acl prevention: programs & results mike flynn, ms atc lat
TRANSCRIPT
ACL Prevention: Programs & Results
Mike Flynn, MS ATC LAT
Purpose
• To provide a simple, common sense approach to preventing ACL and lower extremity injuries.
Intended Result
• To identify the key elements to consider when developing a program.
• To understand the components of a prevention program.
• To demonstrate how to effectively implement these components into a program.
Injury Stats
• 100,000 to 462,000 ACL injuries in the US every year!
• 85 percent of ACL injuries, regardless of gender, are non-contact!
• Higher occurrence in females!( up to 9 times more likely than males)
When Injuries Happen
• Planting & Cutting• Landing • Stops • Pivoting• Rapid Deceleration
Prevention Stats
• Bert Mandelbaum, MD, Santa Monica Orthopedic and Sports Medicine Research Foundation - PEP– Female high school soccer players
• 2000 season– 1,041 in training group, 2 ACL injuries– 1,902 in control group, 32 ACL injuries
• 2001 season– 844 in training group, 4 ACL injuries– 1,092 in control group, 35 ACL injuries
Prevention Stats
• Giuliano Cerulli, MD, Santa Maria Hospital associated with the University of Perugia in Italy – 900 high-level male soccer players over three
seasons• 600 in training group, 10 ACL injuries• 300 in control group, 70 ACL injuries
Prevention Stats
• Tim Hewett, PhD, Director of the Sports Medicine Research Institute and Human Performance Laboratory, Children’s Hospital Research Foundation in Cincinnati – Sportsmetrics, WIPP– Female athletes
• 366 in training group, 2 ACL injuries• 463 in control group, 10 ACL injuries
Prevention Stats
• Oslo Sports Trauma Research Centre, Santa Monica Orthopedic and Sports Medicine Research Foundation, and FIFA – 11+ (2008)– 1055 in the training group, 121 lower ext.
injuries– 837 in the control group, 143 lower ext.
injuries
Prevention Stats
• Swedish Football Association – female soccer players from age 12-17 (2009)
– 2085 athletes in the control group– 2479 athletes in the intervention group
• 64% reduction of ACL injury rate
Prevention Stats
• Uppsala Primary Care, Uppsala County Council – HarmoKnee (2010)– 777 in training group– 729 in control group
• 77% lower incidence of any knee injury• 90% lower incidence of non-contact injury
Prevention Stats
• Chicago Public Schools – 90 Coaches (2011)– 755 athletes in control group– 737 athletes in intervention group
• 35% reduction in overuse lower extremity injuries• 44% reduction in acute non-contact lower extremity
injuries• 34% reduction in non-contact ankle sprains
All the athletes with non-contact lower extremity injuries resulting in surgery were in the control, all ACL injuries.
Prevention Stats
• FIFA - 11+ & Male Basketball Players 11-22 yrs (2012)– 14 of 80 players in the FIFA 11+ group were injured– 17 of 40 players in the other group had injuries
Prevention StatsMeta-analysis
• 8 Studies Analyzed– At least 10 minutes of neuromuscular training,
3 times/wk– An ACL tear risk reduction of;
• 52% in female athletes• 85% in male athletes
Program Components
• Form Runs• Dynamic Flexibility• Core Strength• Balance/Proprioception• Agility• Explosive Strength• Sport-specific conditioning
Form Runs
• Skips• Carioca• High Knee• Butt Kicker• Side Shuffle• Serpentine Run• Plant & Cuts• 180’s & 360’s
Dynamic Flexibility
• Knee Hugs• Hurdle Walks• Crawling Series
– Inch Worm– Spiderman
• Lunge Series
Balance/Proprioception
• Single Leg Balance– Standing– Side to Side– Rotation
• Hop & Sticks – Double Leg– Single Leg– Multi-Directional
Agility
• Foot Ladder– Forward– Backward – Sideways
• Sprint it out to a stop!
Explosive Strength
• Plyometrics– Landing– Jump Ups– Double Leg Hops– Single Leg Hops– Bounds– Alternate Leg Box Jumps
Strength
• Core strength– Basic Core
• Bridge Series• Lunge Series
Sport-Specific Conditioning
• Make it look like the game!!
Putting It All Together!
• Form Runs• Basic Core• Balance/Proprioception• Dynamic Flexibility• Agility• Explosive Strength• Conditioning
Retention
• Program Duration Study – UNC (2012)– 140 youth soccer athletes (11 to 17)
• All participated in either a 3 month or a 9 month program
• 84 (60%) showed improved LESS scores• 3 months following the completion of the programs
only the extended duration group retained their improvements
References
• Umile Giuseppe Longo, MD, MSc; Mattia Loppini, MD; Alessandra Berton, MD; Andrea Marinozzi, MD, PhD; Nicola Maffulli, MD, MS, PhD, FRCS(Orth); Incense Denaro, MD. The FIFA 11+ Program Is Effective in Preventing Injuries in Elite Male Basketball Players A Cluster Randomized Controlled Trial. Am J Sports Med May 2012 vol. 40 no. 5 996-1005 .
• Padua DA, DiStefano LJ, Marshall SW, Beutler AI, de la Motte SJ, DiStefano MJ. Retention of movement pattern changes after a lower extremity injury prevention program is affected by program duration. Am J Sports Med. 2012 Feb;40(2):300-6.
• Sadoghi P, von Keudell A, and Vavken P. Effectiveness of Anterior Cruciate Ligament Injury Prevention Training Programs. J Bone Joint Surg Am. 2012; 94:1-8.
References
• Cynthia R. LaBella, MD; Michael R. Huxford, MEd, ATC; Joe Grissom, MPP; Kwang-Youn Kim, PhD; Jie Peng, MS; Katherine Kaufer Christoffel, MD, MPH. Effect of Neuromuscular Warm-up on Injuries Female Soccer and Basketball Athletes in Urban Public High Schools. Arch Pediatr Adolesc Med. 2011;165(11):1033-1040
• Martin Hagglund, PhD; Markus Walden, MD, PhD; Isam Atroshi, MD. Preventing knee injuries in adolescent female football players – design of a cluster randomized controlled trial. BMC Musculoskeletal Disorders 2009, 10;75.
• Kiani A, Hellquist E, Ahlqvist K, Gedeborg R, Michaelsson K, Byberg L. Prevention of Soccer-Related Knee Injuries in Teenage Girls. Arch Intern Med. 2010;170(1):43-49
References
• Albaugh J, Friedman J, Cody S, Ganley T. Joint Efforts. Training & Conditioning, 20.3 April 2010
• Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Knee Surg Sports Traumatol Arthrosc. 2009 Aug;17(8):857-8
• Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R, Andersen T. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomized controlled trial. BMJ 2008;337:a2469
• Vern Gambetta, Bettering the Odds, Training & Conditioning, 13.5, July/August 2003
• Vern Gambetta, Leap of Strength, Coaching Management, 8.3, April 2000
• Guillermo Metz, Restoring the Balance, Training and Conditioning 9.3 April 1999
