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Young Athletes Injuries
So yesterday I offered you a bevy of information from Erin Perry.
But as always, I want to hear from you.
IYCA Members are among the most talented and intelligent in the field
today and trust me when I say that I learn from each and every one of them.
Click on the link below, head over to my blog and tell me your thoughts
about ACL prevention.
Specifically…. What are we doing wrong?
How can we curb the increasing problem of ACL young athletes injuries?
What has to change at the Coaching and Training level to make this
happen?
The IYCA isn’t just about dispensing information.
It’s about giving our Members a voice.
Let’s change the industry for the better together.
Please, leave me your thoughts below
Please check out my presentation on reducing the risk of getting an ACL injury at http://www.strengthcoachwebinars.com Anthony Renna has done a great job of putting together a great website with lots of presentations to view and you don’t even have to leave home.
Thanks,
Tim Yuhas
The biggest problem I see is kids overplaying while not being trained properly. In the soccer world, I see kids playing on travel teams, school teams, and elite teams often at the same time being coached by two or three different coaches, each holding a claim to that player. None of them allows the player to rest, and few, if any, train them with the proper progressions. They focus on short term team results rather than a proper long term focus on what is beneficial for the athlete. Girls are often coached with the same methods used for boys with little regard to preparing their bodies to handle the physical stress of athletics.
I HAVE HAD 4 KNEE SURG. I WORKED W/ WEIGHTS AND MADE ALMOST FULL RECOVERY I AM 71 YRS OLD 5 GOLD MEDALS POLICE GAMES U HAVE TO MAKE THE KNEE STRONG BECAUSE THERE IS SOMETHING MISSING
If you read all the press about ACL injuries in females, you will see all kinds of thing about Q angles, monthly cycles and all kinds of other factors that influence why girls are 4-7x(depending on what study you read) more susceptible to this injury than boys. The key thing here is to sift through all that and find the useful bits of advice that can be employed in your program. We can’t control a females cycle or change her anatomical structure. It is what it is. Don’t waste time talking about that. (And believe me, parents will bring it up because they are reading these articles too). Instead, focus on what we can do. There is a lot out there about stuff that we can do that will work to reduce those instances of injury. Just do those things. What we can do is run better warm ups; we can perform good reaction and agility drills; we can teach good position and get kids moving better in a controlled environment; we can work the hamstrings and balance out the quad domination, etc. Look up the PEP program (a study that showed a dramatic reduction in the instance of ACL tears) and do that. A lot of good information is out there. You just have to find it, and start doing it and then share it with others. Let the scientist and the statisticians debate it.
Brian,
There is no way I can explain how I train our athletes here on this post. I have developed a system of training that has produced excellent results-so much that I have been working on a book to get my information out there. For example, I currently have 10+ Division I teams that have not had an ACL tear in 8 years! The problem I see is that there is so much information out there that most don’t know how to start applying it or where to start. The is the sole reason I am writing my book-not looking to get rich; I am just tired of hearing and seeing young athletes hurting themselves. If only their parent or coach had an easy system to use….. I’d be more than happy to share this info with you and then maybe you could pass it along. I have some small articles on injury prevention on my free website that you can share with your readers if you wish.
Thank you,
Jerry Shreck
It’s great to hear Erin’s input on ACL’s. As an Athletic Therapist I also see many ACL injuries, especially at the university level, with a large percentage being female. Of these injuries a very significant percentage are of the non-contact variety (aka. the press box sniper). One major trend that I have observed is a deficiency in femoral rotary sability. if you look at the mechanism for an ACL sprain most often there is medial femoral rotation combined with lateral tibial rotation and a fixed distal segment (foot planted). All of the other theorized factors (Q angle, hormonal etc.) don’t become an issue if the femoral rotation is controlled to the point that the structures don’t become stressed. Simply put, strengthen external femoral rotation and then integrate it with movement patterns and I think we can significantly reduce the incidence of ACL sprains (IMHO). We also can’t forget about general strength, balance, flexibility etc. but that goes unsaid.
I have written a free manual on ACL injury prevention which can be downloaded from this address:
http://tinyurl.com/l738lt
Suggestions and comments are welcome.
I agree with Jerry Shreck, let’s just stop these injuries. Great job Jerry!
