acl injury prevention program

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4 th Annual Marino Lecture and Symposium ACL/ Injury Prevention Program Phases Sports and Physical Therapy Associates

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Sports and Physical Therapy Associates share a presentation on the ACL Injury Prevention Program.

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Page 1: ACL Injury Prevention Program

4th Annual Marino Lecture and Symposium

ACL/ Injury Prevention ProgramPhases

Sports and Physical Therapy Associates

Page 2: ACL Injury Prevention Program

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

Page 3: ACL Injury Prevention Program

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

Page 4: ACL Injury Prevention Program

Training To Reduce ACL Injuries

Cincinnati Children’ HospitalTimothy Hewett, Ph.D.Jump Training www.cincinnatichildrens.org/sportsmedPep ProgramDr. Bert Mandelbaum, MD www.aclprevent.com

Page 5: ACL Injury Prevention Program

ACL/General Injury Prevention Program Phases

Dynamic Warm-up/Cool downPlyometrics/ Neuro Muscular Re-edProprioception/ BalanceStrengthening Lower Extremities/CoreFlexibilityAgility PEP/Cincinnati Sports Medicine

Page 6: ACL Injury Prevention Program

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

Page 7: ACL Injury Prevention Program

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

Page 8: ACL Injury Prevention Program

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

Page 11: ACL Injury Prevention Program

ACL Injury

Page 13: ACL Injury Prevention Program

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

Page 14: ACL Injury Prevention Program

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

Page 15: ACL Injury Prevention Program

Plyometrics/Jump Training

Higgins/Duke

Page 18: ACL Injury Prevention Program

Strengthening

StrengtheningTo increase a muscles

tolerance to physical stress. This in turn will increase its cross sectional area.

Progressive Resistive means move up!!!

NSCA

Page 20: ACL Injury Prevention Program

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

Page 22: ACL Injury Prevention Program

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

Page 23: ACL Injury Prevention Program

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

Page 24: ACL Injury Prevention Program

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

Page 25: ACL Injury Prevention Program

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

Page 26: ACL Injury Prevention Program

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

Page 27: ACL Injury Prevention Program

Periodization

The science of cycling reps and intensities during different parts of the training cycle.

NSCA

Page 29: ACL Injury Prevention Program

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

Page 31: ACL Injury Prevention Program

Time to stretch?

Optimal time to stretch– After warm-up – At end of Cool

Down

Ian Jeffreys, MS CSCSNSCA

Page 32: ACL Injury Prevention Program

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

Page 33: ACL Injury Prevention Program

Pick Agilities to Fit Sport

Agility Patterns that mimic sports movements– Grapevines

Side to side– Run ,plant and cut

NSCA

Page 34: ACL Injury Prevention Program

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

Page 35: ACL Injury Prevention Program

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

Page 37: ACL Injury Prevention Program

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