot of times that happens because they don't have proper mechanics, they don't have proper strength, and they don't know how to control their bodies. So we need to start teaching that, so the injury doesn't happen again.
Q: Do you require these injured athletes to come in to your facility every day or a couple times a week? What’s the time schedule like?
CP: Ideally, with a high-end professional collegiate athlete you try to get them in anywhere from 4 to 5 days a week. Unfortunately because of today's healthcare system, it's not always possible from a financial standpoint and also because everybody's lives are so busy. We typically try to get our ACL kids in here three days a week, but we give them stuff to do on their own as well.
Q: Do you see an increase of girls coming into your facility with ACL tears?
CP: Yeah, I think we have. Because we are so sports-oriented, the majority of our sports rehab people are athletic trainers and they’re out there and they see injuries occur, so a lot of times we work with the athletes from the day they get hurt to the day they get back.
But I definitely think there is an increase in general in ACL tears. You can look at the research – it's all over the Internet and that shows you that the ACL tears, especially in females, are up.
Q: Is there a correlation between playing on artificial turf? What are your thoughts on playing soccer or any sport on artificial turf?
CP: You know the turf has changed over the last – it's probably been 30 to 40 years since the original one came out in the Astrodome. But the Field Turf now is pretty good.
With the OC Blues, we've been lucky enough to move back and forth between practicing on artificial turf and playing on grass field. And to be quite honest, I don't see a big difference.
We've talked to a few of our other clients who suffered ACL tears and asked them if they are more comfortable on turf or on grass. And they all say the same thing – they don’t like playing on turf just because the ball moves differently, but they feel more comfortable on turf because grass is not perfect, especially in high school and sometimes in college. On grass, there are a lot of divots, there are a lot of holes, there are hard patches and soft patches. But the thing with artificial turf is it's all the same.
In my experience, from an ACL tears to similar acute injuries, I don't see a big difference between grass and turf. There are two big studies that have recently come out – one from the University of Idaho and the other from University of Pennsylvania, and both of them basically said they don't see a difference in acute injuries.
However, I do think that because turf is a little bit harder than grass, that you can still develop overuse injuries. The ones that we've noted the most in all the years the Blues practiced on turf are patellar tendonitis and Achilles tendonitis. But whether it's an acute ankle sprain or ligament injuries like an ACL tear, we really don't see much of a difference between grass and turf.
Q: That's interesting that you mention Achilles tendonitis because U.S. Women’s National Team forward Abby Wambach has been dealing with Achilles tendonitis for many years. She says that she has it under control now but it's one of those injuries that we would never know about unless the athlete talks about it.
CP: Yeah and I think it's one of those things, especially at a professional level, that you try to keep quiet because you don't want your competition to know about it and take advantage of it.
In our first year with the LA Blues (when the OC Blues were in LA), we were up at one facility where the turf was a lot older and it was a lot harder and we had a lot more overuse injuries there. When we moved to the next facility, the turf was a little bit softer and it had a better turf.
We saw a little bit of change but the main change was the overuse injury of the patellar tendon and the Achilles tendon. And I think a lot of that was just from the surface being harder.
Q: Do you have a theory as to why ACL tears are going up? I like to blame artificial turf but do you have a professional theory as to why?
CP: Unfortunately in today's society, kids are forced into taking up one sport at an early age and they just play that one sport.
They don't have that crossover like they had 10, 15, 20 years ago when kids played a sport in the fall, another sport in the winter, another sport in the spring. It seems like now honestly by the time you’re 10 years-old or 12 years-old, you're picking one sport.
I'll use girls’ soccer because it's a perfect example. Girls have a 5 to 8-times higher incidence rate for ACL tears compared to males. And I think it’s because girls are playing the same exact sport, doing the same exact thing over and over and they start to create bad habits.
Also they develop strength in one area and weakness in another area. A lot of these athletes will play the same sport year around and never get to rest – they never get to do the things that their bodies need to stay healthy.
Look at an elite high school girls soccer player – she’s going to be on her high school team pretty much from the time school starts in September all the way up until whenever the beginning of winter season is (around here I think it's October or November). And then, she’ll go play for her club team.
When she starts the high school season, her coaches haven't seen her in awhile and so they condition her for the first 2 to 4 weeks and run her into the ground. Then they’ll play a whole bunch of games and as soon as the high school season stops – let’s say it stops on a Saturday, her club season may start on the following Monday.
Then the club coaches say, “I haven't seen you for you two months, so we’re going to condition and run you into the ground.”
These girls are getting run into the ground again and a lot of them are not only playing the second half of the club season, they're also looking to play for a different club the following year. So they're guesting with the second club. So, they're technically playing for two clubs at one time, and then their high school coaches are telling them they also have to run track in the high school off-season.
It's really predominate over the last couple of years that in the spring girl soccer players are running high school track 3 to 5 days a week, practicing twice a week with their club team, practicing once a week with a different club team, playing two to three club games during the weekend, and mix in a private lesson here and there and then they wonder why they're tired and they're hurting.
