acl injury prevention: coaches clinic april 6, 2011 justin dudley, pt, dpt
TRANSCRIPT
ACL Injury Prevention:Coaches Clinic
April 6, 2011Justin Dudley, PT, DPT
Objectives
• Introduction• Why ACL injury
prevention important• Barriers to ACL injury
prevention• BSC Warm-up• Where do we go from
here?• Questions
Introduction
• Personal background– Playing history– Coaching history– Sports performance
training• Education and
Professional experience• Cascade Sports
ACL Injury Prevention
Will this be your athlete’s knee?
ACL Injury Prevention
• Basketball ACL Injury• Soccer ACL Injury• ABC News Story
ACL Injury Prevention
• It is estimated that there are over 750,000 injuries of athletes each year in the United States.– 100,000 – 200,000 of those injuries will be ACL injuries– 70-84% of ACL injuries are non-contact
• Vast majority of these injuries are to young healthy individuals in “non-contact” situations, likely resulting from: – inadequate muscular strength – poor muscular control– poor biomechanics
• Studies have shown that through sport specific trainings with highly trained personnel the incidence of these “non-contact” injuries can be reduced by up to 87%.
What are the effects of ACL injury?• As a coach – your athlete is out for the
season• Parent - $25,000 medical bills, heart ache,
time for rehab• Athlete – out for season, pyschological
trauma, long rehab, increased risk of osteoarthritis, decreased future sport performance…
• ACL injury causes the most time lost from competition in soccer
• Despite most earnest efforts of orthopaedic surgeons to preserve integrity of knee joint during ACL reconstruction surgery, patients continue to present with degenerative changes or cartilage.
• Study showed that in girls playing soccer who sustained ACL injury after 12 years 82% had radiographic changes and 51% fulfilled criterion for radiographic OA.
PREVENTION IS BEST WAY TO REDUCE RISK OF OA FOLLOWING
ACL INJURY!
ACL Injury PreventionMechanism of Injury
• Common playing situations that preclude a non-contact ACL injury include:– Change of direction or cutting
manuever, combined with decceleration
– Landing from a jump in or near full extension
– Pivoting with knee near full extension and a planted foot.
• Females 2.5-10x’s more likely to tear ACL than males
ACL Injury preventionWhy is the incidence of ACL injury in females higher than males?
• Anatomy• Hormones• Joint Laxity• Smaller ACL• Quadriceps:Hamstring Ratio• Muscular Fatigue• Biomechanical Factors
ACL Injury preventionWhy is the incidence of ACL injury in females higher than males?
Non-contact ACL injuries in soccer players likely has a multi-factorial etiology
Biomechanical and Neuromuscular Factors
• Most modifiable risk factor• Neuromuscular control of knee involves
complex interaction of nerves, joint receptors and muscles
• Proprioception….what is it?– Information from peripheral nervous system about
joint position and joint motion in space in order to elicit active and reflexive movement
Biomechanical and Neuromuscular Factors
• Muscular strength and recruitment are crucial to knee stability– Males activate their hamstrings at three times the
level of females during landing from a jump.• Female soccer players demonstrate decreased
hip and knee flexion angles when landing from jump or cutting maneuvers compared to males
• Females rely on ligaments for stability• Is muscle weakness and timing the only factor?
Biomechanical and Neuromuscular Factors
The knee joint is formed by the femur, tibia, and patella. The ACL is one of the four main ligaments in the knee that connect the femur to the tibia. The knee is a hinge joint that is held together by the MCL, LCL, ACL and PCL.
Knee Anatomy
• Studies show that combination of forces produces a higher strain on the ACL than isolated motions and torques
• Need to look at the body hollistically
• Again, most common non-contact injury mechanism occurs during:– Deceleration task with high knee internal
extension torque combined with dynamic valgus rotation with the body weight shifted over the injured leg and plantar surface of the foot fixed flat on the playing surface
BSC and Cascade Sports
• Teamed up to implement ACL injury prevention program
• Biggest barriers to implementing ACL program– Cost– Time away from technical
coaching and training– Athlete interest– Equipment – Sustainability
BSC and Cascade Spors
• Our Approach– Standardize warm-up with focus on activities that
help to reduce risk of ACL injury– Program will be implemented by coaches– Incorporate soccer specific movements and drills– Additional expertise available upon special request– Preferred scheduling for BSC athletes at CCWC– Tournament Medical Coverage– Future ACL injury prevention camps and clinics
BSC Warm-up
• Close attention to athletes by the coaches
• Not a time for coaches to socialize with each other and/or parents
• Study by Mandelbaum et al. showed that a 15-20 minute program designed to replace the traditional warm-up can prevent LE injury by up to 88%
• Key is coach’s attention to detail and correction of faulty movements
BSC Warm-up
• Set up two cones 10 yards apart– Jog forward/backward between cones x4– Side shuffle between cones x4– Toe walks/Heel walks x2– Jog forward/backward and change direction on coach’s
command using multistep deceleration (30sec)– Side Shuffle and change direction on coach’s command
using multistep deceleration (30sec)• Focus on solid foot-ground contact, good knee alignment and
adequate hip and knee flexion
BSC Strengthening
• Walking Lunges Forward/Backward– w/ knee tuck (x2)
• Single leg bridges (4x15sec)• Plank w/ leg lifts (2x30sec)
BSC Plyometrics
• Tuck Jumps (3x20 sec)• Lateral hop over ball (3x20 sec)• Forward/Backward hop over ball
(3x20 sec)• 180deg Jump turn w/ volley (x15
volleys each leg)
Agility
• Forward/Backward Shuttle Run (x4)
• Ladder or cone drills• Box drill– Forward/backwards/
side/diaganol(at least x3)
What about stretching?
• Evidence on benefit of stretching prior to work-out is conflicting
• Movements performed within the warm-up take athlete through a range of motions stretching various muscles with each task
• Option: perform stretches during breaks in warm-up or between drills.
Additional Drills
• Diagonal run w/ stop and pivot• 180 degree Jumps• Scissor Jumps• Single Leg Combo Hop*• Single Leg Hop Diagonal*• Bridging with ball roll
Single Leg Combo Hop
Single-leg Hop Diagonal
Drills
• Any skill or athletic drill can be utilized to help prevent ACL injury prevention
• Develop an eye for good mechanics with movement– Better athletic movements
and improved biomechanics result in improved athletic performance.
BSC and Cascade Sports
• Additional services offered– Team ACL Screening– Sports Performance Training (individual, small
group, team)– Rehabilitation and Return to Sport– ACL Injury Prevention Off-season Camps
• Benefit of working with Sports Medicine Team
• Professional approach
Coaches Clinic Day 2
• Sunday April 10th, 5:30 PM at Highland Park
• On field application of warm-up
• U-14 Girls Team• Strategies to correct
faulty movements• Final questions and
discussion
Questions?