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UK snowsports ACL injury


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Presentation from UK Snowsports coaching seminar on ACL injuries and their prevention in skiers

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UK snowsports ACL injury

  1. 1. Strength and Conditioning for Skiing ACL injuries and their prevention
  2. 2. Session overview <ul><li>A bit about me </li></ul><ul><li>Common injuries </li></ul><ul><li>Mechanisms of ACL injury </li></ul><ul><li>How to screen for these injuries </li></ul><ul><li>Practical - injury prevention strategies </li></ul>
  3. 3. Neil Welch MSc ASCC <ul><li>BSc Sports science and physiology </li></ul><ul><li>MSc Strength and conditioning </li></ul><ul><li>Worked with snowboard-X and ski coaches in Canada </li></ul><ul><li>Experience with premiership rugby team Leeds Carnegie </li></ul><ul><li>S&C coach for the the England alpine ski team </li></ul><ul><li>Work with athletes from multiple sports including rugby, cricket, rowing and triathlon </li></ul><ul><li>Founder of nw conditioning strength and conditioning consultancy </li></ul>
  4. 4. Common Injuries <ul><li>In terms of injury type, biggest is acute trauma </li></ul><ul><li>Not much we can do about impacts, nature of the sport, although better strength and conditioning will mean better ability to concentrate </li></ul><ul><li>Pulled muscles are definitely preventable, need; </li></ul><ul><ul><li>Appropriate strength through full range of motion </li></ul></ul><ul><ul><li>No bilateral imbalances </li></ul></ul><ul><ul><li>Limit agonist antagonist imbalances </li></ul></ul><ul><li>Traumatic injuries such as tendon/ligament ruptures we can have some say in reduction </li></ul>
  5. 5. Common Injuries <ul><li>In terms of area, knee is the biggest concern, depending on where you look, between 30-40% of injuries occur in the knee </li></ul><ul><li>Due to limited motion at the ankle, more force has to be ‘handled’ through the joint </li></ul><ul><li>Lots of uneven surfaces and rapid accelerations and decelerations around the joint </li></ul><ul><li>Fatigue plays an important role and as such so does nutrition around training </li></ul><ul><li>Cruciate ligament injuries are particularly common </li></ul>
  6. 6. The knee - ligaments <ul><li>4 ligaments in the knee </li></ul><ul><li>Collateral ligaments prevent lateral movement </li></ul><ul><li>Cruciate ligaments prevent anterior posterior movement </li></ul>
  7. 7. The knee - musculature <ul><li>Significant musculature surrounding the joint </li></ul><ul><li>Imbalance can put altered load on the ligaments </li></ul><ul><li>Lack of strength can increase load on the ligaments </li></ul>
  8. 8. Causes of ACL injury <ul><li>Can be due to weakness in musculature about the hips and core </li></ul><ul><li>Particularly vulnerable in a position of knee valgus </li></ul><ul><li>Knee valgus can lead to medial collateral ligament strain and increase risk of anterior cruciate ligament (ACL) injury </li></ul><ul><li>ACL injury also due to shearing forces, often related to ski boot stiffness </li></ul><ul><li>More susceptibility with females due to q-angle at the hip and more reliance on ligaments </li></ul><ul><li>Usually involves a rapid deceleration of the joint, therefore increased strength is a requirement </li></ul>
  9. 9. Female athletes and ACL injury <ul><li>More occurrence of ACL injury than males </li></ul><ul><li>Due to hormonal, anatomical and neuromuscular differences </li></ul><ul><li>Neuromuscular control deficits: strength, power or activation patterns </li></ul><ul><li>Ligament dominance: imbalance between ligament and neuromuscular control of knee stability </li></ul><ul><li>Quadriceps dominance: imbalance between quads and hamstrings </li></ul><ul><li>Leg dominance: imbalance from leg to leg </li></ul><ul><li>Trunk dominance: inability to activate core correctly </li></ul>
  10. 10. Screening <ul><li>Allows progression to be monitored </li></ul><ul><li>Can show the athlete why they need to be doing the exercises/training they’ve been set </li></ul><ul><li>It can highlight those most at risk and allow the coach to target specific work to those athletes </li></ul>
  11. 11. Methods of screening: Hop and stop <ul><li>Measures differences in force production and stability relative to height </li></ul><ul><li>Gives quantitative information to compare on an ongoing basis </li></ul><ul><li>Is quick and easy to administer </li></ul><ul><li>For details and reminder of protocol see link: </li></ul>