Well, they never get a chance to recover. So when you look at a lot of these non-acute injuries, some of it has to do with fatigue. Kids are tired. Their bodies can’t handle anymore and something has to break down.
Q: When you put it like that, it sounds crazy. I have a lot of readers who are high school athletes and play club sports as well, and you just described their lives.
CP: It's so much a part of these kid’s lives that predominantly for an ACL repair or ACL recovery, we deal with a lot of high school kids who never get a break – they're always going, going, going and running, running, running.
And a lot of times what happens is they start to develop more quad strength than hamstring strength. And its hamstring and glute strength and the muscles in the back of the leg that helps protect the ACL. So, the ones that run, run, run – all they do is build quad strength.
So a lot of the theories out there will say that when you start to fire the quads – they are so strong that they actually pull the tibia forward and that's what tears the ACL.
So even someone who's in good condition, if they don't learn how to fire their hamstrings, their glutes and their quads all at the same time and work synergistically then they end up having some issues and that sometimes leads to that ACL tear.
Q: You're so knowledgeable and I can't help but think when I listen to you that a lot of these kids would be better off if they had access to pro trainers or quality trainers like yourself. Do you think a lot of youth teams or women's teams really don't have the money to get good trainers?
CP: I think that the funding is a good point and it's definitely a factor, but one of the things that we see, especially at a club level, is there is so much information on the Internet today, that a lot of the coaches go on and try to implement things themselves. And unfortunately, if they don't know exactly how to implement then it could be done incorrectly. And if it's done incorrectly, then maybe you’re not fully hurting your athletes, but you're not fully helping them either.
When we talk to our kids that come in with these ACL repairs, the question that we get with each and every one of them is, “When am I done? When am I done rehabbing? When am I done training?”
The answer I always give them is, ‘When you decide not to play a sport anymore.’
And they always look at me funny. Well, your injuries were non-contact injuries, which means you had an instability or a weakness. If you don't work on these things consistently, then you're going to leave yourself open to another injury.
That is the part that bugs me the most when I see kids come in here and have had a few ACL tears. I’ve seen kids, who have gone out and tore an ACL, then they do their rehab and they only work on the one leg – the injured one. Then they get healthy and they go back and play and they tear the other one.
There are underlying reasons why they tore the first one. And unfortunately, wherever they went for rehab – they only worried about the leg that was injured.
Well hey, you know if the injured leg was at risk, then wouldn’t you think the non-injured leg was probably at risk? So we always train both legs regardless. We train them separately but we train them both.
An it doesn't mean you have to come into our facility for an hour, three times a week – we give our athletes stuff to do on their own in addition to what they are doing here. A lot of takes only 10 to 15 minutes prior to practice to help get their muscles firing in the right direction and making sure they handle things the right way.
And to me it's a daily thing – it's part of your regiment, it's part of becoming an athlete at that next stage. If you want to continue to play and stay healthy, you have to take that step.
Q: Now let's say I'm a young athlete and I am playing a sport and I am healthy. What can I do to make sure that I take care of my ACL so it doesn't get hurt?
CP: The big thing that we always try to do is a work on mechanics. So, let’s say, when they jump, they land so their knees are under their hips and make sure their knees don't buckle in. A lot of that is glute strength. A lot of it is learning how to work on stopping and landing. The majority of non-contact ACL injuries is when they come down from a jump and land wrong or when they go to pivot and push – their knee is in the wrong position.
So a lot of what we do is to teach them proper landing mechanics and proper changing direction mechanics. And also work on single leg strength – whether it's single leg squats or single leg bridge to try to get the muscles to start to fire so that they know that the difference between the safe way, which is really more efficient so that they'll be quicker and faster, but also help prevent the injuries.
Q: Is there one thing you’d like to say to kids out there who are going through a set back with an ACL injury?
CP: The one thing that I want to get across to these kids with ACL repairs is that you will get a lot better and you will succeed. We get them on the right track, but then it's all up to them. And the amount of work you put into it, will determine your success.
Q: Thanks so much Chris for talking with us about this important subject. This is so beneficial for young athletes – you have no idea what a great services it is that you took the time out of your busy schedule to talk to us.
CP: Well, I appreciate the chance to talk about it. I've suffered two ACL tears myself so I know these are life-changing injuries, not just career-changing, but life-changing injuries.
You know it's unfortunate that a lot of people have to go through these types of injuries more than they probably should. But the nice part for us and the reason why we work so hard, is that we’ve seen a lot of high school athletes that come in with ACL tears – no matter if they’re freshmen or sophomores – and then move on and play collegiately. And they all say, "You know, I'm way faster, way stronger, and way better than I was before."
Chris is dedicated to helping athletes obtain their goals, and through sports rehab, physical therapy and proper training methods - he and his staff strive to get athletes back from injury and back on the playing field.
To hear a condensed version of this interview, check out Women's World Football Show!
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