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This image depicts the anatomy of the ACL.

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An anterior cruciate ligament (ACL) injury occurs when the ligament that stabilizes the knee joint experiences a sprain or tear.

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The image depicts female athletes playing sports that are often associated with ACL injuries.

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Female athletes who play in competitive sports such as basketball and soccer have a 2-8x risk higher chance of developing an ACL injury compared to men.

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This image depicts a strand of DNA, referring to the genetic component of ACL injuries.

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Studies have found that the likelihood of developing an ACL injury can be hereditary among families.

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This GIF depicts a person with an ACL injury in soccer, relating to the various ways the injury could have occured.

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ACL Injuries can occur for a multitude of reasons, the most common of which include:

-> Changing Directions Quickly

-> Sudden pivoting

-> Stopping Suddenly

-> Overextending the knee

-> Landing from a jump

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The image depicts a high school, oftentimes the point in a teen's life where their risk of ACL injuries sharply increases.

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ACL Injuries increase in likelihood among preteens and early teens as a result of their physical growth. The chances of injury increase for girls beyond the age of 12 and boys beyond the age of 14.

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Anatomical Structures Involved in ACL Injuries

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Anatomical Structures Involved in ACL Injuries

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The primary structure involved in an ACL injury is the ACL itself however, the ACL serves as a band of tissues that connects the femur to the tibia, meaning that both are somewhat involved as structures within an ACL injury.

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According to this article, when one undergoes an ACL Injury, oftentimes, they will experience feelings of instability within their knee which can hinder performance in sports, leading to a feeling of the knee "giving out".

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According to this article, when an ACL injury is present, individuals may often feel some or all of the various symptoms. These include

Pain on the back of the knee

Swelling of the knee, especially in the first few hours after the injury

Limited movement of the knee

Discomfort when walking

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Anterior Cruciate Ligament Injury (ACL) - Symptoms and Causes

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The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the knee. Injury occurs from over-stretching or tearing. Read more to learn about symptoms, treatment options, and Penn’s Sports Medicine and Rehabilitation programs.

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Other Anatomical Structures Involved in an ACL Injury

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Other Anatomical Structures Involved in an ACL Injury

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ACL injuries can involve an MCL injury as well. This occurs around 20-38% of the time and is often the result of sports such as basketball, football, and soccer that involve a high degree of rotation of the knee.

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Combined Anterior Cruciate Ligament and Medial Collateral Ligament Knee Injuries: Anatomy, Diagnosis, Management Recommendations, and Return to Sport

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The diagnosis and management of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries have been a controversial topic for several decades. No single approach has proven optimal for treatment and there is no consensus…

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Subsequent to an ACL Injury, one will often experience a feeling of pain within the knee. This can occur for various reasons, whether that be because of the actual ACL injury, or whether accompanying injuries to areas around the ACL are causing pain.

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Often, after an ACL injury, one will experience swelling in their affected knee. This occurs as a result of blood trapped in the joint. This may also occur when a small blood vessel is torn during the ACL tear which can also cause significant swelling.

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Because of spinal reflex pathways, motion is limited as an involuntary response to the injury.

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The popping sound that one often hears or feels after an ACL injury occurs due to the rupturing of the ligament. The sound occurs due to the tissue being broken and further damage to areas around the ACL can exacerbate these "popping" sounds.

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The most common and accurate method of diagnosing an ACL injury is the Lachmen Test. This test reveals injuries by looking at the integrity of the ligament and determines whether an injury is present.

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The MRI can diagnose an ACL Injury by creating images of both the hard & soft tissues that are present within the knee which can be assessed to determine if an injury is present.

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In severe cases of ACL Injuries, the ACL can be reconstructed using either a donated ligament or one from another part of the body to fix the problem

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Surgery may be the most appropriate option to treat a common sports injury in the knee involving a sprain or tear in the anterior cruciate ligament (ACL).

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The goal of this treatment for less severe cases of ACL Injuries is to strengthen the areas surrounding the ACL which can thus lead to more stability around the knee and progress healing.

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Non-surgical ACL Tear or Injury Treatments: What to Expect

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Non-surgical treatment for an ACL tear or treatment may be appropriate for some people, including older people and those with minor injuries. Learn more.

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Consequence 1: Instability in the Knee Joint

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Consequence 1: Instability in the Knee Joint

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In some more severe cases of Anterior Cruciate Ligament injuries, the injured individual can experience long-term instability in their knee joint. This often occurs due to other secondary structures that are damaged at the same time as the original ACL injury. This creates the sensation of instability.

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Research has found that around half of individuals with an ACL Injury will experience Osteoarthritis occurring after 10-20 years from their initial injury. Osteoarthritis is a joint disease that is caused by the bone in a joint breaking down and weakening over time. ACL Injuries exacerbate this condition as it increases inflammation within the knee.

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Consequence 3: Increased risk of other Health Conditions

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Consequence 3: Increased risk of other Health Conditions

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With individuals who experience osteoarthritis within their knee after an ACL Injury, they often find themselves at a higher risk for developing diseases such as heart disease and diabetes. This occurs as a secondary consequence of an ACL injury as individuals with osteoarthritis often are unable to play in sports and exercise as others may be able to. This can lead to the onset of these other diseases that can affect their lives.

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How can a torn ACL affect you later in life?

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People who injure their ACL have a higher risk of developing arthritis in their knee, even if they have surgery to repair the damaged ligament.

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For certain cases of ACL Injuries, people may seek out physical therapy to strengthen the area around the ACL and the knee itself to prevent re-injury. Physical therapy usually costs between $75-$150 per hour without insurance. It is quite likely that insurance will cover the cost of an ACL injury but it depends on your deductible whether it will be full or partial coverage. If the person does not seek treatment, the consequences can include permanent weakness within the knee and and incomplete healing.

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What happens during physical therapy for an ACL injury?

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You were playing soccer or basketball with friends when you turned around and felt or heard a pop in your knee. There was instant pain and swelling, and you couldn’t finish the game. What happened? You probably injured your anterior cruciate ligament, or ACL.

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The cost of knee braces aimed to aid the healing process of an ACL injury can vary in cost. It usually falls between $200-$400 but can be higher depending on the brand and quality of the brace. In terms of coverage, a lot of insurances do cover the cost of a brace however it does depend so there is a moderate chance it would be covered and would vary by insurance provider. If the person does not seek this treatment, they stand a higher risk for a repeated injury and may end up paying more in the future.

