ACL Prevention: Programs

1
ACL Prevention Programs Results

• Mike Flynn, MS ATC LAT

2
Purpose

• To provide a simple, common sense approach to
  preventing ACL and lower extremity injuries.

3
Intended Result

• To identify the key elements to consider when
  developing a program. 
• To understand the components of a prevention
  program. 
• To demonstrate how to effectively implement these
  components into a program.

4
Injury Stats

• 100,000 to 462,000 ACL injuries in the US every
  year!
• 85 percent of ACL injuries, regardless of gender,
  are non-contact!
• Higher occurrence in females!
• ( up to 9 times more likely than males)

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When Injuries Happen

• Planting Cutting
• Landing
• Stops
• Pivoting
• Rapid Deceleration

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Prevention Stats

• Bert Mandelbaum, MD, Santa Monica Orthopedic and
  Sports Medicine Research Foundation - PEP
• Female high school soccer players
• 2000 season
• 1,041 in training group, 2 ACL injuries
• 1,902 in control group, 32 ACL injuries
• 2001 season
• 844 in training group, 4 ACL injuries
• 1,092 in control group, 35 ACL injuries

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Prevention Stats

• Giuliano Cerulli, MD, Santa Maria Hospital
  associated with the University of Perugia in
  Italy
• 900 high-level male soccer players over three
  seasons
• 600 in training group, 10 ACL injuries
• 300 in control group, 70 ACL injuries

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Prevention Stats

• Tim Hewett, PhD, Director of the Sports Medicine
  Research Institute and Human Performance
  Laboratory, Childrens Hospital Research
  Foundation in Cincinnati Sportsmetrics, WIPP
• Female athletes
• 366 in training group, 2 ACL injuries
• 463 in control group, 10 ACL injuries

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Prevention Stats

• Oslo Sports Trauma Research Centre, Santa Monica
  Orthopedic and Sports Medicine Research
  Foundation, and FIFA 11 (2008)
• 1055 in the training group, 121 lower ext.
  injuries
• 837 in the control group, 143 lower ext. injuries

10
Prevention Stats

• Swedish Football Association female
• soccer players from age 12-17 (2009)
• 2085 athletes in the control group
• 2479 athletes in the intervention group
• 64 reduction of ACL injury rate

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Prevention Stats

• Uppsala Primary Care, Uppsala County Council
  HarmoKnee (2010)
• 777 in training group
• 729 in control group
• 77 lower incidence of any knee injury
• 90 lower incidence of non-contact injury

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Prevention Stats

• Chicago Public Schools 90 Coaches (2011)
• 755 athletes in control group
• 737 athletes in intervention group
• 35 reduction in overuse lower extremity injuries
• 44 reduction in acute non-contact lower
  extremity injuries
• 34 reduction in non-contact ankle sprains
• All the athletes with non-contact lower extremity
  injuries resulting in surgery were in the
  control, all ACL injuries.

13
Prevention Stats

• FIFA - 11 Male Basketball Players 11-22 yrs
  (2012)
• 14 of 80 players in the FIFA 11 group were
  injured
• 17 of 40 players in the other group had injuries

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Prevention StatsMeta-analysis

• 8 Studies Analyzed
• At least 10 minutes of neuromuscular training,
  3 times/wk
• An ACL tear risk reduction of
• 52 in female athletes
• 85 in male athletes

15
Program Components

• Form Runs
• Dynamic Flexibility
• Core Strength
• Balance/Proprioception
• Agility
• Explosive Strength
• Sport-specific conditioning

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Form Runs

• Skips
• Carioca
• High Knee
• Butt Kicker
• Side Shuffle
• Serpentine Run
• Plant Cuts
• 180s 360s

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Dynamic Flexibility

• Knee Hugs
• Hurdle Walks
• Crawling Series
• Inch Worm
• Spiderman
• Lunge Series

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Balance/Proprioception

• Single Leg Balance
• Standing
• Side to Side
• Rotation
• Hop Sticks
• Double Leg
• Single Leg
• Multi-Directional

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Agility

• Foot Ladder
• Forward
• Backward
• Sideways
• Sprint it out to a stop!

