educate ACL INJURY BY THE NUMBERS 12/4/2010 LIVE ON-SCREEN DEMONSTRATION ACL INJURY PREVENTION TECHNIQUES
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1 LIVE ON-SCREEN DEMONSTRATION Joseph Smith, MS, ATC Elise Hammond, ATC Jason Miyamoto, MS, ATC PRE-EMPTIVE STRIKE: ACL Injury Prevention Techniques ACL INJURY PREVENTION TECHNIQUES educate assess train ACL INJURY PREVENTION TECHNIQUES educate ACL INJURY BY THE NUMBERS 80, ,000 ACL injuries annually in U.S.A. 50% are young athletes years of age (Griffin, 2006) 100,000 ACL reconstructions performed annually in U.S.A. (CDC, 1996) $1 Billion costs annually in the U.S. $17,000 per injury (CDC, 2006; Parkkari, 2008) 1
2 FEMALE ATHLETE STATISTICS ACL INJURY CONSEQUENCES High school female athlete: 1/100 chance of ACL injury Collegiate female athlete: 1/10 chance of ACL injury (Wilk, 1998) Female soccer players: 6x more ACL injuries than men (Lindenfeld,1994) Suffer 5x more season-ending knee injuries men Consequences include: Temporary disability Permanent disability Posttraumatic DJD Discontinuation from athletics Reinjury Emotional difficulties Academic problems Scholarship / contract loss ACL INJURY MECHANISM Over 60% occur with non-contact mechanism (Wilk, 1999) The most common high-risk situations appear to be deceleration, changing direction, or landing from a jump (Griffin, 2006) ACL INJURY RISK FACTORS Environmental Anatomical Hormonal Family Tendency Neuromuscular 2
3 NEUROMUSCULAR RISK FACTORS Increased flexibility / genu recurvatum Knee valgus / Q angle Internal rotation of the hip External rotation of the tibia Knee joint stiffness Quadriceps / hamstring imbalance Diminished muscular force Slow muscular force generation Poor muscular endurance ADDRESSING THE RISK Increased flexibility / genu recurvatum Knee valgus / Q angle Internal rotation of the hip External rotation of the tibia Knee joint stiffness Quadriceps / hamstring imbalance Diminished muscular force Slow muscular force generation Poor muscular endurance ABDOMINAL STRENGTH CORE STABILITY DYNAMIC BALANCE JUMP MECHANICS LOWER LIMB CONTROL AEROBIC FITNESS ACL INJURY PREVENTION TECHNIQUES 1 2 assess ABDOMINAL STRENGTH CORE STABILITY JUMP MECHANICS LOWER LIMB CONTROL DYNAMIC BALANCE AEROBIC FITNESS 3 4 3
4 1 ABDOMINAL STRENGTH CORE STABILITY 1. ABDOMINAL STRENGTH + CORE STABILITY Double Leg Lowering Test Evaluation: ability to control pelvic neutral while legs are actively lowered Measurement: angle of inclination when pelvic control is lost grade angle C 90 Š 75 C+ 75 Š 60 B- 60 Š 45 B 45 Š 30 B+ 30 Š 15 A 15 Š 0 1. ABDOMINAL STRENGTH + CORE STABILITY Double Leg Lowering Test (Kendall) 2 DYNAMIC BALANCE 4
5 Star Excursion Balance Test Evaluation: ability to maintain control of center of mass while weight bearing on a single limb Measurement: anterior, lateral, and posterior reach distance Observation: balance, knee control, dominant muscles Really GOOD! JUMP MECHANICS LOWER LIMB CONTROL 3 5
6 3. JUMP MECHANICS + LOWER LIMB CONTROL Drop Jump Video Test Evaluation: ability to decelerate and accept load without knee deviation into valgus / internal rotation Measurement: knee separation distance during landing Observation: noise, positioning 3. JUMP MECHANICS + LOWER LIMB CONTROL 3. JUMP MECHANICS + LOWER LIMB CONTROL 3. JUMP MECHANICS + LOWER LIMB CONTROL Really BAD! 6
7 AEROBIC FITNESS 4 4. AEROBIC FITNESS + Multi-Stage Fitness Test Evaluation: aerobic conditioning and muscular endurance Measurement: shuttle level, VO 2 Max estimation 4. AEROBIC FITNESS + Multi-Stage Fitness Test Shuttle Level - VO 2 Max Estimation chart 4. AEROBIC FITNESS + VO 2 Max Normative Data 7