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Whether you're recovering from knee surgery or rehabilitating a knee injury, a knee brace can make a real difference to your rehab and recovery journey. Many people find that a quality knee brace can get them back on their feet and doing what they love quickly and safely.

Despite the clear benefits of a knee brace when it comes to recovery, many people are still hesitant to invest in a brace of their own due to questions about knee brace prices. But how much is a knee brace, really?

In this guide, we'll explain everything you need to know about the cost of knee braces from leading manufacturers like Breg and Donjoy. We'll explain the factors that affect knee brace prices and help you understand what you can expect to pay for a quality brace.

We'll compare knee brace costs for different brands, explain why you shouldn't shop based on price alone, and help you make smart, savvy decisions when it comes to investing in your knee health.

Factors Influencing the Knee Brace Cost

If you've already started shopping around for knee braces, you might have noticed that the prices can vary dramatically. There are a number of reasons for the differences in knee brace costs - let's take a look at some of the main factors.

Material and Design Complexity

The materials used in the construction of a knee brace can have a substantial impact on its price. Knee braces are made from various materials, including neoprene, elastic, and advanced lightweight alloys.

More complex and technologically advanced designs, such as hinged or custom-fitted braces, tend to be pricier. These designs often offer enhanced support, durability, and comfort, which can be important for those with severe knee injuries or people seeking long-term solutions.

While basic knee sleeves are more affordable, they don't provide the same level of support as an advanced brace, like the best knee brace for a torn meniscus . Understanding whether you need a knee brace vs knee sleeve is an important step in finding the right solution for your knee.

Type and Specific Functionality

Knee braces come in various types, each designed to address specific conditions or situations. A simple compression sleeve, which mostly offers mild support, will be more cost-effective than a knee brace designed for athletes or those recovering from surgery.

Functional knee braces are engineered to provide targeted support, often incorporating adjustable hinges, straps, and other features. The specific functionality you require will impact the cost of the brace, with specialized braces catering to distinct needs commanding higher prices.

Brand Reputation and Research Development

The reputation of the brand and the extent of research and development invested in their products can also influence the price of a knee brace. Well-established brands with a history of innovation and quality control may charge a premium for their products.

However, this premium often comes with the assurance of a reliable and effective product. Newer or lesser-known brands may offer more budget-friendly compared to a Donjoy knee brace price, but the quality and efficacy of their knee braces can be variable.

Shipping Considerations

If you're purchasing a knee brace online, shipping costs may add to the overall price. Shipping fees can vary based on your location and the supplier's shipping policies. When budgeting for knee brace costs, make sure you factor in shipping to get a clear picture of the total expense.

Insurance and Reimbursement Options

In some cases, health insurance coverage or reimbursement programs can offset the cost of a knee brace. Check with your healthcare provider or insurance company to see if your condition qualifies for coverage.

If so, you may be able to obtain a knee brace at a reduced cost or even for free. Be sure to understand the requirements and documentation necessary to benefit from these programs, and ask your healthcare provider for help if needed.

So, How Much is a Knee Brace?

So, how much is a knee brace? As mentioned, knee brace costs can vary significantly, but we can still give you an idea of what you can expect to pay for different types of knee braces. Here's an idea of knee brace costs to help you understand how to choose a knee brace for your specific needs.

The Average Knee Brace Price

The average knee brace cost can vary widely based on the factors discussed earlier. At the lower end of the spectrum, basic compression sleeves can typically be found for around $20 to $50. These are suitable for minor knee discomfort and preventative measures.

For more complex and specialized knee braces designed for post-injury recovery, athletic use, or severe knee conditions, prices can range from $200 to $600 or more. These rigid braces are highly adjustable and come with a range of features compared to a basic compression sleeve.

How Much is a Breg Knee Brace?

Breg knee braces are widely considered the gold standard when it comes to orthopedic knee braces. Breg offers a range of knee braces tailored to different needs, including post-surgery recovery, sports support, and daily wear. So, how much is a Breg knee brace?

The cost of a Breg knee brace can vary based on the specific model and features. On average, Breg knee braces typically range from $200 to $400 or more. The top-rated Breg Fusion knee brace , designed for ACL rehab and other serious ligament issues, typically costs around $600.

What About the Donjoy Knee Brace Price?

When it comes to Donjoy vs Breg , not much separates the two brands in terms of quality. So, how does the Donjoy knee brace price compare to Breg? Knee brace costs between Donjoy and Breg are fairly similar, with Donjoy braces perhaps coming in slightly on the more affordable side.

Lightweight wraparound Donjoy braces can be found for less than $100, while more heavy-duty rigid braces designed for surgical recovery can cost upwards of $400. Both types of braces are made from high-quality materials and built to last.

Why You Shouldn't Shop Based on the Cost of Knee Braces Alone...

When shopping for knee braces, it can be tempting to focus solely on the price tag, seeking out the most budget-friendly option. However, this approach may ultimately prove detrimental to your overall health and well-being - here's why.

Quality and Durability Over Price

It's important to remember that knee braces are not just a one-time purchase but an investment in your comfort and recovery. Opting for the cheapest option available might save you money in the short term, but it can cost you more in the long run.

Higher-priced knee braces often come with superior materials, better construction, and enhanced durability. This means they are more likely to withstand the rigors of daily wear, offering long-lasting support.

Low-cost knee braces may not provide the necessary support for your condition, potentially leading to discomfort or exacerbation of your knee issues, which can slow down your recovery and lead to setbacks in your rehab.

A budget knee brace can also cause frustration if it's poorly designed and won't stay securely in place. You may find yourself constantly wondering how to keep a knee brace from sliding down , whereas with a quality brace, you can sometimes even forget you're wearing it.

The True Cost of Inadequate Support

Choosing a knee brace solely based on its cost can mean that you end up with a brace that doesn't support your knee properly. Just think about it - how much is a knee brace going to cost you if it doesn't help you heal?

If your knee condition requires substantial support and you opt for a cheap, non-specialized brace, you risk making your injury worse or prolonging your recovery. This could result in extra medical expenses, pain that lasts longer, and lost weeks or months due to ongoing discomfort.

