Can anterior cruciate ligament injuries be mitigated?
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Can anterior cruciate ligament injuries be mitigated? Ella Ward
description
Overall, despite much scientific research, the incidence and prevalence of ACL injuries still remains high. I do not believe ACL injuries can be completely mitigated as they are so multi-factorial and involve both contact and non-contact situations. And although preventative programs have been found to reduce the incidence of ACL injuries by up to 90% in some cases, I still believe a lot more research needs to be conducted in regards to how much training stimulus is required to produce a protective effect. I understand that many coaches may be sceptical in regards to employing a preventative program, but the research indicates even something as simple as plyometric training can help train neuromuscular control and improve lower leg strength. Overall, I believe something is better than nothing, and if more often than not intervention programs are producing positive outcomes, the coaches really have nothing to lose. The key is to achieve widespread awareness and widespread use; so spread this presentation and message so we can achieve this and help reduce the debilitating consequences this injury has on so many young athletes.
Transcript of Can anterior cruciate ligament injuries be mitigated?
Can anterior cruciate ligament injuries be mitigated?
Ella Ward
Overview of presentation
• Background
• Importance of study
• Role of the coach
– Knee valgus
– Jump landing technique
– Strength
– Plyometrics
• Practical applications and further research
• Summary
Learning objectives
1. Be aware of the coaches role in reducing the incidence of ACL injuries.
2. Describe what factors contribute to an increased risk of injury.
3. Identify different components that can be incorporated into a preventative program.
“ACL injury incidence has been generally steady over the past few seasons”
(Brent et al 2012; Orchard, Orchard & Seward 2013)
In Australia from 2003-2008, there were 50,187 ACL reconstructions, resulting in
75 million dollars being spent on reconstructive surgery annually.
(Driscoll et al 2011)
After an ACL injury, you are
10 times more likely to develop
early-onset of knee osteoarthritis.
(Chu & Friel 2013)
The effects of current training programs on ACL
injury rate, however, are inconsistent. This review
was focused on the effects of current ACL injury
training programs on neuromuscular risk factors
and ACL injury rate.
(Driscoll et al 2011; Dai et al 2012; Garrett et al 2005; Mandelbaum & Silvers 2011), image sourced from ClipArt
Results: During the 2000 season, there was an 88%
decrease in anterior cruciate ligament injury in the
enrolled subjects compared to the control group. In year
2 , during the 2001 season, there was a 74% reduction
in anterior cruciate ligament tears in the intervention
group compared to the age- and skill-matched controls.
Role of the coach
Anatomical
Environmental
Hormonal
Neuromuscular
(Myers & Hawkins 2010; Mandelbaum & Silvers 2011), images sourced from Clip Art
Female athletes are up to 8 times more likely to sustain an ACL injury than male
athletes.
(Elliot, Goldberg & Kuehl 2010)
Undiagnosed ACL injuries
Diagnosed ACL injuries
50,187 ACL reconstructions
Diagram modified from: (Driscoll et al 2011)
(Driscoll et al 2011), image sourced from: http://flic.kr/p/b6Su8k
(McLean, Lipfert & van den Bogert 2004)
Knee valgus
LOW risk HIGH risk
(Celebrini et al 2009), image sourced from Clip Art
“While our approach to screening might be viewed as over simplistic, its
straightforwardness is aimed at optimising screening compliance
among clinicians and coaches.”
(Celebrini et al 2009)
Landing technique
ModifiedBaseline
(Myers & Hawkins 2010), image sourced from Clip Art
(Tsang & Dipasquale 2011)
Practical applications
• Awareness of risk-factors
• Implement in high-risk sports and
populations
• Observational screening
• Multi-component programs
Further research
• Can we modify other risk factors?
• How much training stimulus is required?
• What are the implications of detraining?
(Aldous et al 2005; Orchard, Orchard & Seward 2013)
Discussion
• FIFA 11+
• Prevent injury and Enhance Performance (PEP)
• HarmoKnee
• SportsMetrics
Image sourced from Clip Art
Hamstring strains?
Ankle sprains?Concussions?
Overuse injuries?
Conclusion
1. Coaches play a pivotal role in reducing the incidence of ACL injuries.
2. Neuromuscular factors can be targeted to decrease risk of ACL injuries.
3. Programs should incorporate multi-components.
Can anterior cruciate ligament injuries be mitigated?
References• Aldous D, Bennell K, Chivers I, Orchard JW & Seward H. (2005). Rye grass is associated with fewer non-
contact anterior cruciate ligament injuries than bermuda grass. British Journal of Sports Medicine, 39, 704-709.
• Brent JL, Ford KR, Hewett TE & Myer GD (2012). An integrated approach to change the outcome part I: neuromuscular screening methods to identify high ACL injury risk athletes. Journal of Strength and Conditioning Research, 26(8), 2265–2271.
• Celebrini RG, Ekegren CL, Eng JJ, Macintyre DL & Miller WC. (2009). Reliability and validity of observational risk screening in evaluating dynamic knee valgus. Journal of Orthopeadic Sports Physical Therapy, 39(9), 665-674.
• Chu CR & Friel NA. (2013). The role of ACL injury in the development of post-traumatic knee osteoarthritis. Journal of Clinical Sports Medicine, 32, 1-12.
• Driscoll T, Janssen K, Orchard J, & van Mechelen W. (2011). High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003–2004 to 2007–2008. Scandinavian Journal of Medicine & Science in Sports.
• Mandelbaum BR & Silvers HJ. (2011). ACL Injury Prevention in the Athlete. Sports Orthopaedics and Traumatology, 27(1), 18-26.
• McLean SG, Lipfert SQ, & Bogert VJ. (2004). Effect of gender and defensive opponent on the biomechanics of sidestep cutting. Med Sci Sports Exerc, 36(6), 1008-1016.
• Orchard J, Orchard J & Seward H. (2013). 21st annual AFL injury report: 2012.
• Tsang KK, & Dipasquale AA. (2011). Improving the H:Q ratio in women using plyometric exercises. Journal of Strength and Conditioning Research, 25(10), 2740–2745.
Images
• Sourced from Clip Art
• Skier sourced from Flickr Creative Commons: http://flic.kr/p/b6Su8k
• Pictures of knee valgus and landing technique were photographed by Ella Ward
