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

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

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

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

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

6. 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%.

7. 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.

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

9. 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 x’s more likely to tear ACL than males

10. 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

11. 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

12. 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

13. 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?

14. Biomechanical and Neuromuscular Factors

15. 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.

16. 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

18. 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

19. 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

20. 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 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

21. 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

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

23. 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)

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

25. 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.

26. 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

27. Single Leg Combo Hop

28. Single-leg Hop Diagonal

29. 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.

30. 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

31. 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

32. Questions?