A poor-quality knee brace can even affect your quality of life. If your brace doesn't give your knee the support it needs, you may not be able to do everyday tasks or play the sports you love. The emotional impact of this, along with persistent pain, is a significant cost that shouldn't be forgotten.

Invest in Your Health and Get the Lowest Knee Brace Price With World-Class Customer Support at Ortho Bracing!

At Ortho Bracing, we stock premium knee braces, including Donjoy products and Breg products , designed for many different scenarios. Whether you need a knee brace to reduce post-surgery swelling or to protect your knees while you play soccer, you'll find exactly what you need.

How much is a knee brace from Ortho Bracing? We don't believe you should ever have to choose between your health and your bank balance, so we have braces available at many different price points. We offer premium braces for lower prices than you'll find anywhere else.

Not sure what you need? Our orthopedic experts are available 24/7 to point you in the right direction and offer helpful tips on when to wear a knee brace , what to wear under knee braces , how to put on a Breg knee brace , how to put on a Donjoy knee brace , and how long to wear a knee brace .

Ortho Bracing has a lot more to offer than knee braces. We stock a vast selection of orthopedic products and equipment, as long as we believe it will truly help you heal. Explore our shoulder braces and best cold therapy machines , including the Breg Polar Care Kodiak ice machine .

Parting Thoughts on Knee Brace Price Points

So, how much is a knee brace? Although knee braces can come at a range of different price points, it's better to invest in the highest quality knee brace you can afford. A good knee brace can make a huge difference to your healing journey, getting you back on your feet with comfort and safety.

At Ortho Bracing, we have premium knee braces at affordable prices, to help your body heal the right way. With next-day shipping and first-class customer support, there's nowhere better to invest in a quality knee brace that gives the support and stability your knee needs.

As well as our braces, we have top-rated orthopedic equipment like polar ice machines that can make a big difference to your recovery. Explore our ice braces for knees , as well as units like the AirCast Cryo Cuff and Donjoy Iceman Cear 3 for safe, rapid, comfortable rehab.

Heal safely and comfortably with a knee brace designed just for you. Shop Ortho Bracing today.

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How Much is a Knee Brace? Cost of Knee Braces from Breg, Donjoy, and More

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Whether you're recovering from knee surgery or rehabilitating a knee injury, a knee brace can make a real difference to your rehab and recovery journey. Many people find that a quality knee brace can get them back on their feet and doing what they love quickly and safely.

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The price for ACL surgery can cost between $9,500-$26,000 with an average price of $15,445. In terms of insurance, it is quite likely that insurance will cover the full cost of the surgery if a doctor has determined that the surgery is "medically necessary". If a person does not seek this treatment, they can risk arthritis within the knee and permanent knee pain and other issues regarding the strength of their knee, leading to a much lower overall quality of life.

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Psychotherapy would likely be needed in cases of ACL Injuries. The treatment would involve helping the patient re-frame their methods of thinking in regards to the injury, and working toward seeing their progress. The treatment would be designed to treat the depressive symptoms that are often associated with ACL Injuries. This type of treatment would be administered by a licensed psychologist who could help the patient work through their struggles.

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Psychological Rehabilitation From Anterior Cruciate Ligament–Medial Collateral Ligament Reconstructive Surgery: A Case Study

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Research has shown that some of the more common psychological responses to injury (ie, depression, anger, anxiety) are amplified in cases of traumatic injury. An 18-year-old male scholarship soccer player who, owing to a perceived deliberate…

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Time Projection is another technique that could be used to treat the long-term effects of ACL Injuries. The treatment "involves the individual imagining himself or herself in the future or in the past" (NIH.GOV), " it is used to motivate the client to see himself or herself at a future stage in rehabilitation or to retrospectively reflect on progress made over the course of rehabilitation". (NIH.GOV) The treatment is meant to treat the anger and frustration that is associated with the injury. The treatment would likely be administered by a clinical psychologist as well.

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Psychological Rehabilitation From Anterior Cruciate Ligament–Medial Collateral Ligament Reconstructive Surgery: A Case Study

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Research has shown that some of the more common psychological responses to injury (ie, depression, anger, anxiety) are amplified in cases of traumatic injury. An 18-year-old male scholarship soccer player who, owing to a perceived deliberate…

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None of these Rehabilitation Techniques are Necessary

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None of these Rehabilitation Techniques are Necessary

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Given an ACL Injury, speech, hearing, and cognitive rehabilitation are not necessary as those aspects of an individual are not affected during an ACL Injury. The injury and it's rehabilitation techniques required strictly tend toward physical therapy and other physical based treatments.

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Rehabilitation Treatment 1: Balance and Coordination Drills

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Rehabilitation Treatment 1: Balance and Coordination Drills

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This treatment is applied by requiring the patient to work through exercises on various surfaces that would help restore balance. It would be designed to treat increased risk of other health conditions along with instability within the knee. A physical therapist is required to deliver this treatment

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An anterior cruciate ligament tear is an injury to the knee commonly affecting athletes, such as soccer players, basketball players, skiers, and gymnasts. Nonathletes can also experience an ACL tear due to injury or accident. Approximately 200,000 ACL injuries are diagnosed in the United States each year. It is estimated that there are 95,000 ruptures of the ACL and 100,000 ACL reconstructions performed per year in the United States. Approximately 70% of ACL tears in sports are the result of noncontact injuries, and 30% are the result of direct contact (player-to-player, player-to-object). Women are more likely than men to experience an ACL tear. Physical therapists are trained to help individuals with ACL tears reduce pain and swelling, regain strength and movement, and return to desired activities.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
Find a PT Near You!

What Is an ACL Tear?

The ACL is one of the major bands of tissue (ligaments) connecting the thigh bone (femur) to the shin bone (tibia) at the knee joint. It can tear if you:

Twist your knee while keeping your foot planted on the ground.

Stop suddenly while running.

Suddenly shift your weight from one leg to the other.

Jump and land on an extended (straightened) knee.

Stretch the knee farther than its usual range of movement.

Experience a direct hit to the knee.

How Does It Feel?

When you tear the ACL, you may feel a sharp, intense pain or hear a loud "pop" or snap. You might not be able to walk on the injured leg because you can't support your weight through your knee joint. Usually, the knee will swell immediately (within minutes to a few hours), and you might feel that your knee "gives way" when you walk or put weight on it.

