Football will finish at the high school level this week. Thus, for the next nine months, those who are obsessed with head trauma among youth and high school athletes will be somewhat less vocal.
Meanwhile, with basketball underway, the carnage to knees — particularly among girls — will continue unabated and nobody but the victims, their families and a few coaches will care.
Something is wrong with this picture.
Let’s be clear here; there is ample reason to be concerned with the long-term effects to the brain from extended playing of collision sports (football, hockey, lacrosse, rugby, soccer and wrestling).
However, for those who play those sports at the high school level alone, the statistical evidence is clear: there is no greater risk of developing degenerative neurological conditions (dementia, Lou Gehrig’s Disease and Parkinson’s Disease) than there is for anybody else.
No such luck regarding the long-term effects of knee injuries, specifically the torn anterior cruciate ligament. There are roughly 250,000 ACL tears per year in the United States and the number of annual surgical reconstructions has risen from 85,000 to 130,000 in the last two decades.
Worse, suffer a torn ACL and you face a 50 percent chance of needing a knee replacement later in life.
Concerned about too quick a return from concussion? Minimal criteria-for-return from that injury are regulated by law in most states.
No such regulations exist for a torn ACL. The November issue of the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) includes a study that shows only 13.9 percent of adolescents and young adults are physically ready (as measured by strength and hop testing) when they are released by their orthopaedic surgeons to return to sport after reconstruction of the ACL.
When considering strength of the quadriceps and hamstrings alone, just over one quarter of those studied had strength in both muscle groups that was within 10 percent of the uninjured knee. A year after being released, more than 80 percent of those with that adequate strength were still playing. However, for those with inadequate strength, only 60 percent were still playing.
More ominously, fully 20 percent of all those studied suffered another ACL injury before the year was out. The study did not break down whether the new injuries were to the same or opposite knee. Most studies, though, show that second ACL tears occur to the opposite knee roughly twice as often as to the same knee.
Supervised physical therapy is the best way to assure a better outcome following ACL reconstruction, says another study in the current JOSPT. Performed at the University of Utah, the study showed that being under the age of 20 and attending fewer than nine sessions of physical therapy made a second surgery to the same knee more likely.
Rather than treating injuries to either location — head or knee — it is better to prevent them. Football, hockey and soccer organizers have taken steps at various levels that have proven effective at reducing concussions. No such luck yet among helmet manufacturers.
Meanwhile, medical researchers have shown time and again that targeted exercise programs will significantly reduce the incidence of ACL injuries. A third study in this month’s JOSPT demonstrates how balance training protects against knee injuries.
Yet, the coaches who will take the time to institute these ACL injury-prevention programs are few and far between. If your daughter is playing high school basketball, ask her coach what the team does to prevent ACL tears. Any knee-targeted exercise program less than 20 minutes, three times per week, is not enough.