Suzanne Hecht, MD UM Sports Medicine Team Physician; UM Athletics Program Director; UM Sports Med Fellowship

Suzanne Hecht, MD UM Sports Medicine Team Physician; UM Athletics Program Director; UM Sports Med Fellowship

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Review the importance of injury prevention programs List 3 evidence-based injury prevention programs Be aware of injury prevention resources

Sports injuries are common! Pain & suffering Lost time from sports Time of increased depression risk Re-injury risk increases Financial implications Long term issues

Screening Equipment Facilities/Environment Education Rules Conditioning/Rehab Optimal treatment of injuries to prevent reinjury

PPEs: Look for at risk athletes Injury Hx Family Hx ROS PE?EKG: Debate Education Concussion Sun screen etc

Helmets, mouthguards, face shields, eye protection, pads Break away bases, padded goal posts Emergency equipment

Facility regulations Zoning laws ADA Sports Organizations Heat Illness Prevention Soccer: shorter halves & increased H20 breaks

Spear tackling in football Decreased the risk of catastrophic cervical spine injuries

ACL injury prevention Hamstring strain prevention Ankle sprain prevention

250,000 ACL injuries/yr in USA 1in 3000 $1.5 billion annual cost > 70% ACL injuries are NON-contact 80-90% return to previous level of play Season ending injury Recovery 6-9 mo Females at higher risk

Lots of programs Different amount of time (10-90 min) Duration: 6 wks-whole season Variety of exercises Best results w/ the combination of Neuromuscular training Strength Plyometrics Jumping & landing techniques

At least 42 programs (1995-2011) Only 5 programs w/ published data on performance testing & injury reduction 2 (Sportsmetrics & PEP) showed significant reductions in ACL tears in HS girls soccer & basketball 1 (PEP) approached significance in college Noyes & Barber Westin, Sports Health 2012;4(1):36-46

Balance mats/boards Flexibility Agility Plyometrics Strength Session length Timing in season Sportsmetric s Pre 60-90 min Yes Yes Yes Yes No Mykelbust During 15 min No No Yes No Yes KLIP During 20 min No Yes Yes No No PEP During 20 min Yes Yes Yes Yes No The 11 During 15 min Yes Yes Yes No Yes

Sportmetrics Hewett, 1999, Amer J Sports Med http://www.sportsmetrics.net/ PEP (Prevent injury Enhance Performance) Mandelbaum, 2005, Amer J Sports Med http://www.aclprevent.com/pepprogram.htm

Proper jump/land techniques Land on balls of feet Soft landing Toe-to-heel rocking of the foot ground reactive forces Knees flexed Knees forward Discourage inward buckling of knees (knockkneed landing) Chest over knees Hewett 1999 AJSM, Mandelbaum 2005 AJSM, Boden 2000 Physportsmed www.physsportsmed.com

Before Training After training Barber-Westin, 2006, AJSM; Noyes 2005 AJSM

on-contact injuries in trained groups SPORTSMETRICS UT: Untrained T: Trained MC: Male Control PEP Injury/ 1000 exp 0.5 0.4 0.3 0.2 0.1 0 0.35 0 0.05 UT T MC 0.5 0.45 0.4 0.35 0.3 0.25 0.2 0.15 0.1 0.05 0 0.09 T 0.47 UT

Sugimoto BJSM 2012 Reviewed 12 NMT studies in female athletes NNT = 108 to prevent 1 non-contact ACL tear Relative risk reduction 73% non-contact Reduction in other knee & ankle injuries?performance improvement Limitations: High NNT, Compliance & Generalizability

Grimm; AJSM 2015 Meta-analysis & systematic review 9 RCTs; 11,562 athletes Knee injury or ACL prevention programs Knee injury prevention: Knee injuries reduced ACL prevention: No significant change

Meyer; BJSM 2017 Systematic review Neuromuscular/proprioceptive interventions to prevent knee injuries & ACL tears 24 studies; >26,000 subjects 63% female Knee injuries decreased by 27% ACL injuries decreased by 51%

Nordic Hamstring Exercise Program Oslo Sports Trauma Research Center Focus: Injury Prevention Eccentric strengthening

Peterson, AJSM 2011 Aim: Prevent new hamstring injuries 942 soccer players 10 wk hamstring eccentric strengthening No injuries during 10 wk program Overall combine reduction: 70% NNT New injury: 25 (95% CI: 15-72) Recurrent: 3 (95% CI: 2-6) Combined: 13 (95% CI: 9-23)

Braces, taping & NMT are effective for preventing recurrences Strongest literature for NMT Limited effect for 1 st time ankle sprain prevention Tape or Brace + NMT= best prevention outcome Verhagen: Optimising ankle sprain prevention: a critical review and appraisal of the literature. BJSM 2010

STOP Sports Tauma & Overuse Prevention AOSSM 2007; Youth athletes www.stopsportsinjuries.org Youth Sports Safety Alliance NATA 2010 www.youthsportssafetyalliance.org Guidelines from professional orgs ie ACSM, AMSSM

Injury prevention comes in various forms Team physician can influence all of the factors Conditioning/Training ACL, Hamstring & Ankle Sprains Limitations Lots of available resources Be proactive!