Youth injuries, ACL, synthetic turf and the monkey with a knife.

We have an expression in Spanish that says “More dangerous than a monkey with a knife!” (“Mas peligroso que mono con navaja!”). Basically, give a tool to somebody that does not know how to use it and the consequences can be disastrous.

Sports shoes are tools that have a specific purpose according to each sport. Its indiscriminate utilization can produce problems with severe consequences.
In the epidemiology of sports, and youth sports in particular, we observe with consternation that the injuries are in the raise and getting more severe. This is happening even when the science and technology sectors are putting huge amount of effort and money in trying to prevent it.
Among all the injuries, the torn ACL is one of the most concerning today. When this injury happens, the result is a devastated athlete that frequently has to give up his/her athletic aspirations. Also it generates a huge media attention accompanied with a succession of complains from the sports management, coaches and parents about the equipment used, the playing surface, the sport characteristics and more.

But I could not find yet any serious research or professional discussion published that consider two fundamental aspects as the probable main causes of this type of injury: 1) athlete’s shoes utilization and 2) athlete’s movement technique.
In my practice, I had the opportunity to rehabilitate and help to return to competition several ACL injured athletes from different sports. After the analysis of many variables to discover possible cause/s of the injury, I consistently found the same fundamental issues: the athlete does not understand how to properly use his/her sport tools (shoes among others) and usually that lack of information produces technique inefficiencies.

To illustrate my comment please observe the two young athletes that I had the opportunity to evaluate and rehabilitate.
As you know, one of the main causes of ACL tear is the rotation of the femur in the opposite direction respect of the tibia.

When the cleats of a soccer player . . .


. . . or the shoes of a thrower . . .

In both cases presented here the support foot (left) does not change its position during the movement sequence. The hip rotation creates a torque at the knee level (in both athletes the same knee that had an ACL injury).



. . . are stuck in the ground the risk of injury increases. To allow a quick and safe body rotation the athlete has to pivot on his/her toes (and this is why the distribution and shape of the cleats are like they are). But when the cleat is completely in contact with the ground, it prevents movement of the foot, therefore the point of rotation is translated from the toes to the knee.
The numerous wrong repetitions thanks to the absence of proper instruction, and the biological limitations related to the growing process of the young athlete creates the perfect mechanical, biochemical and structural environment for the damage to happen.
We can’t know yet, with the available information, if the injury is a one unique time event or a situation that happens after the anatomical region is stressed for a prolonged time (the last one is my strongest hypothesis). What it is sure is that the more the athletes repeat a wrong movement, the more they increase the risk of damage.

Shoes are tools and before the athlete is able to use them, as any other sport equipment, WE have to teach them how. We need to stop to disguise our youth to look like an athlete, but instead we need to teach and educate them how to properly perform like an athlete.
My conclusion is, after many years studying the epidemiology and causes of sports injuries, that we have an “educational problem”. In order to prevent injuries, like the torn ACL and others, our attention should be in improving our coaching resources before we get concerned about the sport technology. We should be focusing our efforts mainly in the coaches education, the sports evaluations, the training controls and the talent selection process to create a safer sport practice.

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