Transcript ACL INJURY PREVENTION PROGRAMS

ACL INJURY
PREVENTION
PROGRAMS
Gregory M. Mathien, M.D.
Knoxville Orthopaedic Clinic
ACL ANATOMY
•Ligament: Inner wall lateral
femoral condyle to intercondylar
eminence or tibia
•Two Bundles: Anteromedial and
Posterolateral
ACL FUNCTION
•Primary restraint to anterior translation of tibia
•Restraint to rotational instability
MOST COMMON MECHANISM OF
INJURY
•Non-Contact
•Deceleration
•Change of Direction
EPIDEMIC
Approximately 250,000 ACL Injuries occur each
year in individuals between 15 to 25 years old
Estimated 100,000 to 200,000+
ACL Reconstructions are done in the U.S. each year
ACL Reconstruction is the 6th most common
orthopaedic procedure in the U.S.
SINCE TITLE IX…
•Male participation – 3.8 million
•Female participation – 0.3 to 3 million
•Female athletes 4-6 times more likely to sustain an ACL tear than
male athletes
AGAIN…
ACL Injury is more common in female athletes
4-6 x males
Approximately 1 in 70 female athletes in high school will
sustain an ACL Injury during any given year
WHY WOMEN?
Multiple Factors:
◦ Wider hips
◦ Smaller joints
◦ Increased joint laxity
◦ Small ACL’s
◦ Increased BMI
◦ Different patterns of movement
SHORT TERM DISABILITY
•Pain
•Swelling
•Instability
•Prolonged absence from sport
LONG TERM DISABILITY
•Decreased function
•Premature osteoarthritis
SCREENING TOOLS?
LANDING ERROR SCORING SYSTEM
Possible screening tool
Landing Error Scoring System “LESS”
“LESS”
Training may facilitate neuromuscular adaptations
helping to protect the ACL
NEUROMUSCULAR TRAINING
PROGRAMS
•Plyometrics
•Balance
•Technique Training
•Reduces the risk of injury
Dedicated program MAY reduce risk/incidence of injury
DO NO HARM!
LITERATURE REVIEW
Recent literature review of 10 studies:
• 2 – significant decrease
• 4 – trended to reduced ACL Injuries
• 2 – studies increase
PEP PROGRAM
PREVENT INJURY AND ENHANCE PERFORMANCE
•D1 Soccer
•ACL Injury – 88% less ACL Injuries
74%
Santa Monica PEP Program
(Prevent Injury and Enhance Performance)
ACL Injury Prevention Exercises
(PEP program)
PEP Program
FIFA - 11+
Running Warm Up -- Straight Ahead -FIFA 11+ (1.0)
Running Warm Up -- Hip out Exercise -FIFA 11+ (2.0)
Running Warm Up -- Hip In Exercise -FIFA 11+ (3.0)
Running Warm Up -- Circling Partner -FIFA 11+ (4.0)
Running Warm Up -- Shoulder Contact
Exercise -- FIFA 11+ (5.0)
Running Warm Up -- Quick Forwards &
Back -- FIFA 11+ (6.0)
Bench -- Static -- FIFA 11+ (7.1)
Bench -- Alternating Legs Exercise -- FIFA
11+ (7.2)
Bench -- One Leg Lift & Hold Exercise -FIFA 11+ (7.3)
Sideways Bench Exercise -- Static -- FIFA
11+ (8.1)
Bench -- Raise & Lower Hip Exercise -FIFA 11+ (8.2)
Sideways Bench -- With Leg Lift -- FIFA
11+ (8.3)
Hamstrings Exercise -- Beginner -- FIFA
11+ (9.0)
Single Leg Stance --Holding Ball -- FIFA
11+ (10.1)
Single Leg Stance -- Throwing Ball -- FIFA
11+ (10.2)
Single Leg Stance Exercise -- Test Your
Partner -- FIFA 11+ (10.3)
Squats -- With Toe Raise -- FIFA 11+
(11.1)
Squats -- Walking Lunges -- FIFA 11+
(11.2)
Squats -- One-Leg Squats -- FIFA 11+
(11.3)
Jumping -- Vertical Jump Exercises -- FIFA
11+ (12.1)
Jumping Exercise -- Lateral Jumps -- FIFA
11+ (12.3)
Jumping -- Box Jumps Exercise -- FIFA 11+
(12.3)
Running Warm Up -- Across The Pitch -FIFA 11+ (13.0)
Running Warm Up - Bounding -- FIFA 11+
(14.0)
Running Warm Up -- Plant & Cut -- FIFA
11+ (15.0)
Cincinnati SPORTSMETRICS
SPORTSMETRICS TECHNIQUE &
TRAINING
“Sportsmetrics™ Techniques and Training is the foundation upon
which sports specific skills are built. Training builds from technique
development to performance enhancement.”
“This six week program was scientifically proven to significantly
reduce the risk of serious knee injuries in female athletes, while
improving hamstrings to quadriceps strength ratio and jumping
height. It combines a dynamic warm up, plyometrics, strength
training and flexibility.”
www.sportsmetrics.org
SPORTSMETRICS TECHNIQUE &
TRAINING
•Dynamic Warm-up
•Plyometrics/Jump Training
•High Intensity Strength Training
•Flexibility Training
www.sportsmetrics.org
Dynamic Warm-up: (5 minutes)
Prepares the body with functional based activities that use sport
specific motions. It raises core body temperature, increases blood
flow to the muscles and improves flexibility, balance and
coordination.
www.sportsmetrics.org
Plyometrics/Jump Training:
(30 minutes)
Plyometrics, the core of the Sportsmetrics™ program, are used to
focus on correct jumping technique and are divided into three two
week phases. Each phase has a different training focus and the
exercises change accordingly. Plyometrics develops muscle control
and strength that are critical for reducing the risk of knee injury and
increasing jump height.
www.sportsmetrics.org
High Intensity Strength Training:
(30 minutes)
With emphasis on body alignment and form. Sportsmetrics™
provides structured (yet adaptable) strength training guidance. This
section focuses on development of core strength and improving
overall muscular efficiency. This can be done with or without
equipment or free weights.
www.sportsmetrics.org
Flexibility Training: (10 minutes)
Stretching is essential to achieve maximum muscle length, allowing
muscles to work with power through complete range of motion. This
is important for decreasing injury and post-training muscle soreness.
www.sportsmetrics.org
COMPONENTS IN MOST PROGRAMS
•Plyometrics
•Biomechanics Technique Feedback
•Balance
•Core Stability
•Strength Training
Plyometrics should be included
Balance training alone not as effective
Majority of studies suggest a trend toward a reduction
in ACL Injuries in female athletes using a
Neuromuscular Training Program
Moderate evidence that multi-faceted
Neuromuscular Programs involving
preseason conditioning, including Plyometrics,
may reduce the risk of injuries in female athletes
Moderate evidence that programs that utilize
only in-season conditioning do not reduce
ACL Injuries in female athletes
Moderate evidence that programs that only use
Proprioception or Plyometrics do NOT reduce
ACL Injuries in female athletes
Definitive conclusion on program success cannot
be made regarding effectiveness of prevention
programs in reducing ACL Injuries in female athletes
CONCLUSION
In my opinion… there is strong evidence in support of effect of ACL
Injury Prevention Programs.