How Is It Diagnosed?

Immediately following an injury, you may be examined by a physical therapist, athletic trainer, or orthopedic surgeon. If you see your physical therapist first, your therapist will conduct a thorough evaluation that includes reviewing your health history. Your physical therapist will ask:

What you were doing when the injury occurred.

If you felt pain or heard a "pop" when the injury occurred.

If you experienced swelling around the knee in the first 2 to 3 hours following the injury.

If you felt your knee buckle or give out when you tried to get up from a chair, walk up or down stairs, or change direction while walking.

Your physical therapist may perform gentle "hands-on" tests to determine the likelihood that you have an ACL tear, and may use additional tests to assess possible damage to other parts of your knee.

An orthopedic surgeon may order further tests, including magnetic resonance imaging (MRI), to confirm the diagnosis and rule out other possible damage to the knee.

Surgery

Most people who sustain an ACL tear will undergo surgery to repair the tear; however, some people may avoid surgery by modifying their physical activity to relieve stress on the knee. A select group can actually return to vigorous physical activity following rehabilitation without having surgery.

Your physical therapist, together with your surgeon, can help you determine if nonoperative treatment (rehabilitation without surgery) is a reasonable option for you. If you elect to have surgery, your physical therapist will help you prepare both for surgery and to recover your strength and movement following surgery.

How Can a Physical Therapist Help?

Once an ACL tear has been diagnosed, you will work with your surgeon and physical therapist to decide if you should have surgery, or if you can recover without surgery. If you don't have surgery, your physical therapist will work with you to restore your muscle strength, agility, and balance, so you can return to your regular activities. Your physical therapist may teach you ways to modify your physical activity in order to put less stress on your knee. If you decide to have surgery your physical therapist can help you before and after the procedure.

Treatment Without Surgery

Current research has identified a specific group of patients (called "copers") who have the potential for healing without surgery following an ACL tear. These patients have injured only the ACL, and have experienced no episodes of the knee "giving out" following the initial injury. If you fall into this category, based on the specific tests your physical therapist will conduct, your therapist will design an individualized physical therapy treatment program for you. It may include treatments such as gentle electrical stimulation applied to the quadriceps muscle, muscle strengthening, and balance training.

Treatment Before Surgery

If your orthopedic surgeon determines that surgery is necessary, your physical therapist can work with you before and after your surgery. Some surgeons refer their patients to a physical therapist for a short course of rehabilitation before surgery. Your physical therapist will help you decrease your swelling, increase the range of movement of your knee, and strengthen your thigh muscles (quadriceps).

Treatment After Surgery

Your orthopedic surgeon will provide postsurgery instructions to your physical therapist, who will design an individualized treatment program based on your specific needs and goals. Your treatment program may include:

Bearing weight. Following surgery, you will use crutches to walk. The amount of weight you are allowed to put on your leg and how long you use the crutches will depend on the type of reconstructive surgery you have received. Your physical therapist will design a treatment program to meet your needs and gently guide you toward full weight bearing.

Icing and compression. Immediately following surgery, your physical therapist will control your swelling with a cold application, such as an ice sleeve, that fits around your knee and compresses it.

Bracing. Some surgeons will give you a brace to limit your knee movement (range of motion) following surgery. Your physical therapist will fit you with the brace and teach you how to use it safely. Some athletes will be fitted for braces as they recover and begin to return to their sports activities.

Movement exercises. During your first week following surgery, your physical therapist will help you begin to regain motion in the knee area, and teach you gentle exercises you can do at home. The focus will be on regaining full movement of your knee. The early exercises help with increasing blood flow, which also helps reduce swelling.

Electrical stimulation. Your physical therapist may use electrical stimulation to help restore your thigh muscle strength, and help you achieve those last few degrees of knee motion.

Strengthening exercises. In the first 4 weeks after surgery, your physical therapist will help you increase your ability to put weight on your knee, using a combination of weight-bearing and non-weight-bearing exercises. The exercises will focus on your thigh muscles (quadriceps and hamstrings) and might be limited to a specific range of motion to protect the new ACL. During subsequent weeks, your physical therapist may increase the intensity of your exercises and add balance exercises to your program.

Balance exercises. Your physical therapist will guide you through exercises on varied surfaces to help restore your balance. Initially, the exercises will help you gently shift your weight on to the surgery leg. These activities will progress to standing on the surgery leg, while on firm and unsteady surfaces to challenge your balance.

Return to sport or activities. As athletes regain strength and balance, they may begin running, jumping, hopping, and other exercises specific to their individual sport. This phase varies greatly from person-to-person. Physical therapists design return-to-sport treatment programs to fit individual needs and goals.

Can This Injury or Condition Be Prevented?

Much of the research on ACL tears has been conducted with female collegiate athletes, because women are 4 to 6 times more likely to experience the injury. Preventive physical therapy programs have proven to lower ACL injury rates by 41% for female soccer players. Researchers have made the following recommendations for a preventive exercise program:

The program should be designed to improve balance, strength, and sports performance. Strengthening your core (abdominal) muscles is key to preventing injury, in addition to strengthening your thigh and leg muscles.

Exercises should be performed 2 or 3 times per week and should include sport-specific exercises.

The program should last no fewer than 6 weeks.

Although most exercise studies have been conducted with female athletes, the findings may benefit male athletes as well.

What Kind of Physical Therapist Do I Need?

Although all physical therapists are prepared through education and experience to treat a variety of conditions or injuries, you may want to consider:

A physical therapist who is experienced in treating people with orthopedic (musculoskeletal) problems.

A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic or sports physical therapy and has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists with these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist:

Get recommendations from family and friends or from other health care providers.

When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with ACL tears.

Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of ACL tears. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are listed by year and are linked either to a PubMed* abstract of the article or to free access of the full article, so that you can read it or print out a copy to bring with you to your health care provider.

Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DN. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med. 2016;7:21-32. Article Summary on PubMed.

Anderson MJ, Browning WM III, Urband CE, Kluczynski MA, Bisson LJ. A systematic summary of the systematic reviews on the topic of the anterior cruciate ligament. Orthop J Sports Med. 2016;4:2325967116634074. Article Summary on PubMed.

Anterior cruciate ligament injury. Medscape website. Accessed June 16, 2016.

Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ, Godges JJ; Orthopaedic Section of the American Physical Therapy Association. Knee stability and movement coordination impairments: knee ligament sprain. J Orthop Sports Phys Ther. 2010;40:A1-A37. Article Summary on PubMed.

Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA. A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2010;40:705-721. Article Summary on PubMed.

Nyland J, Brand E, Fisher B. Update on rehabilitation following ACL reconstruction. Open Access J Sports Med. 2010;1:151-166. Article Summary on PubMed.

Risberg MA, Holm I. The long-term effect of 2 postoperative rehabilitation programs after anterior cruciate ligament reconstruction: a randomized controlled clinical trial with 2 years of follow-up. Am J Sports Med. 2009;37:1958-1966. Free Article.

Gilchrist J, Mandelbaum BR, Melancon H, et al. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med. 2008;36:1476-1483. Article Summary on PubMed.

Hurd WJ, Axe MJ, Snyder-Mackler L. A 10-year prospective trial of a patient management algorithm and screening examination for highly active individuals with anterior cruciate ligament injury: Part 1, outcomes. Am J Sports Med. 2008;36:40-47. Article Summary on PubMed.

Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther. 2006;36:267-288. Article Summary on PubMed.

Hewett TE, Ford KR, Myer GD. Anterior cruciate ligament injuries in female athletes: part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med. 2006;34:490-498. Article Summary on PubMed.

Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichol CE. Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med. 2005;33:1751-1767. Article Summary on PubMed.

Fitzgerald GK, Piva SR, Irrgang JJ. A modified neuromuscular electrical stimulation protocol for quadriceps strength training following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2003;33:492-501. Article Summary on PubMed.

*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.

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Guide | Physical Therapy Guide to Anterior Cruciate Ligament Tear

# data[].attributes.attachment_link.description
An anterior cruciate ligament, or ACL, tear is an injury to the knee that often affects athletes who participate in soccer, basketball, skiing, and gymnastics.

# data[].attributes.body
These exercises are meant as a tool of increasing a patient's ability to put pressure and weight on their knee, often utilizing both weight and non-weight bearing exercises. This would be designed to treat instability in the knee along with increased risk of other health conditions. A physical therapist is required to deliver this treatment.

# data[].attributes.attachment_link.readable_text
An anterior cruciate ligament tear is an injury to the knee commonly affecting athletes, such as soccer players, basketball players, skiers, and gymnasts. Nonathletes can also experience an ACL tear due to injury or accident. Approximately 200,000 ACL injuries are diagnosed in the United States each year. It is estimated that there are 95,000 ruptures of the ACL and 100,000 ACL reconstructions performed per year in the United States. Approximately 70% of ACL tears in sports are the result of noncontact injuries, and 30% are the result of direct contact (player-to-player, player-to-object). Women are more likely than men to experience an ACL tear. Physical therapists are trained to help individuals with ACL tears reduce pain and swelling, regain strength and movement, and return to desired activities.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
Find a PT Near You!

What Is an ACL Tear?

The ACL is one of the major bands of tissue (ligaments) connecting the thigh bone (femur) to the shin bone (tibia) at the knee joint. It can tear if you:

Twist your knee while keeping your foot planted on the ground.

Stop suddenly while running.

Suddenly shift your weight from one leg to the other.

Jump and land on an extended (straightened) knee.

Stretch the knee farther than its usual range of movement.

Experience a direct hit to the knee.

How Does It Feel?

When you tear the ACL, you may feel a sharp, intense pain or hear a loud "pop" or snap. You might not be able to walk on the injured leg because you can't support your weight through your knee joint. Usually, the knee will swell immediately (within minutes to a few hours), and you might feel that your knee "gives way" when you walk or put weight on it.

How Is It Diagnosed?

Immediately following an injury, you may be examined by a physical therapist, athletic trainer, or orthopedic surgeon. If you see your physical therapist first, your therapist will conduct a thorough evaluation that includes reviewing your health history. Your physical therapist will ask:

What you were doing when the injury occurred.

If you felt pain or heard a "pop" when the injury occurred.

If you experienced swelling around the knee in the first 2 to 3 hours following the injury.

If you felt your knee buckle or give out when you tried to get up from a chair, walk up or down stairs, or change direction while walking.

Your physical therapist may perform gentle "hands-on" tests to determine the likelihood that you have an ACL tear, and may use additional tests to assess possible damage to other parts of your knee.

An orthopedic surgeon may order further tests, including magnetic resonance imaging (MRI), to confirm the diagnosis and rule out other possible damage to the knee.

Surgery

Most people who sustain an ACL tear will undergo surgery to repair the tear; however, some people may avoid surgery by modifying their physical activity to relieve stress on the knee. A select group can actually return to vigorous physical activity following rehabilitation without having surgery.

Your physical therapist, together with your surgeon, can help you determine if nonoperative treatment (rehabilitation without surgery) is a reasonable option for you. If you elect to have surgery, your physical therapist will help you prepare both for surgery and to recover your strength and movement following surgery.

How Can a Physical Therapist Help?

Once an ACL tear has been diagnosed, you will work with your surgeon and physical therapist to decide if you should have surgery, or if you can recover without surgery. If you don't have surgery, your physical therapist will work with you to restore your muscle strength, agility, and balance, so you can return to your regular activities. Your physical therapist may teach you ways to modify your physical activity in order to put less stress on your knee. If you decide to have surgery your physical therapist can help you before and after the procedure.

Treatment Without Surgery

Current research has identified a specific group of patients (called "copers") who have the potential for healing without surgery following an ACL tear. These patients have injured only the ACL, and have experienced no episodes of the knee "giving out" following the initial injury. If you fall into this category, based on the specific tests your physical therapist will conduct, your therapist will design an individualized physical therapy treatment program for you. It may include treatments such as gentle electrical stimulation applied to the quadriceps muscle, muscle strengthening, and balance training.

Treatment Before Surgery

If your orthopedic surgeon determines that surgery is necessary, your physical therapist can work with you before and after your surgery. Some surgeons refer their patients to a physical therapist for a short course of rehabilitation before surgery. Your physical therapist will help you decrease your swelling, increase the range of movement of your knee, and strengthen your thigh muscles (quadriceps).

