acl injury prevention program
DESCRIPTION
Sports and Physical Therapy Associates share a presentation on the ACL Injury Prevention Program.TRANSCRIPT
4th Annual Marino Lecture and Symposium
ACL/ Injury Prevention ProgramPhases
Sports and Physical Therapy Associates
Cincinnati Sports Medicine
1999 Using a combination of Jump Training/ PlyometricsStrength Training and Flexibility6 week preseason program Reduced ACL injuries in the Trained Women vs. Untrained women
Hewett 1999 AJSM
PEP Program
USC, Santa Monica California, from 2000 to 2002 completed 3 studies Highly specific Training session Used to replace the conventional warm upDramatic reduction in ACL injuries from 72% to 88% compared to the control groups
Mandelbaum AMJS 2005
Training To Reduce ACL Injuries
Cincinnati Children’ HospitalTimothy Hewett, Ph.D.Jump Training www.cincinnatichildrens.org/sportsmedPep ProgramDr. Bert Mandelbaum, MD www.aclprevent.com
ACL/General Injury Prevention Program Phases
Dynamic Warm-up/Cool downPlyometrics/ Neuro Muscular Re-edProprioception/ BalanceStrengthening Lower Extremities/CoreFlexibilityAgility PEP/Cincinnati Sports Medicine
Dynamic Warm up
Prepares the Body for the demands of the work out or practiceIncreases heart and respiratory rate and blood flow to musclesIncreases core body TemperatureEnhances Muscles elasticityAthlete Should break a sweat w/o excessive fatigue
Usually 10-20 minutesNSCA
Dynamic Warm Up
Progress from low to high intensityInclude all planes of motion, Multi directional and Diagonal PatternsWarm up should include exercises for both upper and lower extremitiesWarning: May induce fatigue in deconditioned athlete
NSCA
Dynamic Warm Up
Many Of the Components of The Injury Prevention Program can be worked on during this phase
DukeHealth.org: Mike Huff and VerneGambetta have taken Low intensity agilities, Plyos and dynamic stretchesto act as warm up
Cool Down
Following Sport or Activity Cool down consists of moving in same movement patterns as warm up withdecreasing IntensityStatic Stretching Optimal TimeRehydrate/ Refuel CarbsRelax
Ian Jeffreys MS CSCSNSCA
Plyometrics/StrengthProgressive Leaping and bounding exercisesThis gives Muscle pre stretch which enhances muscle contraction Allerheigen 1994
Jump Training/ Neuro Muscular ControlDevelop stability during the movement patterns that seems to put knee in most vulnerable landing or cutting positionsValgus landing with rotationCo contraction of Muscles to Stabilize Joint
Mandelbaum 2000
ACL Injury
Prior to starting Plyos
Instruct Athlete on the stability/power position Knees bent 25-30 degreesHip and Knee in Neutral alignmentControl valgusGreatest level of Ham to quad co contraction
NSCA
Reps and SetsFoot Contacts per workout:
Level Low intensity Med Intensity High Intensity Beginner 40 60 80
Intermediate 60 80 100Advanced 100 120 140
McNeely NSCA 2008
Criteria for Advancing
Once Athlete has mastered each jump for at least 2 consecutive practice sessions , this means good form and DOMS has subsided you may progress to greater level of difficulty.If athlete is in middle of high volume jumping season, basketball, volley ball etc. watch for signs of overtraining NSCA
Plyometrics/Jump Training
Higgins/Duke
Proprioception
The ability to maintain stability and orientation during static and dynamic activities. Mechano Receptors are neuro sensory cells that are responsible for monitoring joint position and movement.6 exteroceptive senses 1 interoceptive sense
Kinetics
Proprioception
A proprioception program should stimulate these mechano receptors. The ability to know where you are in space
NSCA
Strengthening
StrengtheningTo increase a muscles
tolerance to physical stress. This in turn will increase its cross sectional area.