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Explosive Strength

• Plyometrics
• Landing
• Jump Ups
• Double Leg Hops
• Single Leg Hops
• Bounds
• Alternate Leg Box Jumps

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Strength

• Core strength
• Basic Core
• Bridge Series
• Lunge Series

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Sport-Specific Conditioning

• Make it look like the game!!

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Putting It All Together!

• Form Runs
• Basic Core
• Balance/Proprioception
• Dynamic Flexibility
• Agility
• Explosive Strength
• Conditioning

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Retention

• Program Duration Study UNC (2012)
• 140 youth soccer athletes (11 to 17)
• All participated in either a 3 month or a 9 month
  program
• 84 (60) showed improved LESS scores
• 3 months following the completion of the programs
  only the extended duration group retained their
  improvements

25
References

• Umile Giuseppe Longo, MD, MSc Mattia Loppini,
  MD Alessandra Berton, MD Andrea Marinozzi, MD,
  PhD Nicola Maffulli, MD, MS, PhD, FRCS(Orth)
  Incense Denaro, MD. The FIFA 11 Program Is
  Effective in Preventing Injuries in Elite Male
  Basketball Players A Cluster Randomized
  Controlled Trial. Am J Sports Med May 2012 vol.
  40 no. 5 996-1005 .
• Padua DA, DiStefano LJ, Marshall SW, Beutler AI,
  de la Motte SJ, DiStefano MJ. Retention of
  movement pattern changes after a lower extremity
  injury prevention program is affected by program
  duration. Am J Sports Med. 2012 Feb40(2)300-6.
• Sadoghi P, von Keudell A, and Vavken P.
  Effectiveness of Anterior Cruciate Ligament
  Injury Prevention Training Programs. J Bone Joint
  Surg Am. 2012 941-8.

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References

• Cynthia R. LaBella, MD Michael R. Huxford, MEd,
  ATC Joe Grissom, MPP Kwang-Youn Kim, PhD Jie
  Peng, MS Katherine Kaufer Christoffel, MD, MPH.
  Effect of Neuromuscular Warm-up on Injuries
  Female Soccer and Basketball Athletes in Urban
  Public High Schools. Arch Pediatr Adolesc Med.
  2011165(11)1033-1040
• Martin Hagglund, PhD Markus Walden, MD, PhD
  Isam Atroshi, MD. Preventing knee injuries in
  adolescent female football players design of a
  cluster randomized controlled trial. BMC
  Musculoskeletal Disorders 2009, 1075.
• Kiani A, Hellquist E, Ahlqvist K, Gedeborg R,
  Michaelsson K, Byberg L. Prevention of
  Soccer-Related Knee Injuries in Teenage Girls.
  Arch Intern Med. 2010170(1)43-49

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References

• Albaugh J, Friedman J, Cody S, Ganley T. Joint
  Efforts. Training Conditioning, 20.3 April
  2010
• Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G,
  Romero D, Lazaro-Haro C, Cugat R. Prevention of
  non-contact anterior cruciate ligament injuries
  in soccer players. Knee Surg Sports Traumatol
  Arthrosc. 2009 Aug17(8)857-8
• Soligard T, Myklebust G, Steffen K, Holme I,
  Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R,
  Andersen T. Comprehensive warm-up programme to
  prevent injuries in young female footballers
  cluster randomized controlled trial. BMJ
  2008337a2469
• Vern Gambetta, Bettering the Odds, Training
  Conditioning, 13.5, July/August 2003
• Vern Gambetta, Leap of Strength, Coaching
  Management, 8.3, April 2000
• Guillermo Metz, Restoring the Balance, Training
  and Conditioning 9.3 April 1999

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Thank You!
Contact Information mike_at_reboundsportsperformance
.com 785.272.8025