Treatment After Surgery

Your orthopedic surgeon will provide postsurgery instructions to your physical therapist, who will design an individualized treatment program based on your specific needs and goals. Your treatment program may include:

Bearing weight. Following surgery, you will use crutches to walk. The amount of weight you are allowed to put on your leg and how long you use the crutches will depend on the type of reconstructive surgery you have received. Your physical therapist will design a treatment program to meet your needs and gently guide you toward full weight bearing.

Icing and compression. Immediately following surgery, your physical therapist will control your swelling with a cold application, such as an ice sleeve, that fits around your knee and compresses it.

Bracing. Some surgeons will give you a brace to limit your knee movement (range of motion) following surgery. Your physical therapist will fit you with the brace and teach you how to use it safely. Some athletes will be fitted for braces as they recover and begin to return to their sports activities.

Movement exercises. During your first week following surgery, your physical therapist will help you begin to regain motion in the knee area, and teach you gentle exercises you can do at home. The focus will be on regaining full movement of your knee. The early exercises help with increasing blood flow, which also helps reduce swelling.

Electrical stimulation. Your physical therapist may use electrical stimulation to help restore your thigh muscle strength, and help you achieve those last few degrees of knee motion.

Strengthening exercises. In the first 4 weeks after surgery, your physical therapist will help you increase your ability to put weight on your knee, using a combination of weight-bearing and non-weight-bearing exercises. The exercises will focus on your thigh muscles (quadriceps and hamstrings) and might be limited to a specific range of motion to protect the new ACL. During subsequent weeks, your physical therapist may increase the intensity of your exercises and add balance exercises to your program.

Balance exercises. Your physical therapist will guide you through exercises on varied surfaces to help restore your balance. Initially, the exercises will help you gently shift your weight on to the surgery leg. These activities will progress to standing on the surgery leg, while on firm and unsteady surfaces to challenge your balance.

Return to sport or activities. As athletes regain strength and balance, they may begin running, jumping, hopping, and other exercises specific to their individual sport. This phase varies greatly from person-to-person. Physical therapists design return-to-sport treatment programs to fit individual needs and goals.

Can This Injury or Condition Be Prevented?

Much of the research on ACL tears has been conducted with female collegiate athletes, because women are 4 to 6 times more likely to experience the injury. Preventive physical therapy programs have proven to lower ACL injury rates by 41% for female soccer players. Researchers have made the following recommendations for a preventive exercise program:

The program should be designed to improve balance, strength, and sports performance. Strengthening your core (abdominal) muscles is key to preventing injury, in addition to strengthening your thigh and leg muscles.

Exercises should be performed 2 or 3 times per week and should include sport-specific exercises.

The program should last no fewer than 6 weeks.

Although most exercise studies have been conducted with female athletes, the findings may benefit male athletes as well.

What Kind of Physical Therapist Do I Need?

Although all physical therapists are prepared through education and experience to treat a variety of conditions or injuries, you may want to consider:

A physical therapist who is experienced in treating people with orthopedic (musculoskeletal) problems.

A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic or sports physical therapy and has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists with these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist:

Get recommendations from family and friends or from other health care providers.

When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with ACL tears.

Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of ACL tears. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are listed by year and are linked either to a PubMed* abstract of the article or to free access of the full article, so that you can read it or print out a copy to bring with you to your health care provider.

Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DN. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med. 2016;7:21-32. Article Summary on PubMed.

Anderson MJ, Browning WM III, Urband CE, Kluczynski MA, Bisson LJ. A systematic summary of the systematic reviews on the topic of the anterior cruciate ligament. Orthop J Sports Med. 2016;4:2325967116634074. Article Summary on PubMed.

Anterior cruciate ligament injury. Medscape website. Accessed June 16, 2016.

Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ, Godges JJ; Orthopaedic Section of the American Physical Therapy Association. Knee stability and movement coordination impairments: knee ligament sprain. J Orthop Sports Phys Ther. 2010;40:A1-A37. Article Summary on PubMed.

Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA. A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2010;40:705-721. Article Summary on PubMed.

Nyland J, Brand E, Fisher B. Update on rehabilitation following ACL reconstruction. Open Access J Sports Med. 2010;1:151-166. Article Summary on PubMed.

Risberg MA, Holm I. The long-term effect of 2 postoperative rehabilitation programs after anterior cruciate ligament reconstruction: a randomized controlled clinical trial with 2 years of follow-up. Am J Sports Med. 2009;37:1958-1966. Free Article.

Gilchrist J, Mandelbaum BR, Melancon H, et al. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med. 2008;36:1476-1483. Article Summary on PubMed.

Hurd WJ, Axe MJ, Snyder-Mackler L. A 10-year prospective trial of a patient management algorithm and screening examination for highly active individuals with anterior cruciate ligament injury: Part 1, outcomes. Am J Sports Med. 2008;36:40-47. Article Summary on PubMed.

Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther. 2006;36:267-288. Article Summary on PubMed.

Hewett TE, Ford KR, Myer GD. Anterior cruciate ligament injuries in female athletes: part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med. 2006;34:490-498. Article Summary on PubMed.

Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichol CE. Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med. 2005;33:1751-1767. Article Summary on PubMed.

Fitzgerald GK, Piva SR, Irrgang JJ. A modified neuromuscular electrical stimulation protocol for quadriceps strength training following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2003;33:492-501. Article Summary on PubMed.

*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.

# data[].attributes.attachment_link.title
Guide | Physical Therapy Guide to Anterior Cruciate Ligament Tear

# data[].attributes.attachment_link.description
An anterior cruciate ligament, or ACL, tear is an injury to the knee that often affects athletes who participate in soccer, basketball, skiing, and gymnastics.

# data[].attributes.body
Physical Therapy involves actively performing exercises with a licensed Physical Therapist who guides a patient in their recovery process by aiding with these exercises. On a scale from 1-10, I would rate Physical Therapy a 5 as there may be a financial component that may impact a patient's ability to access this treatment. Secondly, there's the difficulty of committing to the program and performing the exercises regularly on their own from physical therapy. You would need a licensed Physical Therapist for this lifestyle change.

