Those three little letters - ACL

NEWCASTLE (Paul Nilsen's Women's Basketball Worldwide) - While I have to hold my hands up and say I didn’t have time to research whether absolutely statistically true or not, I still remain convinced we have had more elite women’s basketball players go down this season with serious injuries than during any other year I can remember.
 
It’s a real shame for the players concerned, their respective clubs and of course for us, the fans – who are denied the chance to see our heroes do what they do best out on the court for long periods. It’s always even more upsetting when players miss major events or tournaments as a result of serious injury.
 
Even within a relatively small circle of nations, the names of top level players who have sustained serious injuries during the past year or so rolls effortlessly off the tongue – Amaya Valdemoro, Alba Torrens, Marija Vrsaljko, Andja Jelavic, Gulsah Gumusay, Anete Jekabsone, Edita Sujanova, Ilona Burgrova – those are just a few names popping into my head in the first few seconds of thinking about it.
 
While some injuries have been horrifically freakish - such as the double wrist fracture sustained by Valdemoro - there have been the almost inevitable ankle injuries but it has been the dreaded Anterior Cruciate Ligament (ACL) which has been the miserable 'injury tornado' tearing its way through our star names this year.
 
Much like my last column when I felt the need to seek out professional advice on setting up a successful basketball club, I felt compelled to go straight to an expert this time around in a bid to widen my own knowledge of the ACL scurge.
 
So I turned to Professor James Watkins, an expert of considerable renown at the Sport and Exercise Science Research Centre in Swansea, Wales, where he specialises in Sport Science and specifically Biomechanics and Muscoskeletal Anatomy.
 
He very kindly offered his insight on the dreaded ACL injury and it became clear just why basketball players in particular are at significant risk.
 
He explained: “A large number of studies have investigated the incidence and aetiology (cause/origin) of ACL injuries.
 
“The interest in ACL injuries is largely because it is such a debilitating injury and, unless properly treated, will accelerate the onset of osteoarthritis (due to prolonged, continuous instability between the femur and tibia).
 
“Most studies indicate that ACL injury occurs most frequently in two situations: firstly plant-and-cut movement and secondly, one-leg jumping and landing (on the same leg).
 
“Both of these movements are usually accompanied by forceful valgus (abduction of the lower leg at the knee), internal or external rotation of the lower leg at the knee, with the knee close to full extension.
 
“When the knee is partially flexed (150 to 160 degrees, rather than 180 degrees which is fully straight) a small amount of valgus and rotation of the lower leg at the knee is possible without damage to the ligaments,” continued Professor Watkins.
 
“However, valgus and rotation of the lower leg is not normal in a tensed fully extended (straight) knee because the ligaments, ACL and PCL (Posterior Cruciate Ligament) on the inside of the knee joint, and the lateral ligament and medial ligament on the outside of the knee joint are normally taut when the knee is fully extended.
 
“Consequently, even very small amounts of valgus or rotation are likely to damage one or more of the ligaments when the knee is fully extended.”
 
From this explanation, it’s not difficult to see why our players are so at risk. I guess the real gold dust for a women’s basketball ‘nut’ like myself is how and indeed if we can develop ways to ensure we don’t have as many stars missing from the basketball court in the future.
 
While avoiding injury completely is something unlikely to ever be attained, apparently there are ways of potentially reducing the likelihood of an ACL injury according to Professor Watkins.
 
He said: “With regard to ACL injury prevention, it is important to concentrate on technique and strength training.
 
“In terms of technique, a player should avoid those actions that are likely to cause injury. However, in playing the game and especially at the highest level, it’s not possible to avoid such actions.
 
“In these circumstances, it’s important for a player to try to modify her technique in these actions to reduce the risk of injury.
 
"With regard to ACL injuries, this means (i) do not plant-and-cut on a straight knee; (ii) at foot plant, keep the foot in line with the lower leg (i.e. not turned in or turned out); (iii) rotate the trunk about the leg at the hip, not at the knee; may need to increase flexibility of hips; this is often neglected in training.
 
“Meanwhile when it comes to strength training, players must ensure that there is no strength imbalance between the knee extensors (quadriceps) and knee flexors (hamstrings).
 
He added: “Too often, the quadriceps are stronger than the hamstrings, such that in high-force situations, like a plant-and-cut or jump/land on one foot, there is a tendency for the upper end of the tibia to be displaced forward relative to the lower end of the femur which puts excessive strain on the ACL.”
 
I’m sure you’ll agree this is intriguing stuff from Professor Watkins and hopefully it has shed a little more light on the situation – it certainly did for me.
 
I also hope it will offer some food for thought for young and emerging women ballers out there who don’t have access to the kind of medical and sport science advice enjoyed by many pro players at top clubs.
 
I guess based on what the analysis is, we probably have to face up to the fact that while there are possibly ways of mitigating the risk, injuries can arguably be defined as an occupational hazard for elite athletes and will sadly never be eliminate altogether.

The other striking thing this season is the way that (outwardly at least) many of the injured players have embraced positivity during the early signs of their rehabilitation. Without the need for an expert opinion, I am sure the phrase ‘if you don’t laugh, you cry’ encapsulates that heartening approach.
 
It’s at this point, I just feel pretty lucky about my own occupational hazards since they are far less serious. Aside from back pain hunching over my laptop in often cramped media tribunes, my only other real problem is the potential health risk posed by irate coaches, players, club staff and fans angry at what I have written about them!
 
So, if someone could possibly find me a professor who offers advice on becoming more elusive during future tournaments I would be very grateful.

Paul Nilsen

FIBA

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