8 1 2 ABDOMINAL STRENGTH CORE STABILITY JUMP MECHANICS LOWER LIMB CONTROL DYNAMIC BALANCE AEROBIC FITNESS 3 4 ACL INJURY PREVENTION TECHNIQUES 1 ABDOMINAL STRENGTH CORE STABILITY train 8
9 1. ABDOMINAL STRENGTH + CORE STABILITY Pelvic Neutral Lay on back, knees bent, feet shoulder-width apart Tighten AB muscles (draw belly button in, flatten back) HINT: hiss like a snake to activate lower AB s Start position for core exercises 1. ABDOMINAL STRENGTH + CORE STABILITY Dead Bugs Find pelvic neutral Raise legs to 90 Alternate lowering one leg at a time, touching heel to table. Good: 2-4 min KEY: maintain pelvic neutral during exercise 1. ABDOMINAL STRENGTH + CORE STABILITY Uni-bridge Find pelvic neutral Raise hips Straighten one leg, hold for 10 sec; alternate legs Good: 2-4 min KEY: maintain pelvic neutral during exercise 2 DYNAMIC BALANCE 9
10 Single Leg Squat Stand on one leg Slowly bend knee to 45, hold 3 sec, return to start position 3 sets, 15 reps KEY: keep head up knee in line with foot Single Leg Cup Touch Place 5 cups in a semicircle in front of foot While performing a single leg squat, reach out and touch a cup; return to starting position Repeat until finished 2 sets w/ each hand KEY: maintain balance; keep knee in line w/ foot Advanced: Perform exercises while balancing on an unstable surface Foam pad DynaDisc Trampoline Advanced balance activities work on improving proprioception Squats on DynaDiscs 10
11 JUMP MECHANICS LOWER LIMB CONTROL 3 3. JUMP MECHANICS + LOWER LIMB CONTROL Grid Jumps Place two strips of tape on the floor to form a + Jump: Front to back Side to side Diagonal 3 sets, sec KEY: keep head up; soft, quiet landings 3. JUMP MECHANICS + LOWER LIMB CONTROL Jump progression 3. JUMP MECHANICS + LOWER LIMB CONTROL Box Jumps Jump on/off a box/step Advanced: Increase height of step/box Increase speed of jumping KEY: keep head up; soft, quiet landings 11
12 3. JUMP MECHANICS + LOWER LIMB CONTROL Box jump progressions AEROBIC FITNESS 4 4. AEROBIC FITNESS + 4. AEROBIC FITNESS + W Cut Drill Jog 10 yd intervals forward and backward in W shape Focus on good footwork in/out of breaks KEY: keep eyes up; work on increasing speed while maintaining technique Box Drill Jog/carioca in 10 yd intervals Jog forward Carioca long/slow Jog backward Carioca short/quick Focus on good footwork KEY: keep eyes up; work on increasing speed while maintaining technique 12
13 1 2 ABDOMINAL STRENGTH CORE STABILITY JUMP MECHANICS LOWER LIMB CONTROL DYNAMIC BALANCE AEROBIC FITNESS 3 4 ACL INJURY PREVENTION TECHNIQUES educate assess train REFERENCES THANK YOU! Centers for Disease Control and Prevention, National Center for Injury Prevention Control. Injury Research Agenda [monograph on the Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2002 [cited 2006 Sep 07]. Available from: Centers for Disease Control and Prevention, National Center for Health Statistics. National hospital discharge survey: annual summary, 1996 [monograph on the Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 1996 [cited 2008 Mar 11]. Available from: Griffin LY, Albohm MJ, Arendt EA, Bahr R. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting. Am J Sports Med ; 34(9). Hewett TE, Myer GD, Ford KR, Colosimo AJ, McLean SG. Cruciate Ligament Injury Risk in Female Athletes : A Prospective Study. Am J Sports Med 2005 ; 33: 492. Hewett TE, Lindenfeld TN, Riccobene JV, et al. The effect of neuromuscular training on the incidence of knee injury in female athletes: A prospective study. Am J Sports Med. 1999;27: Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med Oct;35(10): Schmitt DJ, Hendy MP, Mangine RE, Noyes FR. Incidence of injury in indoor soccer. Am J Sports Med. 1994; 22(3):
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