# data[].attributes.attachment_link.title
Activity preferences, lifestyle modifications and re-injury fears influence longer-term quality of life in people with knee symptoms following anterior cruciate ligament reconstruction: a qualitative study - PubMed

# data[].attributes.attachment_link.description
Activity preferences, lifestyle modifications and fear of re-injury influenced quality of life in people with knee symptoms up to 20 years following ACLR. People with a preference for competitive sport who do not enjoy recreational exercise might be at heightened risk of poor quality of life outcome …

# data[].attributes.headline
Lifestyle Change 2: Modifying Activities

# data[].attributes.subject
Lifestyle Change 2: Modifying Activities

# data[].attributes.body
To prevent re-injury and allow time for the ACL to return to its former strength, one must modify their daily activities by altering them in ways that reduces the stress placed on the knee and the surrounding areas. This treatment can vary from 1-10 in difficulty based on the person and the lifestyle they live, therefore I'll rate it based on how difficult it would be for me, giving it a 7. A lot of the activities that I enjoy in life often involve putting pressure on your knee. This includes basketball, rock climbing, and hiking. As such, it would be difficult for me to modify these activities and it would greatly reduce the fun of these activities. You would not need a professional for this lifestyle change however a physical therapy can likely provide excellent advice and tips for best modifying your activities.

# data[].attributes.attachment_link.title
Activity preferences, lifestyle modifications and re-injury fears influence longer-term quality of life in people with knee symptoms following anterior cruciate ligament reconstruction: a qualitative study - PubMed

# data[].attributes.attachment_link.description
Activity preferences, lifestyle modifications and fear of re-injury influenced quality of life in people with knee symptoms up to 20 years following ACLR. People with a preference for competitive sport who do not enjoy recreational exercise might be at heightened risk of poor quality of life outcome …

# data[].attributes.headline
Intervention 1: Injury Prevention Programs

# data[].attributes.subject
Intervention 1: Injury Prevention Programs

# data[].attributes.body
Injury prevention programs are programs that train athletes various methods of mitigating the risk of injury while simultaneously improving flexibility and strengthening at risk areas. This is designed to target the individual. A possible challenge to this is willingness of people to join. It seems unlikely that people would join such a program until an injury occurs which can defeat it's purpose.

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ACL Injury Prevention — Recognize to Recover

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Intervention 2: Modification and Education

# data[].attributes.subject
Intervention 2: Modification and Education

# data[].attributes.body
Modification and Education is a public health intervention that provides education to coaches and professionals that allow for modification regarding sports that can reduce the risk of an ACL injury. The hardest part about this is finding ways for knowledge to spread and for coaches and professionals to actually act on the provided information.

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National Athletic Trainers’ Association Position Statement: Prevention of Anterior Cruciate Ligament Injury

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To provide certified athletic trainers, physicians, and other health care and fitness professionals with recommendations based on current evidence regarding the prevention of noncontact and indirect-contact anterior cruciate ligament (ACL) injuries…

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Risk Assessments are designed to evaluate an athlete or child on their risk of developing an ACL injury and can give athletes insight on their individual risks. The difficulty with implementing this is again scale and getting this technology to the greatest amount of people.

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About ScienceDirect
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Policy is a public health intervention that requires certain changes to be made to sports or proper training to be required that serves as a means of preventing injury. The issue with this is passing policies and more legislation that will enable this.

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Death during sport or physical activity is a tragic and unexpected event. However, with appropriate evidence-based policies in place, death can often be prevented. The top causes of sudden death in sport and physical activity are sudden cardiac arrest (SCA), exertional heat stroke (EHS), head injuries, and exertional sickling. Studies1-3 suggest that more than 90% of sudden deaths in sport are attributable to these 4 causes, with SCA accounting for about 75% of sudden death during sport participation. Although sudden death from the aforementioned causes is not 100% preventable, the implementation of evidence-based safety policies such as emergency planning and access to automated external defibrillators (AEDs), heat acclimatization, instruction on proper tackling techniques (such as the "Heads Up Football" educational program), and sickle cell trait (SCT) screening in targeted populations can dramatically reduce overall risk. American football presents a unique risk profile for head injuries, EHS, and exertional sickling, which have driven many of the policy changes, but best practices for sport safety and emergency planning are relevant across all sports.

In 2012, the National Athletic Trainers' Association (NATA) released a position statement on the prevention of sudden death in athletes.4 Similarly, in 2013, the NATA released an interassociation task force document on preventing sudden death, specifically in the secondary school setting.5 The purposes of these documents were to provide evidence-based minimum best-practice recommendations to prevent, recognize, and treat the leading causes of death in sport and physical activity. To further focus efforts on preventing sudden death in the secondary school setting, the NATA, along with the American Medical Society for Sports Medicine and the Korey Stringer Institute, held the first annual "Collaborative Solutions for Safety in Sports" meeting in March 2015, at which a representative from each state's secondary school athletics association and a representative from each state's sports medicine advisory committee convened to discuss sport safety best practices and policy changes relevant to secondary school athletics. The second annual meeting in March 2016 will continue to provide state representatives with information and guidance for implementing evidence-based policies to protect their student-athletes.

HEAT ACCLIMATIZATION: AN EXAMPLE OF POLICY CHANGE THAT WORKS

In 2003, the National Collegiate Athletic Association (NCAA) implemented heat-acclimatization policies for preseason August football practices, requiring the phasing in of both activity and protective equipment during the hottest portion of the calendar year, when student-athletes are at highest risk of suffering EHS. Before heat-acclimatization policies were implemented, 1 or 2 EHS-related deaths occurred in NCAA student-athletes during August practices each year.1 Implementation of heat acclimatization at the collegiate level has been hugely successful, reducing the total number of August EHS-related deaths to just 1 (total) since the 2003 policy- enactment date, a 95% reduction. This simple policy change that cost no money to implement has spared the life of an estimated 20 collegiate football players and has also likely reduced the number of instances in which an athlete survived EHS but had long-term complications. The NCAA heat-acclimatization policy is a great example of a policy change that can make a difference in student-athlete safety.

Casa et al,6 in 2009, published heat-acclimatization guidelines specific to high school athletes in an effort to reduce the number of deaths from EHS. Since 2011, 15 states have adopted heat-acclimatization policies as mandated by each state's high school athletics association ( Figure). During high school preseason practices from 1980 to 2015 (a total of 488 preseasons), 22 of the 44 EHS deaths occurred in these 15 states before implementation of heat-acclimatization policies. Since implementation (a total of 50 preseasons), no student-athletes have died of EHS in these 15 states when schools followed the mandated heat-acclimatization guidelines. However, there was an EHS death at a Florida school in violation of state-mandated heat-acclimatization policies, thus emphasizing the importance of (1) implementing evidence-based heat-acclimatization policies for preseason practices and (2) complying with these policies to mitigate risk.7

Figure. .

