Posts tagged injury prevention
Reducing Your Risk Of Alpine Skiing Injuries
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Alpine skiing remains one of the most popular outdoor winter sports in Colorado. It is estimated over 6.8 million skiers participated in the sport over the 2016/2017 winter season. There are inherent risks of death and injury in both skiing and snowboarding, but thankfully due to technological updates and innovations overall injuries have fallen by half over the last 30-40 years. Although injuries on the whole have decreased some traumatic cases, such as ACL tears, remain common today. A recent article summarized the available evidence on the most common ACL tears, as well as, offered an update on injury prevention strategies in alpine or downhill skiing.

Davey and colleagues published the review article recently in the journal Sports Health (2018). Authors reviewed the available evidence on ski injury prevalence including injury location, known risk factors, and ski injury prevention. Data was available from a total of 64,667 ski injuries over a 25 year period. They reported the average age of skiers injured was 30 years old with a range of 24 to 35 years. Those found at highest risk included both the young, adolescents and children, as well as, older adults (>55 years). While males were more likely to experience lower extremity fracture, consistent with other sports females are more prone to ACL tears.

As expected, the lower extremity remains the most commonly injured area of the body accounting for up to 77% of all injuries. Further, 14% of injuries involve the thumb and shoulder and 13% involve the head and neck. The knee ligaments (ACL and MCL) remain the most common injury followed by thumb and head and facial injuries. Trend data showed a drop in tibial fracture, but an increase in ACL tears. Most common mechanisms included deep knee flexion with rotation or knee hyper extension and forward movement of the thigh over the stationary leg in the boot. In addition, despite advances in helmet use and technology, the number of traumatic skiing fatalities remained constant.

Ski technological advances, including helmets, bindings, and ski poles, deserve the most credit for the 50% reduction of ski injuries. Helmet use has increased to 80% of all skiers and has been a significant advancement in the safety of participants and reduction of head and face injuries. As expected, helmets have consistently been shown to reduce both the prevalence and severity of head injuries without a subsequent increase in “risky skiing”. The risk of death with head injury has stayed relatively constant either because the forces of impact exceed the protective capacity of the helmet or the skier sustained other bodily injury causing death despite sparing their head and face.

Ski boot binding systems have contributed to the large decrease in leg fractures and contusions due to improved release mechanisms. In addition, skiers who routinely have their bindings checked by certified ski shops sustain fewer injuries than those who ski without inspected bindings. These bindings are designed to prevent fracture and leg injuries, not knee ligaments, and bindings often do not release with common ACL injury mechanisms in skiing.

Established programs such as “lids on kids” and “heads up” remain effective at improving the awareness and utilization of helmets. ACL prevention programs (Vermont Ski Safety Equipment) have focused on educating skiers to avoid situations most associated with knee sprain, as well as, instructions in how to fall with decreased risk to your knee. These programs have been shown to reduce a skier’s risk of knee injury by 60%. Interestingly, ski lessons have not been shown to reduce the risk of knee injury among skiers. In our practice, strength also remains a key component of injury prevention programs. Skiers are recommended to work with a local Physical Therapist to design an effective ski injury prevention exercise program.

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Pre Season Y Balance Scores Did Not Accurately Predict Future Injury
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Pre-participation movement screens have gained popularity among sports teams and health professionals over the past decade. Their aim is to determine the likelihood of an individual sustaining a future injury by testing them through a battery of movements. Clinicians may utilize a composite of individual tests to identify risk for a specific injury (ex. ACL tear) or use a commercially available stand alone test designed to screen for all injuries (ex. FMS or Y Balance). One of the determining factors in these stand alone tests is examining symmetry of movement patterns, comparing one side of the body to the other or to an established “norm” of movement. These tests have been under scrutiny as recent research has challenged the validity of these tests suggesting these tests may not be able to accurately identify individuals at risk for future injury.

The Y- Balance Test is a common pre-participation movement screen determining lower extremity injury. Individuals are asked to move their leg in 3 planes while in single leg stance on the opposite leg. Previous research has shown a difference in reach distance from side to side may indicate a risk of future injury. A recent article out of the Sports Journal looked at a homogeneous group of 169 male collegiate basketball players over 2 seasons (Brumitt et al. 2019). During the study, all athletes were given a pre season Y balance test and then followed through the seasons. The authors found no association between preseason Y-Balance scores and future time-loss from their sport or lower quadrant non contact injury during the upcoming seasons. These results add to the growing evidence questioning the validity of these stand alone movement screens. Injury prevention for specific injuries such as ACL tears and composite testing of individual tests may provide better risk reduction test batteries.

Best Injury Reduction Rates Found Among Most Compliant Participants
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Risk reduction programs in sports have been shown effectively reduce sports injury.  In particular, the research on knee injuries, including ACL, in soccer have shown dramatic reductions in injury rates.  These programs, often designed and implemented by Physical Therapists, include exercises designed to improve an athlete's strength, balance, coordination, and agility.  Research shows these programs can reduce an athlete's risk of future injury by 30-80%.  

