6ACL Injury PreventionIt 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 injuries70-84% of ACL injuries are non-contactVast majority of these injuries are to young healthy individuals in “non-contact” situations, likely resulting from:inadequate muscular strengthpoor muscular controlpoor biomechanicsStudies 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%.
7What are the effects of ACL injury? As a coach – your athlete is out for the seasonParent - $25,000 medical bills, heart ache, time for rehabAthlete – 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 soccerDespite 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.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.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.
8PREVENTION IS BEST WAY TO REDUCE RISK OF OA FOLLOWING ACL INJURY!
9ACL Injury Prevention Mechanism of Injury Common playing situations that preclude a non-contact ACL injury include:Change of direction or cutting manuever, combined with deccelerationLanding from a jump in or near full extensionPivoting with knee near full extension and a planted foot.Females x’s more likely to tear ACL than males
10ACL Injury prevention Why is the incidence of ACL injury in females higher than males? AnatomyHormonesJoint LaxitySmaller ACLQuadriceps:Hamstring RatioMuscular FatigueBiomechanical Factors
11ACL Injury prevention Why is the incidence of ACL injury in females higher than males? Non-contact ACL injuries in soccer players likely has a multi-factorial etiology
12Biomechanical and Neuromuscular Factors Most modifiable risk factorNeuromuscular control of knee involves complex interaction of nerves, joint receptors and musclesProprioception….what is it?Information from peripheral nervous system about joint position and joint motion in space in order to elicit active and reflexive movement
13Biomechanical and Neuromuscular Factors Muscular strength and recruitment are crucial to knee stabilityMales 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 malesFemales rely on ligaments for stabilityIs muscle weakness and timing the only factor?
15Knee AnatomyThe 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.
16Need to look at the body hollistically Studies show that combination of forces produces a higher strain on the ACL than isolated motions and torquesNeed to look at the body hollisticallyAgain, 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
18BSC and Cascade SportsTeamed up to implement ACL injury prevention programBiggest barriers to implementing ACL programCostTime away from technical coaching and trainingAthlete interestEquipmentSustainability
19BSC and Cascade Spors Our Approach Standardize warm-up with focus on activities that help to reduce risk of ACL injuryProgram will be implemented by coachesIncorporate soccer specific movements and drillsAdditional expertise available upon special requestPreferred scheduling for BSC athletes at CCWCTournament Medical CoverageFuture ACL injury prevention camps and clinics
20BSC Warm-up Close attention to athletes by the coaches Not a time for coaches to socialize with each other and/or parentsStudy by Mandelbaum et al. showed that a 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
21BSC Warm-up Set up two cones 10 yards apart Jog forward/backward between cones x4Side shuffle between cones x4Toe walks/Heel walks x2Jog 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
22BSC Strengthening Walking Lunges Forward/Backward w/ knee tuck (x2) Single leg bridges (4x15sec)Plank w/ leg lifts (2x30sec)
23BSC 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)
24Agility Forward/Backward Shuttle Run (x4) Ladder or cone drills Box drillForward/backwards/side/diaganol(at least x3)
25What about stretching?Evidence on benefit of stretching prior to work-out is conflictingMovements performed within the warm-up take athlete through a range of motions stretching various muscles with each taskOption: perform stretches during breaks in warm-up or between drills.
26Additional Drills Diagonal run w/ stop and pivot 180 degree Jumps Scissor JumpsSingle Leg Combo Hop*Single Leg Hop Diagonal*Bridging with ball roll
29DrillsAny skill or athletic drill can be utilized to help prevent ACL injury preventionDevelop an eye for good mechanics with movementBetter athletic movements and improved biomechanics result in improved athletic performance.
30BSC and Cascade Sports Additional services offered Team ACL ScreeningSports Performance Training (individual, small group, team)Rehabilitation and Return to SportACL Injury Prevention Off-season CampsBenefit of working with Sports Medicine TeamProfessional approach
31Coaches Clinic Day 2 Sunday April 10th, 5:30 PM at Highland Park On field application of warm-upU-14 Girls TeamStrategies to correct faulty movementsFinal questions and discussion