ACL Injury Prevention: Coaches Clinic April 6, 2011 Justin Dudley, PT, DPT

Objectives Introduction Why ACL injury prevention important Barriers to ACL injury prevention BSC Warm-up Where do we go from here? Questions

Introduction Personal background Education and Professional experience Playing history Coaching history Sports performance training Education and Professional experience Cascade Sports

Will this be your athlete’s knee? ACL Injury Prevention Will this be your athlete’s knee?

ACL Injury Prevention Basketball ACL Injury Soccer ACL Injury ABC News Story

ACL Injury Prevention It 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 injuries 70-84% of ACL injuries are non-contact Vast majority of these injuries are to young healthy individuals in “non-contact” situations, likely resulting from: inadequate muscular strength poor muscular control poor biomechanics Studies 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%.

What are the effects of ACL injury? As a coach – your athlete is out for the season Parent - $25,000 medical bills, heart ache, time for rehab Athlete – 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 soccer 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. 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.

PREVENTION IS BEST WAY TO REDUCE RISK OF OA FOLLOWING ACL INJURY!

ACL Injury Prevention Mechanism of Injury Common playing situations that preclude a non-contact ACL injury include: Change of direction or cutting manuever, combined with decceleration Landing from a jump in or near full extension Pivoting with knee near full extension and a planted foot. Females 2.5-10x’s more likely to tear ACL than males

ACL Injury prevention Why is the incidence of ACL injury in females higher than males? Anatomy Hormones Joint Laxity Smaller ACL Quadriceps:Hamstring Ratio Muscular Fatigue Biomechanical Factors

ACL 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

Biomechanical and Neuromuscular Factors Most modifiable risk factor Neuromuscular control of knee involves complex interaction of nerves, joint receptors and muscles Proprioception….what is it? Information from peripheral nervous system about joint position and joint motion in space in order to elicit active and reflexive movement

Biomechanical and Neuromuscular Factors Muscular strength and recruitment are crucial to knee stability Males 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 males Females rely on ligaments for stability Is muscle weakness and timing the only factor?

Biomechanical and Neuromuscular Factors

Knee Anatomy The 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.

Need to look at the body hollistically Studies show that combination of forces produces a higher strain on the ACL than isolated motions and torques Need to look at the body hollistically Again, 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

BSC and Cascade Sports Teamed up to implement ACL injury prevention program Biggest barriers to implementing ACL program Cost Time away from technical coaching and training Athlete interest Equipment Sustainability

BSC and Cascade Spors Our Approach Standardize warm-up with focus on activities that help to reduce risk of ACL injury Program will be implemented by coaches Incorporate soccer specific movements and drills Additional expertise available upon special request Preferred scheduling for BSC athletes at CCWC Tournament Medical Coverage Future ACL injury prevention camps and clinics

BSC Warm-up Close attention to athletes by the coaches Not a time for coaches to socialize with each other and/or parents Study by Mandelbaum et al. showed that a 15-20 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

BSC Warm-up Set up two cones 10 yards apart Jog forward/backward between cones x4 Side shuffle between cones x4 Toe walks/Heel walks x2 Jog 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

BSC Strengthening Walking Lunges Forward/Backward w/ knee tuck (x2) Single leg bridges (4x15sec) Plank w/ leg lifts (2x30sec)

BSC 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)

Agility Forward/Backward Shuttle Run (x4) Ladder or cone drills Box drill Forward/backwards/side/diaganol (at least x3)

What about stretching? Evidence on benefit of stretching prior to work-out is conflicting Movements performed within the warm-up take athlete through a range of motions stretching various muscles with each task Option: perform stretches during breaks in warm-up or between drills.

Additional Drills Diagonal run w/ stop and pivot 180 degree Jumps Scissor Jumps Single Leg Combo Hop* Single Leg Hop Diagonal* Bridging with ball roll

Single Leg Combo Hop

Single-leg Hop Diagonal

Drills Any skill or athletic drill can be utilized to help prevent ACL injury prevention Develop an eye for good mechanics with movement Better athletic movements and improved biomechanics result in improved athletic performance.

BSC and Cascade Sports Additional services offered Team ACL Screening Sports Performance Training (individual, small group, team) Rehabilitation and Return to Sport ACL Injury Prevention Off-season Camps Benefit of working with Sports Medicine Team Professional approach

Coaches Clinic Day 2 Sunday April 10th, 5:30 PM at Highland Park On field application of warm-up U-14 Girls Team Strategies to correct faulty movements Final questions and discussion

Questions?