Clearly this is on-going problem that brings out the underlying passion of many practitioners who’s primary goal is to help their patients and clients. I agree completely with some of the thoughts about rotational stability. Mr Connolly mentions possible multi-directional causes as well but if they are traumatic in nature, than we can’t control that. Kind of like menstrual cycles and Q angles. Those are factors beyond our control. Our job is to understand true functional biomechanics and create programs to make athletes as bulletproof as possible. Erin Perry mentions Sraight leg raise testing and achieving 80-90 degrees of motion as a necessary test for ACL prevention. I’m not sure how lying someone on their back and having them show hamstring flexibility has anything to do with weightbearing related injuries that rarely occur anywhere near the end range of hamstring length. As practitioners we need to get beyond the idea that everything that is tight needs to be stretched. Muscles of the body will regularly splint and guard to prevent motions from occurring that it cannot control effectively. In weightbearing the hamstrings are major decelerators of hip flexion (forward tilt of the pelvis over the femur) and rotational control of the tibia (look at the distal attachments). We need to be able to effectively train with this type of understanding knowing that an inability of the abdominals to decelerate the pelvis (extremely common) can cause the hamstrings to splint and guard this motion. I would argue that in this case stretching the hamstrings would be the last thing a body needs and could actually be detrimental. The rotational stability issue is another huge factor as well but once again we need to know that it is the gluts ability to decelerate the femur eccentrically that needs to be trained. An incredible amount of rotational force during running is created by the torso and also needs to be controlled effectively with proper training in all 3 planes of motion. An out of control torso can easily drive too much force distally and give the gluts no chance of decelerating the force into the femur. The poor knee/ACL gets the brunt of this force and did absolutely nothing wrong to deserve all of the blame. (Hello patellofemoral pain, also a plague of our young athletes). Once again we need to have an understanding of how to functionally train the core and not just teach a bunch of pelvic tilts or transverse abdominus splinting which creates artificial stability. Why should we train bones and muscles to not move??? Everyone should keep up the great exchange of ideas and continue working with their passions as we try to figure out the truths of human function.
Dave
There has been some really good info posted already. I have co-written a manual on this and just finished a new training DVD on it as well that is available on PTontheNet. In addition to some of the factors already raised, I would say addressing landing technique and deceleration is extremely important.
I begin working with athletes at an early age on shifting the center of gravity forward (butt down) with deceleration/cutting and landing as athletes are much less likely to suffer a non-contact ACL injury when the knee flexion angle is much greater/deeper. Most girls tend to run, cut and land upright and lack frontal plane control in addition to the quad dominance we so often see.
Adding dynamic reaching, squatting and frontal and transverse plane single leg work (emphasizing the HS) will help teach athletes better body awareness and groove a better feed forward motor pattern, not to mention turn on the gluteus medius in a more functional closed chain manner.
Some recent research supports my asserion about landing and moving the COG forward as well as looking at pronation, recurvatum and decreased anterior pelvic tilt as factors affecting laxity (see text from a slide below from a presentation I gave for Power Systems last month)
Lower ant. pelvic tilt, > genu recurvatum & foot pronation predictors of ↑’d laxity in M/F
Shultz S, Nguyen A-D, Levine BJ. Sports Health 2009;1(1):54-60
Shifting the COM anteriorly may ↓ quad contraction and resulting knee extensor moment while ↑ing HS and PF muscle activity (study done barefoot in females w/drop from 45cm box
Shimokochi Y et al. J Athl Training 2009;44(1):33-38
There was also some great info presented in the Journal of Athletic Training recently from an ACL research retreat that was held. Some points raised by those bright minds are that we need to figure out what makes a prevention program successful, how long do the positive effects last and how best do we tailor them for our athletes.
To all those working to reduce these injuries keep up the great work as I am in it with you to stop as many of these terrible injuries we can!
Brian Schiff
Jamie and Robb have good points. We find three recurring themes in our athletes, injured or not. One is a lack of core strength, (i.e. hips, abs and gluteals), second is poor athletic movement patterns and third is over training with no recovery/rest time.
Dave Arment’s comment is the most intelligent comment I have ever seen on the website. The first Shepard I have seen here in a flock of sheep.
After reading the posts on this site and reviewing the most well known ACL programs (PEP, UofR, Santa Clara, etc.) it is clear that a lot of thought has gone into addressing this important area. I agree with Dave Armet’s suggestions in that they focus on the need to train free form movements rather than splinting and creating artificial, conscious situations.
I have recently developed an ACL Injury Prevention Program for Soccer. From my perspective some vital aspects of the equation are missing in most approaches I have seen. In order to have the most significant effect possible on reduction of ACL injuries we need to include the following:
A movement screen to determine functional movement capacity.
Utilize functional, ground based, three dimensional movements in a proprioceptive rich environment that is consistent with the demands of the sport.
Perform flexibility exercises in a functional ground based manner that utilizes a controlled loading and unloading while working through all three planes of motion.
Develop foot/ankle mobility and stability, trunk control, thoracic mobility and proper chain reaction biomechanics which will result in improved control of femoral rotation. This is achieved by creating a movement environment in which the athletes can produce an effective tri-plane load and therefore an effective unloading. Emphasis is placed on the planes of motion where a movement challenge is identified.
Gradually increase the speed, complexity, deceleration demands and degree of reaction required throughout the warm-up period culminating in a reaction drill that requires spatial awareness of the athletes around them while performing the movements on command.
Stimulate the subconscious proprioceptive mechanisms that will produce efficient and safe movement by effectively distributing the loads placed on the body.
Educate and empower the coaches who will be implementing the strategy on a daily basis.
The athletes must experience the range of movements and situations they will encounter in their sport to be effectively prepared. An athlete who spends time sticking landings, performing isolated stretching and all manner of thought intensive “core/pelvic stability” exercises cannot approach the level of preparedness of an athlete who has been performing reactive tri-plane movements which improve their ability to control their mass and momentum and ground reaction forces in the most important transformation zones for their sport.