Transcript ACL Prevention Program Mandy D’Amour Rebecca Dickinson Anne Louise McDonald Emily Preston John Purdy WHY? • Research shows there will be an estimated 100,000 ACL tears this.

ACL Prevention Program
Mandy D’Amour
Rebecca Dickinson
Anne Louise McDonald
Emily Preston
John Purdy
WHY?
• Research shows there will be an estimated
100,000 ACL tears this year
• Several research studies indicate that this
injury is more common in female athletes
• Several risks factors have been pinpointed
for the increase in frequency in female
athletes
Major Factor For ACL Tear
• Instantaneous loss of motor control while
in combination with landing with knees
and hips straight
• Good news is research is showing that a
dedicated program with the right
components can reduce this risk of injury
Literature Review
• Our focus group performed a thorough
literature review to find studies that looked
at ACL prevention
• We came up with 24 studies that we
decided to examine closer
• Of those, 10 were Level 1 or 2 studies
• We then further broke those 10 down
Research
• The evidence shows that neuromuscular training
including plyometrics, balance, and technique
training reduces the risk of serious knee injuries in
female athletes
• All current preventative programs are different but
center on alteration of neuromuscular risk factors
• Training may facilitate NM adaptations to
increase joint stabilization and muscular
preactivation and reactivation patterns which help
protect the ACL
Research
• Gilchrist, Mandelbaum, Silvers et al
studied 1435 Division 1 Female Soccer
players-Level 1 study
• Program used PEP (Prevent injury and
Enhance Performance) program 3x/wk
during fall season
• Results found ACL injury 1.7x less likely
in intervention group
Research cont.
• Pollard, Sigward, Powers, et al studied 26
female soccer players between ages 14-17
• Implemented the PEP program with soccer
practice
• Results- Players showed significantly less
hip internal rotation and significantly
greater hip abduction
• Thus, PEP has been shown to alter LE
kinematics
Research cont.
• Mandelbaum and Silvers et al. In 20001041 intervention group and 1905 in
control group. Results: 88% less ACL
injuries in intervention group
• 2001-844 in intervention group and 1913
in control Results: 74% less ACL injuries
in intervention group
Research cont.
• Hewett, Ford, and Myer looked at 6 of their
studies that included plyometrics, biomechanics
technique feedback, balance and core stability
training, and strength training
• Results showed training decreased injury in 3 of
the 6 studies and 5 of the 6 demonstrated positive
trends and reduction in odds ratios
• Results of the six studies:
• Balance training alone is not as effective as when
combined with other training
• plyometric training should be included
Hewett cont.
• Strongest studies incorporated
strengthening but it may not be a
prerequisite for prevention
• Training needs to be performed more than
1 time per week with a minimum duration
of 6 weeks
Research cont.
• Hewett’s team and Mandelbaum’s team each
came up with their own separate programs
• Hewett’s program was developed by the
Cincinnati Children’s Sports Medicine
Biodynamics Center and the Human Performance
Laboratory
• Mandelbaum’s program is labeled the PEP
program as discussed earlier
• Each program has exercises that pertain to all the
components needed in order to reduce risk of
ACL injuries
VOI ACL Prevention Program
•
Combination of the two programs that would accommadate for the
amount of time available at each practice session to perform the
exercises, to ensure every athlete could perform it with very little
equipment, and to simplify the exercises to allow for ease of
implementation
Components of Program
•
•
•
•
•
•
Warm up
Stretching
Agility drills
Practice
Strength exercises
Cool Down
Components cont.
• Components are listed in the order that
they should be performed
• Warm up and stretching are to be done at
the beginning of practice followed by the
agility drills
• Then, the athlete would be ready for a
normal practice session
• At the conclusion of practice, a brief
strengthening session followed by the cool
down
Warm Up
•
Warm up is designed to get ready for practice activity and to help prevent injury.
•
Set up two markers about 10-20 yards away from each other and have the players perform
the following 3 warm up activities about 2 minutes each:
•
Forward jogging- Have each participant jog forward from cone to cone. Hip, knee and ankle
should be in alignment and make sure the knees are not falling in toward each other and
that the feet are not moving out to the sides behind them.
•
Side shuffling- Have each participant shuffle sideways between the cones, make sure they
maintain hip and knee in bent position and don’t travel standing straight up.
•
Backward jogging- Have each participant jog backwards from cone to cone, again
maintaining hip, knee, and ankle alignment and not allowing knees to fall inward. They
should also stay on their toes and not jog flat footed.
Stretching
Calf Stretch
• Correct
• Incorrect
•
•
Instructions: Stand on your right leg,
bend forward and put your hands on the
ground in a V-form. Keep your right leg
straight and your right foot flat on the
ground. Bend your left leg and place
your left ankle across your right calf.
Hold this position for 30 seconds.
Switch legs and repeat on your left side.
Things to look for: bending the stance
leg, leaning forward in the pushup
position, arching the back, or raising up
on your toes.
Stretching
Quadriceps Stretch
Correct
Instructions: Stand tall with your weight
evenly distributed. Bend your left knee,
reach behind with your left hand and grab
the front of your left ankle. Bring your heel
up to your buttock and keep your left knee
pointed towards the ground. Keep your left
leg close to your right leg. Hold for 30
seconds and repeat on your right side.
