1. ACL Prevention: Programs & Results Mike Flynn, MS ATC LAT

2. Purpose To provide a simple, common sense approach to preventing ACL and lower extremity injuries.

3. 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.

4. 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)

5. When Injuries Happen Planting & Cutting Landing Stops Pivoting Rapid Deceleration

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. 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

14. Prevention Stats Meta-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

15. Program Components Form Runs Dynamic Flexibility Core Strength Balance/Proprioception Agility Explosive Strength Sport-specific conditioning

16. Form Runs Skips Carioca High Knee Butt Kicker Side Shuffle Serpentine Run Plant & Cuts 180’s & 360’s

17. Dynamic Flexibility Knee Hugs Hurdle Walks Crawling Series –Inch Worm –Spiderman Lunge Series

18. Balance/Proprioception Single Leg Balance –Standing –Side to Side –Rotation Hop & Sticks –Double Leg –Single Leg –Multi-Directional

19. Agility Foot Ladder –Forward –Backward –Sideways Sprint it out to a stop!

20. Explosive Strength Plyometrics –Landing –Jump Ups –Double Leg Hops –Single Leg Hops –Bounds –Alternate Leg Box Jumps

21. Strength Core strength –Basic Core Bridge Series Lunge Series

22. Sport-Specific Conditioning Make it look like the game!!

23. Putting It All Together! Form Runs Basic Core Balance/Proprioception Dynamic Flexibility Agility Explosive Strength Conditioning

24. 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

25. 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.

26. 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

27. 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

28. Thank You! Contact Information: mike@reboundsportsperformance.com 785.272.8025