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ACL Injury Prevention Program


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

Published in: Health & Medicine, Sports
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ACL Injury Prevention Program

  1. 1. 4th Annual Marino Lecture and Symposium ACL/ Injury Prevention Program Phases Sports and Physical Therapy Associates
  2. 2. Cincinnati Sports Medicine 1999 Using a combination of Jump Training/ Plyometrics Strength Training and Flexibility 6 week preseason program Reduced ACL injuries in the Trained Women vs. Untrained women Hewett 1999 AJSM
  3. 3. PEP Program USC, Santa Monica California, from 2000 to 2002 completed 3 studies Highly specific Training session Used to replace the conventional warm up Dramatic reduction in ACL injuries from 72% to 88% compared to the control groups Mandelbaum AMJS 2005
  4. 4. Training To Reduce ACL Injuries Cincinnati Children’ Hospital Timothy Hewett, Ph.D. Jump Training Pep Program Dr. Bert Mandelbaum, MD
  5. 5. ACL/General Injury Prevention Program Phases Dynamic Warm- up/Cool down Plyometrics/ Neuro Muscular Re-ed Proprioception/ Balance Strengthening Lower Extremities/Core Flexibility Agility PEP/Cincinnati Sports Medicine
  6. 6. Dynamic Warm up Prepares the Body for the demands of the work out or practice Increases heart and respiratory rate and blood flow to muscles Increases core body Temperature Enhances Muscles elasticity Athlete Should break a sweat w/o excessive fatigue Usually 10-20 minutes NSCA
  7. 7. Dynamic Warm Up Progress from low to high intensity Include all planes of motion, Multi directional and Diagonal Patterns Warm up should include exercises for both upper and lower extremities Warning: May induce fatigue in deconditioned athlete NSCA
  8. 8. Dynamic Warm Up Many Of the Components of The Injury Prevention Program can be worked on during this phase Mike Huff and Verne Gambetta have taken Low intensity agilities, Plyos and dynamic stretches to act as warm up
  9. 9. Cool Down Following Sport or Activity Cool down consists of moving in same movement patterns as warm up with decreasing Intensity Static Stretching Optimal Time Rehydrate/ Refuel Carbs Relax Ian Jeffreys MS CSCS NSCA
  10. 10. Plyometrics/Strength Progressive Leaping and bounding exercises This gives Muscle pre stretch which enhances muscle contraction Allerheigen 1994 Jump Training/ Neuro Muscular Control Develop stability during the movement patterns that seems to put knee in most vulnerable landing or cutting positions Valgus landing with rotation Co contraction of Muscles to Stabilize Joint Mandelbaum 2000
  11. 11. ACL Injury
  12. 12. Prior to starting Plyos Instruct Athlete on the stability/power position Knees bent 25-30 degrees Hip and Knee in Neutral alignment Control valgus Greatest level of Ham to quad co contraction NSCA
  13. 13. Reps and Sets Foot Contacts per workout: Level Low intensity Med Intensity High Intensity Beginner 40 60 80 Intermediate 60 80 100 Advanced 100 120 140 McNeely NSCA 2008
  14. 14. 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
  15. 15. Plyometrics/Jump Training Higgins/Duke
  16. 16. 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
  17. 17. Proprioception A proprioception program should stimulate these mechano receptors. The ability to know where you are in space NSCA
  18. 18. Strengthening Strengthening To increase a muscles tolerance to physical stress. This in turn will increase its cross sectional area. Progressive Resistive means move up!!! NSCA
  19. 19. Isolation Exercises Isolates Muscle groups to address Imbalance post injury or surgery +Less chance of injury during training - Costly - Doesn’t strengthen stabilizing muscles NATA
  20. 20. 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
  21. 21. Multi Muscle Group Examples Field exercises Squats Diagonal Patterns NATA
  22. 22. 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
  23. 23. 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
  24. 24. Which is Better?? Open Chain vs. Closed Chain Studies show long term no greater results in strengthening and no greater result in injury. PFS or ACL – Use them appropriately Erik Witrvrouw, AJSM 2004 Hooper & Morrisey AJSM 2001
  25. 25. 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
  26. 26. Frequency of Training? How often to train the same movements/muscles? – It depends on similar variables In-season, pre-season, off-season, age and sport of the athlete – Typically the same muscle group no more than 2 x/week NSCA
  27. 27. Periodization The science of cycling reps and intensities during different parts of the training cycle. NSCA
  28. 28. 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
  29. 29. 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
  30. 30. Stretches to decrease Patella Tendinitis Witvrouw AJSM 2001 Stretches – Rectus/Quadriceps - Hamstring
  31. 31. Time to stretch? Optimal time to stretch – After warm-up – At end of Cool Down Ian Jeffreys, MS CSCS NSCA
  32. 32. Agilities Most 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
  33. 33. Pick Agilities to Fit Sport Agility Patterns that mimic sports movements – Grapevines Side to side – Run ,plant and cut NSCA
  34. 34. 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
  35. 35. 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
  36. 36. As Athletic Trainers and Physical Therapists Utilize 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
  37. 37. 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
  38. 38. If Budget is really Bad 1 piece of Chalk 1 pebble 4 single Leg Jumps 2 Double leg Jumps 1 180 Degree Jump 1 Single Leg Squat Make the Squares Bigger Start Again