Three Essentials To Any ACL Reduction Program

From StrengthCoach.com

Movement as Medicine

I had a reader email me the question "What are the top three things that should be in every program to prevent knee injuries?"

While I think this is an incomplete question I want to try to respond with something satisfactory. Injuries mechanisms are multifactorial and complicated so trying to pin down only three things to prevent the occurrence of something like an ACL tear or ankle sprain is impossible. Additionally, we can't actually "prevent" anything but I am confident that you can significantly reduce occurrences with intelligent training.

So here would be my "Top 3"

1). Multidirectional Agility & Movement Drills
The reason many people end up with knee injuries is due to their inability to effectively plant, decelerate and change direction. Progressively challenging the athlete in multiple planes first with rehearsed and scripted drills and eventually with reactive and competitive drills can establish the movement skills necessary to change directions successfully on the field.

2). Stability Focused Plyometric Drills
Many performance programs include plyometrics but far too many place a huge emphasis on force production and very little focus on deceleration. Rehabilitation and reduction strategies should focus on educating the athlete to land properly and accept force from the ground before explosively producing force.

3). Progressively Challenging Strength Training (Primarily Unilateral Lower Body)

None of the aforementioned training techniques will be effective if the athlete enters them with too little strength. Strength training is the foundation for any reactive and dynamic drills that come later on down the line. Progressively moving from isometric to eccentric and finally traditional concentric strength work is a technique I use in rehab that works well in a regular training environment as well. The fundamental strength to decelerate and stabilize the joint should be a primary objective in any training program. Additionally, performance programs should focus primarily on unilateral lower body strength exercise to promote multi-planar stabilization of the hip, knee and ankle.

A couple "runner ups" that I can't leave unmentioned would be....

4). Sagittal Plane Core Stability. Often I find athletes who can't control the relationship between their ribs and pelvis will suffer injuries distally due to lack of control proximally. Teaching an athlete to create stiffness from the center out can go a long way to preventing injuries. 

5). Energy System/Mode Specific Conditioning. Conditioning the athlete via their specific energy systems in modes similar to their sport will ready them to resist fatigue and faulty mechanics at the joint during sustained competition.

Risks From Concussion Injury In Sports Underestimated

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(MSNBC News Services,  Two or more significant blows to the head while playing sports can harm teen-agers,thinking abilities for years to come, according to studies that suggest such injuries are more common and more serious than some coaches and parents might think.

THREE SEPARATE sports injury studies highlighting the risks from concussions were published in Wednesday's issue of the Journal of the American Medical Association. This is a major public health issue that has been given short shrift, said Michael W. Collins, a neuropsychologist at Henry Ford Health System in Detroit and a leader of one of the studies. And this is information parents should know.

A concussion is any alteration in mental function after a blow to the head, said Collins. Signs or symptoms may be subtle, a headache, dizziness, difficulty with balance or memory, confusion or a personality change.

HIGH SCHOOL ATHLETES

One of the studies, conducted by researchers at Med Sports Systems in Iowa City, Iowa, did not explore the effects of concussions but only how often they occurred in football, wrestling, soccer, basketball, softball, baseball, field hockey and volleyball at 235 high schools nationwide from 1995-96 through 1997-98.

There were 1,219 concussions, 63 percent of them in football, and 99 students suffered two or more, said researchers led by John W. Powell, a professor of kinesiology and an athletic trainer at Michigan State University. The researchers estimated that more than 62,800 concussions occur among high school students nationwide annually in the sports they studied. Researchers also reported that sideline tests for concussion may miss many cases of mild brain injury in high school and college athletes, with possible long-term effects on their mental functioning.

While many athletic trainers spot and appropriately manage head injuries on the field, according to Collins, some schools, particularly in rural areas, may rely on the judgment of coaches who are unaware of the more subtle signs of concussion, such as headache, dizziness or confusion. Many people believe concussion means the loss of consciousness, he said. So when athletes aren't knocked out, they're put back in the game.

FOOTBALL PLAYERS

Collins led a study of 393 college football players from four universities that looked at the risk factors for poor recovery from a mild brain injury. His team found that about one in three had suffered a concussion at some time in the past and one in five had suffered two or more.

Those who had suffered two or more were significantly more likely to report continuing problems with headaches, sleep and concentration, and they scored significantly worse on paper-and-pencil tests of the ability to learn words, to think quickly and to handle complex tasks.

Further, players who had learning disorders, 13.5 percent of the sample, fared even worse if they had two or more concussions, suggesting that the disorders make the brain especially vulnerable to jarring injuries. About 12 percent of all collegians have learning disorders, research has shown. "If they have a learning disability, if they have one concussion, you should be a lot more cautious in returning them to game conditions and practices after their first concussion, said an expert not involved in the studies, Jeffrey T. Barth, chief of medical psychology and neuropsychology at the University of Virginia.

He said the research on the prevalence of concussions among high school students confirms previous work but is by far the largest study, and it highlights a problem that, has been kind of ignored over the years. Most emphasis on managing concussion has been at college and pro levels, he said.

Animal research suggests that the youthful brain remains vulnerable after a first concussion for a longer time than a mature brain does, so a high school athlete may need a much longer recovery time from a concussion before returning to play than a college player or a pro, Barth said.

REPEATED BLOWS IN SOCCER

A third article in the journal reported that amateur soccer players scored lower on tests of memory and planning than other amateur athletes did, and that repeated blows to the head may be the culprit. Dutch researchers at the St. Anna Hospital in Geldrop compared the results of brain functioning tests of 33 amateur soccer players with those from 27 middle-distance runners and swimmers. Thirty-nine percent of the soccer players showed impaired performance on tests that measured planning abilities compared to 13 percent in the other group of athletes. On memory tests, 27 percent of the soccer players showed impairment compared to 7 percent of the swimmers and runners. Of the soccer players studied 27 percent had suffered one concussion during their playing career and 23 percent reported a history of two to five concussions. The median number of balls, headed, in a match was 8.5 among those studied.

While some research has implicated, heading, the ball, Barth and other experts believe the more likely explanation is the frequent collisions between players and players, heads hitting the ground or a goalpost.

According to a study published earlier this year in the same journal, Americans suffer about one million traumatic brain injuries each year, resulting in more than 50,000 deaths and about 80,000 long-term disabilities. About 30 percent of these are sports-related.

The Associated Press, Reuters and the Medical Tribune News Service contributed to this report.