Progressive Resistive means move up!!!
NSCA
Isolation Exercises Isolates Muscle groups to address Imbalancepost injury or surgery
+Less chance of injury during training- Costly- Doesn’t strengthen stabilizing muscles
NATA
Multi Muscle Group Training
Sports Specific Training– Training muscle
groups to work together in concert. Training the body to work per the required needs to the specific demands of a sport.
NATA
Multi Muscle Group Examples
Field exercises
Squats
Diagonal PatternsNATA
Open Chain Exercises
Open Chain : Foot is free to move– SLR, SAQ, LAQ– Leg Extension machines– Leg Curl machines
Hamstring /Quad Ratio+great for isolating muscle
groups
Closed Chain Exercises
Closed chain: Foot is Fixed– Wall slides, squats, lunges– Leg Press Machine– Hack Squat Machine+ co-contraction of leg and hip muscles- don’t isolate muscles as well
Which is Better??
Open Chain vs. Closed ChainStudies show long term no greater results in strengthening and no greater result in injury. PFS or ACL– Use them appropriately
Erik Witrvrouw, AJSM 2004Hooper & Morrisey AJSM 2001
Repetitions How Many?
Science of Repetitions– Physiologically higher
repetitions give the joints and tendons better blood flow
– Used better for post-season or rehabilitating an injury 15-20 reps
– Lower reps better for strength/power, used better during power cycles and pre-season
Grimsby
Frequency of Training?How often to train the same movements/muscles?– It depends on similar
variablesIn-season, pre-season, off-season, age and sport of the athlete
– Typically the same muscle group no more than 2 x/week
NSCA
Periodization
The science of cycling reps and intensities during different parts of the training cycle.
NSCA
Flexibility:Improving a Joints Range of Motion
Types of Stretching– Active- Hold 2-3 sec
repeat 20 times
– Static – hold 30 seconds repeat 2 times
– Dynamic -Active Movements through exaggerated ranges NSCA
ACL Injuries/ Patellofemoral Pain
The age group that ACL injuries occur 13-17:Also age group marked decrease in flexibility which can lead to Patellar Tendinitis and or PFS
Witvrouw AJSM 2001
Stretches to decrease Patella Tendinitis Witvrouw AJSM 2001
Stretches– Rectus/Quadriceps
- Hamstring
Time to stretch?
Optimal time to stretch– After warm-up – At end of Cool
Down
Ian Jeffreys, MS CSCSNSCA
AgilitiesMost Sports are in themselves agility movements However practicing cutting movements that tend to cause stress to the athlete’s knee can create improved coordination and strength through sports specific movements NSCA
Pick Agilities to Fit Sport
Agility Patterns that mimic sports movements– Grapevines
Side to side– Run ,plant and cut
NSCA
ACL Prevention Today
Although the Pep program and Cincinnati prevention programs reduced ACL injuries significantly.
Both groups readily admit it is unclear which aspect of their programs were responsible for the reduction in injuries
USC/Cincinnati Sports Medicine
ACL Project Prevent
USC ACL Project Prevent
A 3 year Study Funded By the NIH
Identify Gender Specific Movement Patterns
That may predispose Female Athletes to ACL Injuries
As Athletic Trainers and Physical TherapistsUtilize evidence based Medicine as the backbone of your rehab!Develop a program that works for your coaches, teams and patients !Achieve participation with resources and time available !One Size doesn’t Fit All
FIELD DRILL FOR Injury PREVENTION
Run Back Peddle Run Back Peddle
Cut and Run
Plyometrics, Squats, Side to Side, etc.
Raise level of difficulty as season
progresses
Side to Side, Carioca, etc
30 yards x 30 yards
If Budget is really Bad
1 piece of Chalk1 pebble4 single Leg Jumps2 Double leg Jumps1 180 Degree Jump1 Single Leg SquatMake the Squares BiggerStart Again