Incorrect
Things to look for: bending
at the waist, or letting your
knee “wing” out to the side.
Stretching
Hamstring Stretch
Instructions: Sit on the ground with your left
leg extended out in front. Bend your right knee
and place the sole of your shoe on your left
inner thigh. Keep your back straight and try to
bring your chest to your left knee. Reach
towards your left toes and pull them towards
your head. Hold for 30 seconds and repeat
with the right leg.
Things to look for: rounding your back or
bouncing.
Inner Thigh Stretch
Instructions: Sit on the ground, and
spread your legs evenly apart. Keeping
your back straight, reach overhead with
both hands. Then, slowly reach towards
your right foot with both hands. Hold the
stretch for 30 seconds and then repeat
the stretch on the left side.
Things to look for: rounding your
back, leaning forward too fast or
bouncing
Stretching
Hip Flexor Stretch
Instructions: Lunge forward leading with your left leg and kneel on your right knee.
Rest your left arm on your left thigh, and lean forward with your hips. Keep your
balance, reach back for your right ankle and pull your heel to your buttocks. Hold the
stretch for 30 seconds and repeat the stretch leading with your right leg forward.
Things to look for: maintaining your balance and keeping your hips square with your
shoulders.
Agility Drills
Single Leg Touches
• Instructions: While standing on
one leg with ball on the ground in front
of you, slowly reach down with one
hand and touch the ball, then perform
using other hand. Repeat 10 times on
each side.
• Things to look for: Do not allow
balance knee to fall in towards mid line
of body- keep knee in a slightly bent
position
• Instruction: Stand on one leg and
balance while performing soccer kicks
with the other or dribbling basketball
while balancing. Perform 1-2 minutes
each leg.
• Things to look for: Do not allow
balance knee to fall in towards mid line
of body- keep knee in a slightly bent
position
Agility Drills
Single Leg Sport Specific
•
Instruction: Stand on one leg
and balance while performing
soccer kicks with the other or
dribbling basketball while
balancing. Perform 1-2 minutes
each leg.
•
Things to look for: Do not allow
balance knee to fall in towards mid
line of body- keep knee in a
slightly bent position
Things to look for: When landing make sure to land softly on balls of feet keeping knees slightly bent and pointing straight forward- No landing on heels with knee
Agility Drills
Squat Jump With Hold
Correct Landing
• Instruction: Stand on ground
with feet approximately shoulder
width-perform a quick squat and then
explode into a jump- hold the landing
for a 2 count Perform 20 times.
Incorrect landing
•
Things to look for: When landing
make sure to land softly on balls of
feet keeping knees slightly bent and
pointing straight forward- No
landing on heels with knees
straight!!
Agility Drills
Single Tuck Jump
• Instruction: Stand on ground
with feet approximately shoulder
width apart- jump into air while
bringing knees up toward chest and
hitting knees with hands- Be sure to
land softly on balls of feet with knees
slightly bent- try to bring thighs
parallel to ground. Perform 10 times.
•
Things to look for: Off balance
landings- should land on balls of
feet with knees slightly bent and
pointing forward
Agility Drills
Lateral Jumps
• Instruction: Stand with feet
slightly apart- Push off ground with
plant leg while moving in a sideways
direction landing on opposite foothold 2 seconds- repeat with other leg
Perform 10 times each leg.
•
Things to look for:
Explosion at take off with
plant leg making sure knee
does not fall in to midline of
body and on landing make
sure knee stays in a forward
direction with a slight bend
Strength Exercises
Front Plank
Instruction: Position yourself in a
“push-up” start position, with your
elbows on the floor in line with
shoulders. Tighten your stomach, lift
your hips off floor till your legs and
upper body are in line with shoulders
over elbows.
Things to look for: Make sure to
keep legs and torso straight. Make
sure back is not arched or curved
downward. Hold 20 seconds, Repeat 2
times.
Side Plank
Instruction: Lie on either side, legs
outstretched, lower elbow on floor in
line with shoulder. Tighten your
stomach muscles, lift your hips off
floor until your legs and upper body
are in line.
Things to look for: Make sure
shoulder is positioned over elbow on
the floor. Keep legs and torso straight
and place upper arm against side.
Hold 20 seconds, repeat 2 times each
side.
Strength Exercises
Assisted Russian Hamstring Curl
Instruction: Start on knees
with arms crossed resting on
chest and your partner holding
your feet. Keeping your body
straight, slowly lower self
towards floor and return to
upright position. Repeat 20
times.
Things to look for: Be
sure to tighten your
stomach while moving
forward and back. Make
sure not to arch back
when returning to start
position.
Strength Exercises
Single Leg Calf Raise
Correct
Instruction: Stand on
one foot and slowly raise
up on to toe and then
back down. Repeat 10
times each side.
Incorrect
Things to look for: Be
sure to move up and not
forward (as shown above
in picture 2).
Strength Exercises
Forward Lunge
Correct
Instruction: Take large
step forward and slowly
lower self towards ground
keeping your knee directly
over your toes. Repeat 10
times each side.
Incorrect
Things to look for: Make
sure to keep your knee
over your toes when
performing lunge.
Make sure to keep your
torso straight when
lowering self.
Conclusion
• It is our hope that adapting this routine at
practice will help reduce the incidence of
ACL injuries and allow for successful
participation all year for each athlete
• Next year-Video??