Map of the United States portraying those states meeting evidence-based minimum best practices for heat acclimatization.1 States in gray correspond to those with mandated heat-acclimatization policies for preseason practices and the year in which this policy was mandated. The remaining meet less than the minimum best practices as shown; the total number of recommendations is 7.

SICKLE CELL TRAIT SCREENING LEADS TO INCREASED AWARENESS

In NCAA Division I collegiate football, the leading cause of death during training in the past decade has been an exertional sickling event in those with SCT.8 Division I collegiate football players with SCT are 37 times more likely to die during exertion than those without SCT.8 In response to an exertional sickling-related death of an athlete in 2006, the NCAA enacted a bylaw beginning August 1, 2010, at the Division I level, requiring all institutions to offer SCT identification through either screening or documentation of prior screening in all student-athletes. During the 2000-2001 through 2009-2010 academic years, 10 of 21 Division I collegiate nontraumatic football deaths were attributed to an exertional sickling episode (an average of 1.0 deaths/year).9 During the 2010-2011 through 2014-2015 academic years, nontraumatic exertional sickling-related deaths were significantly reduced, with only 1 of 14 deaths attributed to an exertional sickling episode. This suggests that a policy change fostering knowledge of SCT status in high-risk athletes, coupled with targeted education and tailored precautions, should be considered at other collegiate levels to reduce the risk of sudden death during participation for athletes with SCT.9

NO DEBATE: AEDS SAVE LIVES

Sudden cardiac arrest is the leading cause of sudden death in young athletes during sport and physical activity.10 Early recognition, early cardiopulmonary resuscitation (CPR), and prompt defibrillation are the key factors responsible for increasing survival after SCA. Survival rates decrease approximately 10% for each minute defibrillation is delayed,11 and prior researchers12-16 demonstrated an increase in survival when the time to defibrillation was minimized. Current consensus standards5,17,18 for emergency preparedness in school and athletic settings recommend that an AED be readily available for use within 1-3 minutes to optimize the chance of survival after SCA. In a study14 of SCA on high school campuses, 89% of student-athletes who sustained SCA during exercise survived with prompt recognition and treatment. Thus, SCA in competitive athletes is largely a survivable event through immediate recognition, early CPR, and access to an AED, preferably within 1 minute.

For any athlete who has collapsed and is unresponsive, SCA should be assumed and the emergency action plan activated.7 Critical aspects of a comprehensive policy pertaining to SCA are (1) in every sport venue, easy access to an AED that can be retrieved and used within 1-3 minutes; (2) training of all medical staff, coaches, and other appropriate personnel in CPR and AED use and the location of AEDs; and (3) a sport-specific emergency action plan outlining the emergency response to an athlete or spectator who has collapsed that is rehearsed at least annually by all relevant persons and potential first responders.

THE CHALLENGE OF REDUCING HEAD INJURIES IN SPORT

With increasing scrutiny over head injuries and concussions in football players, steps have been and are currently being taken to address this concern through both education and practice modification. Recent research19 has shown the benefits of proper tackling education to reduce overall head impacts during American football. In addition, USA Football, the governing body for youth football, has been at the forefront of these efforts, launching its "Heads Up Football" program in 2012. The program was created with 6 pillars, or educational components, addressing tackling and blocking techniques, equipment fitting, and reducing player contact during practice, as well as SCA, exertional heat illness, and concussion.20

Recent investigators21 examining injury rates in American youth football found a decline in all injuries, including concussion, when the "Heads Up Football" program and contact restrictions during practice were implemented. Injury rates during practices and games were significantly lower when both coaching education was provided and contact restrictions were enforced (0.97/1000 and 3.42/1000 athlete-exposures [AEs], respectively) compared with coaching education alone (2.42/1000 and 13.76/1000 AEs, respectively) or no coaching education or contact restrictions (7.32/1000 and 13.42/1000 AEs, respectively). When the authors examined types of injuries, coaching education and contact restrictions resulted in fewer injuries of all types, including concussions, than the other 2 groups. Establishing programs that offer proper education to coaches, players, and parents and implementing proper technique can create a safer environment for athletes at all levels.

THE PATH FORWARD

Although sudden death in sport cannot be completely prevented, establishing policies that conform to evidence-based best practices will reduce the overall risk of death and catastrophic injury. Medical professionals (eg, athletic trainers, physicians) should continue to work in conjunction with governing bodies-state high school athletics associations, the National Federation of State High School Associations, and youth sport governing bodies-to develop and implement appropriate policies for athletes at all levels of sport.

REFERENCES

2. Reports. National Center for Catastrophic Sport Injury Research Web site. http://nccsir.unc.edu/reports. Accessed February 7, 2016. [Google Scholar]

7. Attanasio SM, Adams WM, Stearns RL, Huggins RA, Casa DJ. Occurrence of exertional heat stroke in high school football athletes before and after implementation of evidence-based heat acclimatization guidelines [abstract]. J Athl Train. In press. [Google Scholar]

9. Adams WM, Huggins RA, Stearns RL, Anderson SA, Kucera KL, Casa DJ. Policy changes reduce exertional sickling related deaths in Division I collegiate football players [abstract]. J Athl Train. In press. [Google Scholar]

18. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care: part 4. The automated external defibrillator: key link in the chain of survival. The American Heart Association in Collaboration with the International Liaison Committee on Resuscitation. Circulation. 2000; 102 suppl 8: I60- I76. [PubMed] [Google Scholar]

20. Heads Up Football; 2012. USA Football Web site. http://usafootball.com/headsup?gclid=COaRt7WmgcoCFYQfHwods6UJXw. Accessed December 29, 2015. [Google Scholar]

Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association

# data[].attributes.attachment_link.title
Sport Safety Policy Changes: Saving Lives and Protecting Athletes

# data[].attributes.attachment_link.description
Death during sport or physical activity is a tragic and unexpected event. However, with appropriate evidence-based policies in place, death can often be prevented. The top causes of sudden death in sport and physical activity are sudden cardiac arrest (SCA), exertional heat stroke (EHS), head injuries, and exertional sickling.