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ACL Injury Prevention Programs

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ACL Injury Prevention Programs

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    1. ACL Injury Prevention Programs Al T. Douex, Jr., MS, ATC Medical Aspects of Sports Conference University of Delaware 02/25/06

    2. Anatomy Anterior Cruciate Ligament Originates at posteromedial corner of lateral femoral condyle Inserts at anterolateral aspect of tibial spine Functions: Prevents anterior translation of tibia on the femur Prevents hyperextension Secondary stabilizer to valgus and rotational stress

    3. Mechanisms of Injury Common MOI’s Slight knee flexion w/ tibial EROT/IROT at foot strike Excessive valgus, varus, hyperextension or rotation Guillotine Quads active Skiing Phantom Foot Knee Hyperextension in ski boot Valgus rotation Other Sports Sudden Deceleration Abrupt change of direction (fixed foot) Single leg landing

    4. Background

    5. Healthcare Implications In U.S., estimated 38,000 Female ACL injuries/year (athletics) ~200,000 ACL injuries/yr. ~75,000 total ACL Reconstructions/yr. Estimated cost of $17K each Increased risk for OA

    6. Intervention Programs Do Work!!!

    7. Hewett et al. (2005) “there appear to be 3 major etiological contributions to the gender disparity observed in ACL injury rates, namely, anatomical (in essence nonmodifiable by nature), hormonal (extent to which these can be modified remain unclear), and neuromuscular.” “Specifically, dynamic joint stabilization is achieved via a combination of active muscle force and passive ligament restraints.”

    8. Training Perspectives Prophylactic training Comprehensive neuromuscular training ID at-risk athletes Sport/Position Age/Developmental stage Potentially dangerous maneuvers Address specific deficits Weakness Technique Endurance Neuromuscular Imbalances

    9. Neuromuscular Imbalances 3 typical traits in females Ligament Dominance Athlete allows ligaments to absorb GRF Quadriceps Dominance Athlete preferentially increases knee extensor moments Leg Dominance Athlete demonstrates side-to-side differences in lower extremity measures

    10. Neuromuscular Components Strength Training Resistance Plyometrics Proprioception Sport Specific Dynamic Training Education

    11. Address Landing Phenomenon

    12. Strength Training Appropriate functional ratio between quadriceps and hamstrings Co-contraction, coordination & timing Knee dynamic stabilizers Strength to control load vs. GRF ? peak landing forces, valgus/varus torques Incorporate plyometrics

    13. Proprioceptive Training ACL plays a significant role in normal proprioception of the knee Uninjured females inherently more stable than males; injured/reconstructed females less stable and recover slower (SLS) Learn to control loads in coronal plane Develop dynamic balance

    14. Proprioception - Athletic Position

    15. Proprioceptive Training

    16. Sport-Specific Training Train Jump/Cut landings Control for Dynamic Valgus Land using a more bent-knee position Train deceleration Incorporate speed and agility drills ? muscle dominance, ? ligament dominance

    17. Wall Jumps

    18. Tuck Jumps

    19. Broad Jump – Single Leg Hop & Hold

    20. 180° Jump

    21. Squat Jumps

    22. X Hops - Bounding

    23. Jump, Jump, Jump, Vertical Jump

    24. Education Emphasize awareness of dangerous positions, MOI’s, etc. Vermont Ski Instructors Feedback/critical analysis of technique Partner training

    25. Continue to Emphasize Technique For jumps/cuts, 4 basic techniques should be stressed: Correct posture throughout jump Alignment and distribution No excessive side-to-side or A/P movement Soft landings Toe-Heel rocking, knees bent, etc. Instant recoil Preparation for next jump

    26. Take Home We need to train athletes in such a way that they develop feed-forward mechanisms designed to protect them when presented with a biomechanically dangerous and disadvantageous position Sell Performance Enhancement (not just Injury Prevention)

    27. Thank You - Questions For more information on specific protocols, refer to: Cincinnati Children’s Hospital, Sports Medicine Biodynamics Center and Human Performance Laboratory (Cincinnati, OH) Santa Monica Orthopaedic and Sports Medicine Research Foundation (Santa Monica, CA) adouex@udel.edu

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