The “DL” Report: NFL Week 10

The injury bug bites again and the ACL tears have continued to add up. In the span of several hours, two notable players for NFL playoff contenders had their season end. When you see a player go down with a non-contact injury, generally speaking it’s severe. And that was the case on Sunday.

Early Sunday action, Los Angeles Rams’ wide receiver Cooper Kupp re-injured his knee. It was the same knee that he initially injured his medial collateral ligament (MCL) and medial meniscus. But this time, he went down on a non-contact injury and reports have confirmed he tore his ACL.

Later that evening, Philadelphia Eagles cornerback also went down with a non-contact ACL Injury.

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Anatomy Review:

Let’s review the anterior cruciate ligament (ACL) again. It’s a thin ligament (comparatively to the posterior cruciate ligament) that is one of four main ligaments that provide stability to the knee. The main function of the ACL is to prevent excessive anterior translation of the tibia (lower leg bone) about the femur (thigh bone). It also prevents excessive rotation of the tibia about the femur.

What also has to be examined with ACL injuries is the associated damage of the knee. With ACL injuries you look at the integrity of the medial collateral ligament (MCL) and the medial meniscus. The three of them are so intimately connected that with a severe knee injury the three of those structures can all be torn. The reasoning? The MCL essentially is attached to the medial meniscus and the ACL has attachment sites to the medial meniscus.

ACL Injuries can occur:

• Sudden change in direction
• Stopping suddenly
• Landing incorrectly
• Direct blow to the knee in forceful extension

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Rehabilitation Review:

Knee injuries are not uncommon and ACL rehabilitation has progressed immensely over the last several years. Not just athletes but people are recovering more quickly than in years past with the advancement of modalities, surgeries, and exercises.

A focus of rehabilitation that cannot be overstated is strengthening of the hip on the injured knee. There needs to be balance of the quadriceps and hamstring muscles of the thigh. That’s well documented and emphasized in the initial days of rehabilitation post surgery. Often times the individual is doing a lot of quadriceps-emphasized treatment to help build the strength back following surgery. The primary exercise is a quad set: where you just slowly squeeze your quadriceps, hold for several seconds, and then slowly release.

But with many knee injuries the focus cannot just be on knee rehabilitation but on hip rehabilitation as well. There are going to be very straight forward hip exercises one would do in initial phases but with the hips there are two functions of the hip that can be glossed over at times in rehabilitation:

• The hip’s ability to create stability to in the knee (preventing excessive valgus and varus movement)
• The hip’s ability to extend and protect the low back in causing compensatory extension.

So in rehabilitation, I think it cannot be overstated how much the hip rehabilitation should be involved and properly progressed:

• 2 feet concentric hip exercises – sagittal plane
  • Squats
  • Hip Thrusters
• 2 feet eccentric hip exercises – sagittal plane
  • Squats – negative
  • Hip Thrusters – negative
  • Romanian Deadlifts
• 1 foot concentric hip exercises – sagittal plane
  • Hip Thruster
  • Step-Ups
  • Split Squat
  • Lunges
• 1 foot eccentric hip exercises – sagittal plane
  • Single Leg Squats – negative
  • Lunges – negative
  • Split Squats – negative
• 1 foot hip exercises – frontal plane
  • Hip airplane
  • Single Leg Squats – planar directional movement

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Season Outlook:

They are both out for the season. And I think anyone who tears their ACL (and potentially other associated ligaments) are going to be missing part of the next season. I think you are going to continue to see athletes trying to push the limits of their recovery from ACL tears. Carson Wentz is an ideal example for this season, he tore his ACL in December and he played in October. But I do believe it is going to be different with skill position players like wide receivers and cornerbacks.

With Kupp and Darby, I think it’ll be much later in the year before you see them. They may not play until next November or December. They’ll certainly be participants in camp but they most likely won’t be doing team activities and live drills until much later.

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Disclaimer: I do not own the photos or videos. The rights belong to NFL, Associated Press, Philadelphia Eagles, Los Angeles Rams and to the people and individuals to who took the photos and posted the videos.