How to Prevent ACL Injuries

How to Prevent ACL Injuries  

- Talk by Dr. Peter Gorman

There is a new technology called optojump.

ACL (knee ligament) injuries can be career ending.

Will discuss susceptibility and injury prevention.

An international conference in Barcelona each year marries science and sports.

Today the emphasis is on bigger, faster, stronger – but an athlete must be tuned to adjust to increased speed.

There are 200,000 ACL tears/year, 4,000 tears/week, 600 tears/day, 100,000 surgical interventions per year. The majority of ACL injuries happen to females. Most ACL injuries are non-contact injuries caused by jumping, cutting, turning, and landing. The athlete hears classic “pop” behind the knee, where ACL is located. A person must know reaction recovery time, speed and acceleration of each leg and flight time in order to understand proper firing of our muscles and symmetrical development over time. Otherwise an athlete becomes like a car out of alignment. The ACL injury is already harboring inside a child day in and day out as a result of speed imbalance – need symmetry of motion.

Instability in lower extremity leads to ACL injury. An athlete needs to be taught about this. a Landing Error Scoring System is the Gold Standard for evaluating ACL injury susceptibility developed by UNC at Chapel Hill. Evaluation is from both the front and side view for biomechanical correctness regarding posture. Deviations are given a point value of susceptibility. The popular baseball song line “Put me in coach.  I’m ready to play” really should be “I’m ready to finish” because an athlete has had proper conditioning.

Increased female susceptibility is related to:

• Size and shape of the femoral notch
• Increased pelvis width changes angle to knee.
• Quadriceps dominance
• Hamstring weakness
• Increased flexibility
• Heavy calves
• Hormonal
• Shoe wear for field conditions
• Stiffness – female doesn’t absorb shock

Modifiable risk factors can be adjusted in athlete’s favor – postural alignment can reduce ACL injury risk by 40%:

• Knee/valgus should be straight
• Good stance width
• Foot position
• Lateral trunk flexion should be straight

Sports should help with development early on to eliminate problems. Coaches need to look at the athletes stance – Are feet outside shoulders?  If so, re-teach jump and landing.

Are feet turned in or out?  If so, give up power for correctness and redevelop!

Females tend to have less knee flexion than males. Females should do a trunk extension. And when they jump their toes must initiate contact when landing. The more upright they are on their landing, the more susceptibility. Bad form can happen when athlete gets fatigued later in a game.

Leg bone and thigh bone are shearing so they don’t absorb shock. An athlete training for strength, speed, and agility while disregarding proper mechanics is a prescription for failure. One can reduce ACL injury susceptibility with proper form combined with athletic ability. There is a fine line between training and abusing - athletes should be able and agile in all directions.

How to Reduce Susceptibility to Injury

Every child athlete has the right to symmetrical development over time so they are agile in all directions.

Reduce anterior forces on the knee:

• Soft landings are imperative in absorbing shock and preventing force on knee.
• Gastronemeus (calf) must be able to stretch properly.
• Good hamstring control will prevent anterior shear valgus stress and tibial rotation - Need properly functioning soleus muscle.
• Can’t be quadriceps dominant –
• A good exercise to do is squat, keep knees stratigh, butt down, and don’t let heels come off the ground.
• Pelvic tilt exercise and butt squeeze – lie flat on back, knees up, feet on ground – practice pressing curve of lower back to ground by rolling pelvis (also increases core strength).

Must control varlgus-varus movement of knee:

• Pick proper shoe to control pronation and supination.
• Gluteal tone to control unnecessary rotation of knee.
• Prevent inner thigh tightness by stretching – good stretch is to make leg into #4 shape.

We must prevent knee extension:

• Having knees extended minimizes the effect – evenness of the hamstrings.
• Don’t lock knees so train for forward position of knee.

Athlete is usually evaluated when not fatigued. Evaluate influence of stress and fatigue on jumping ability and postural alignment using OPTOGAIT developed by Dr. Gorman.

OPTOGAIT – determines how symmetrical a child athlete is in movement. But the test won’t tell you the reason for asymmetry. Asymmetry can be from hits to the head possibly. Conditions can occur such as chronic traumatic encephalopathy that is like carpal tunnel of the brain.  Second impact syndrome is usually fatal so determine if asymmetry exists before a tragedy happens.

Dr. Gorman developed a system to put heart rate monitor on all athletes on the field.  If a child goes above a certain rate, he or she must come off the field.  The heart rate is monitored on the side line. OPTOGAIT is based on principles of physics and gravity (i.e., how long athlete is off the ground). This system takes pictures from various angles and can evaluate form on most powerful jumps. Then you can see when fatigue sets in. The goal is for biomechanical correctness to get better over time as a result of the evaluation. Also, this system shows the speed of acceleration as an athlete runs through a test area.  Acceleration should increase gradually.  An example of a power differential is when one leg doesn’t push as hard as the other leg. You can analyze the jumps to show the left and right leg power – shows load/explode concept.

It shows power vs. instability – does the leg shift to the side or front/back while the athlete is jumping?

AIM = STABILITY

After the OPTIGAIT analysis, a coach can work on improving the athlete’s stability before increasing power.

I FUN FACT: Tiger Tail Myofacial Compression Tool – is an effective neuromuscular warm up tool.

CONCLUSION

Good balance control is necessary to obtain optimal performance and reduce risk of injury.

Without Balance è No Stability è No Abiltiy

Simple test – pouring cold water in the ear affects balance/equilibrium.

Try balancing on one leg with your eyes open – then challenge yourself to the next level by balancing on one lag with your eyes closed – Is there a different result on the left vs. the right side?  Repeat exercise daily, gradually increasing amount of time you balance.