A couple of months ago there was an increase in ACL (anterior cruciate ligament) sprains and tears among NBA players; it’s a good time to review the LMD SportsMassage take on ACL damage.
To begin let’s look at the players. The ACL and the PCL (posterior cruciate ligament) are deep in the center of the knee. They make an ‘X’ across the medial to lateral side of the joint, and are responsible for a great degree of knee stabilization. The ACL is very susceptible to sprains and tears.
So, to set the ‘LMD’ stage; the SI (sacro-iliac) joints are the ‘#1 Lever’ in the body: all movements and forces flow through them. The body must move around any SI restrictions.
The rotation of the fibula relative to the tibia is the ‘#1a Lever’ in the body. The tibia bears the body weight, and the fibula is there for rotation; just as the ulna & radius provide twist for the wrist, so do the tib/fib provide twist for the lower leg, with much less range but the same function.
In a tensegrity structure, any change in any tension requires balancing tensions that are organized through and throughout the entire structure. Our bodies are dynamic tensegrity structures because they simultaneously balance and move.
If the fibula is not rotating sufficiently around the tibia, then that lost rotation has to be accounted for somewhere in the arthro/skeletal myofascial structures. The ankle and/or the knee are next in line as that rotation is resolved up the structure, through the body. The knee is more vulnerable to this excessive twist than the ankle, it appears; if the tib/fib is stuck, the chances of spraining/straining a ligament or tendon increases, and the ACL is a major resolution for that rotation. As a major knee stabilizer, it will be at the affect of excessive movement.
Another way of describing this scenario is to think of the flexibility in the structure of any body in terms of resilience and resistance. An ideal balance of resilience and resistance in any joint, and all the joints working together, would be that every joint can operate through an optimal range of motion and be completely supported in that ROM. The myofascial structures would not be hypertonic (check out the blog defining hypertonicity), nor would the joints be hyper-mobile. An ideal balance is arguably unobtainable, but effective bodywork helps bodies towards it.
The LMD theory here is that resistance in the tib/fib rotation requires more rotation, more resilience, from the knee, and at some point it will be too much. Our theory is saying, in an ACL tear, the ACL probably wasn’t a weakness, it was just asked to do too much.
The SI joints will usually have an issue if the tib/fib(s) do. In a tensegrity structure, resistances cannot exist alone, any change in tension changes every tension to some degree. You might say anything affects everything, and everything can affect anything. You can see why in LMD’s SportsMassage course the first techniques demonstrated are the SI joints and the tib/fibs, assessing their movement and affecting excessive resistances (and understanding solutions for excessive resiliences).
The accompanying video ACL Injury Prevention reviews common LMD technique suggestions for affecting flexibility and resilience between the tibia and fibula, as well as the SI joints.
Of course, this idea extends well beyond preventing ACL injuries into preventing any strains or sprains, as well as being an integral part of assessing the probable causes of any client complaints, including emotional as well as physical issues. Consider an emotional angle to resilience/resistance: being flexible and able to change direction as desired – or not.