  12. 12. Methods of screening: Tuck jumps <ul><li>Again, quick and easy to administer </li></ul><ul><li>Feet 35cm apart, slight knee bend and jump using an arm swing bringing the knees up to parallel with the floor </li></ul><ul><li>On landing immediately go straight into the next jump continuing for 10 seconds </li></ul><ul><li>The athlete should be encouraged to land softly using a toe to midfoot rocker and keep the same footprint on landing </li></ul><ul><li>The athlete should be instructed to stop if they show a sharp decline in technique </li></ul>
  13. 14. Methods of prevention <ul><li>Now we have an idea of the mechanisms of injury, we can target those areas to help prevent them </li></ul><ul><li>You don’t have to train individual muscles unless to address a specific imbalance or rehab program </li></ul><ul><li>By training the correct movement it makes prevention functional and also aids performance </li></ul><ul><li>Some of these movements will also cross over to future physical preparation </li></ul>
  14. 15. Get stronger! <ul><li>The stronger your athletes, the greater the ability to cope with and produce force, the faster they can ski. </li></ul><ul><li>Reduction in potential for injury, prevention is better than cure. </li></ul><ul><li>Focus on whole body strength, upper body is essential for the start and is often neglected. </li></ul><ul><li>First strength gains are neuromuscular, you get better at the movements. </li></ul>
  15. 16. Addressing ligament dominance: Jumping and landing <ul><li>Focus on technique </li></ul><ul><ul><li>Maintain correct knee alignment </li></ul></ul><ul><ul><li>Landing on forefoot rocking back to mid-foot </li></ul></ul><ul><ul><li>Keep the noise down </li></ul></ul><ul><ul><li>Brace core </li></ul></ul><ul><li>Progressions: </li></ul><ul><ul><li>Increase height </li></ul></ul><ul><ul><li>Change direction </li></ul></ul><ul><ul><li>Introduce rotation </li></ul></ul><ul><ul><li>Single leg </li></ul></ul>
  16. 17. Activating hip abductors <ul><li>To help maintain proper alignment at the knee </li></ul><ul><li>Exercises working against a lateral resistance during uni or bi-lateral exercises </li></ul><ul><ul><li>Band squats </li></ul></ul><ul><ul><li>Split squats </li></ul></ul><ul><ul><li>Step ups </li></ul></ul><ul><ul><li>Monster walks </li></ul></ul><ul><ul><li>Side lying leg raises </li></ul></ul>
  17. 18. Addressing quad dominance: Hamstrings <ul><li>Looking to load the Hamstrings eccentrically </li></ul><ul><li>Number of possible exercises to use </li></ul><ul><ul><li>Nordic hamstrings </li></ul></ul><ul><ul><li>Split stance Zerchers </li></ul></ul><ul><ul><li>Good mornings </li></ul></ul><ul><ul><li>Stiff leg deadlift </li></ul></ul><ul><ul><li>Stiff leg deadlift variations </li></ul></ul>
  18. 19. Addressing leg dominance <ul><li>Even out through correct bilateral technique </li></ul><ul><li>Use of single leg exercises </li></ul><ul><ul><li>Single leg squats </li></ul></ul><ul><ul><li>Split squats </li></ul></ul><ul><ul><li>Lunges </li></ul></ul><ul><li>Increase the load on the non-dominant leg </li></ul>
  19. 20. Core <ul><li>Important to use and train core musculature in the correct way </li></ul><ul><li>Hip tilt awareness </li></ul><ul><li>Use of the abdominal Brace </li></ul><ul><li>The big 4! </li></ul><ul><ul><li>Curl ups </li></ul></ul><ul><ul><li>Bird dogs </li></ul></ul><ul><ul><li>Glute bridges </li></ul></ul><ul><ul><li>Side bridges </li></ul></ul>
  20. 21. Athlete education <ul><li>Education plays an important role, create the all round athlete </li></ul><ul><li>Help the athlete to understand why they’re doing what they’re doing </li></ul><ul><li>Get the athletes to coach each other, will embed the technique </li></ul><ul><li>Will give greater adherence </li></ul><ul><li>Encourage self awareness, the athlete should be able to feel where they are going right and wrong </li></ul>
  21. 22. Recap <ul><li>You don’t have to devote particular time to it, your time with the athletes is valuable. </li></ul><ul><li>Don’t waste the warm up, it is a substantial percentage of training and contact time </li></ul><ul><li>Be creative </li></ul>
  22. 23. Any Questions?
  23. 24. Thank you for your time <ul><li>[email_address] </li></ul><ul><li> </li></ul>