A new study examined the impact of a commonly utilized program, 11+, on injury rates in collegiate male soccer players (Silvers-Granelli et al. Knee Surgery, Sports Traumatology, Arthroscopy. 2018).  27 teams, including 675 players, participated in the study.  The authors measured compliance rates with the program, as well as, injury rates among these participants.  Compliance rates were categorized as low (1-19 doses/season), moderate (20-39 doses/season), and high (> 40 doses/season).  As expected, compliance rates were negatively related to injury rates and days missed from practice or games.  Participants with the highest compliance rates showed a significant reduction in injury or lost time.  

Contact the experts at MEND to learn how you can reduce your injury risk

Injury Prevention Program Reduces ACL Risk by 38% in Female Basketball Players
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In our previous posts on ACL injury we have highlighted girls are 6-8 more likely to sustain an ACL injury compared to boys in the same sport.  Multiple research studies have attempted to reduce this risk by implementing sport specific strength, agility, and balance programs.  On average, these programs have a significant impact on injury rates with ACL injury by 1/3 to 1/2.  A recent long term study was conducted over a 12 year period studying the impact of a hip focused prevention program on girls basketball players.   

Omi and colleagues conducted a prospective intervention study on 309 college female basketball players (Am J Sp Med. 2018) over a 12 year period.  The girls were tracked and observed over the first 4 years of the study and sustained 16 ACL injuries (13 non contact).  Next the authors implemented an 8 year intervention program consisting of strengthening, balance, and agility exercises.  The authors reported ACL injuries were 1/3 as frequent during the intervention program compared to the observation period.  Dropping the risk of ACL injury by 38%.  Amazingly, the exercise compliance rate was 89% during the trial demonstrating the impact of focused, consistently performed exercises in this population.

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Hamstring Training for Sprinters
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Sprinting either in track or sport requires rapid, high force muscle contractions across the lower body.  If the forces utilized during the acceleration phase of running are greater than the capacity of the muscle to absorb these forces injuries can occur.  Hamstring strains in this population of runners are common due to the rapid shortening and lengthening of the contracting muscles.  We have previously written on our Physical Therapy blog on the diagnosis and treatment of these injuries, but off season and in season strengthening remains the standard of care.  Specifically, nordic hamstring curls are often prescribed for sprinting athletes but a recent research article highlights other exercises which be used for hamstring strengthening among sprinters.

photo credit: International Journal of Sports Physical Therapy

photo credit: International Journal of Sports Physical Therapy

In the International Journal of Sports Physical Therapy authors studied healthy male participants as they sprinted and performed a variety of hamstring strengthening exercises (van den Tillaar et al. 2017).  The authors measured hamstring muscle recruitment and lower body biomechanics during each of these tasks to determine which Physical Therapy exercises best represent the muscular and biomechanical demands of sprinting.  The authors report the nordic hamstring curl, as well as, the laying kick activate the hamstring muscles at a high enough level and similar joint angle to benefit sprinters' strength training programs. 

To learn more on which exercises are best for your activity contact your local Physical Therapist. 

Strength Training to Reduce Injury Risk in Climbers
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It is estimated up to 10 million Americans participate in either indoor or outdoor climbing activities.  Research documents 4 to 5 injuries per 1000 hours of climbing participation and each climber can expect 1 to 2 injuries over a climbing career (Backe et al. 2009).  These injuries can be either traumatic or overuse in nature. The available evidence reports several risk factors for the development of a climbing associated injury.  Researchers noted age, greater years of climbing experience, frequency, intensity and participation in lead climbing were independent risk factors for the development of injury (Woollings et al. 2015).  In addition, climbers were 6 times more likely to be injured if they had sustained a prior climbing injury (Woolings et al. 2014). The evidence is inconclusive on modifiable risk factors including a climber's BMI and utilization of flexibility or weight training.  Close to half of injured climbers return to climbing before they are healed with 1 in 2 climbers reporting chronic symptoms (McDonald et al. 2017).  These chronic symptoms explain in part the why one quarter of injured climbers cannot return to pre injury levels.  Thus, risk reduction through strength training is the key to reducing climbing injuries. 

 Strength Training Exercises

Prone Y with Dowel Rod

Lay over ball with hands(thumbs up) holding light wand or dowel.  Keep your chin tucked as you simultaneously extend your spine and lift your arms toward the ceiling.  Keep your shoulder blades down and back without shrugging.

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Standing TRX Pull – Press

Standing in front of secured TRX strap draw your body up while performing a rowing motion.  From this position rotate your shoulders to 90 degrees and then press your arms toward the ceiling.  Slowly lower your arms back to start and repeat.

DB Push Up to Single Arm Row

Assume a push up position with hands on two dumbells.  Drop into a push up keeping your spine straight and shoulder blades down and back.   Press back up to start then perform a single arm dumbbell row allowing your body to rotate to the same side.  Return to start.

TRX Lunge and Row

Stand facing secured TRX.  Stand on one leg and hold TRX straps in opposite hand.  Lower into reverse lunge using opposite hand for support.  Return to start using leg and arm. 

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½ Kneeling Bottoms Up Kettelbell Press

Start in half kneeling holding kettelbell in opposite hand.  Press kettelbell toward the ceiling then lower to start.

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