Posts tagged injury risk
Reducing ACL Injury Risk With Physical Therapy Exercise Programs

ACL injuries are one of the most common sports medicine injuries encountered in a Physical Therapy practice. These injuries can be treated successfully with either conservative or surgical interventions depending on the athlete’s presentation and athletic goals. In addition to the post injury management of these athletes, researchers and clinicians have also focused on reducing an athlete’s risk for future ACL injury. Successful prevention programs for knee injury, including ACL tears, have been developed by numerous researchers and clinicians. Strong evidence supports their utilization in both pre season and in season athletes, especially among female athletes who are 6-8 times more likely to injure their ACL compared to a male in the same sport.

A recent clinical practice guideline, combining the available evidence and expert opinion, was released in the Journal of Orthopedic and Sports Physical Therapy documenting the impact of these risk reduction programs (Arundale et al. 2018). The practice guidelines highlighted the modifiable risk factors for future knee injury including abnormal muscle function and poor movement patterns in athletes. While bracing has continued to fall out of favor in preventing knee injury, Physical Therapy exercises have consistently been shown to effectively reduce injury risk.

Injury risk reduction programs are cost and clinically effective and can be easily implemented by Physical Therapists, coaches, parents, and athletes. Training should incorporate strength and agility training, plyometrics, and sport specific movements required during play. Ideally each program should be completed for 20 minutes, 3-4 times per week. These programs are appropriate for all youth athletes, athletes 12 to 25 years of age, and especially female athletes. Consistent with all exercise interventions, these programs require high degrees of compliance by coaches, clinicians, and athletes in order to reach optimal effectiveness.

Identifying Causes of Patellar Tendon Pain Among Jumping Athletes

Patellar tendinopathy (tendonitis) is a common sports medicine overuse injury most commonly found in jumping (volleyball, basketball) athletes.  This injury has been found in up to 40% of these athletes secondary to the repetitive forces applied to their tendons during their respective sports.  Repetitive loading, without adequate rest, is often found to be the cause of these symptoms, but abnormal loading patterns also play a role.  Changes in dynamic knee alignment due to strength, coordination, and mobility impairments can place the knee at an abnormal angle in preparation for these jumping or landing movements.  A recent research paper looked to identify impairments of flexibility and strength among jumping athletes.

Mendonca and colleagues studied the flexibility and strength of 192 professional basketball and volleyball athletes (JOSPT. 2018). The authors placed athletes in one of two groups based on the presence of patellar tendinopathy (n = 59). The key examination techniques which helped identify those with or without tendinopathy included ankle and leg alignment, hip mobility, and hip external rotation and abduction strength. The study highlights the importance of examining the hip and ankle joint in athletes with patellar tendinopathy. Consistent with the majority of knee diagnoses, hip weakness is one of the strongest correlates with knee pain.

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Reducing Non Contact ACL Injuries

Non contact ACL injuries remain one of the most common traumatic injuries encountered in sports medicine.  The most common mechanism of injury involves a sudden twisting motion at the knee with the foot planted.  Many factors are at play in this scenario including shoewear, field and court conditions, and the athletes ability to resist the forces at the knee joint.  Intervening at the level of the athlete remains one of the most successful interventions to reduce ACL injury risk.  Within these programs, Physical Therapists work to identify and improve impairments in the athlete including agility, balance, strength, and power.  Athletes who complete these programs have been shown to be 50% less likely to injury their ACL compared to their untrained peers.  

A recent review of the literature reveals these programs may offer our best chance to reduce ACL injury risk.  Authors reviewed all the available research on both modifiable and non modifiable risk factors for ACL injury (Pfeifer et al. International J of Sports Physical Therapy. 2018).  The results of this review indicate the main modifiable risk factor for ACL tears is core and hip weakness.  Athletes entering their season with weakness in these muscles are significantly more at risk than their stronger peers.  Thankfully, Physical Therapy prevention programs have been shown to successfully resolve these risk factors reducing the risk for future ACL injury.  

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Athletes With Hip Weakness Experience Twice As Many Ankle Sprains

Ankle sprains remain one of the most common musculoskeletal injuries treated by Physical Therapists.  Our previous blog posts have highlighted the importance of early diagnoses and treatment including manual therapy, as well as, strengthening and balance exercises.  This treatment approach has been proven superior to both R.I.C.E. (rest, ice, compression, and elevation) and usual medical care.  Many ankle sprains become recurrent without treatment secondary to the alterations in agility, balance, and muscle recruitment across the leg.  We often find weakness in both the hip and leg musculature in patients after ankle sprain, but a new study indicates this weakness may have been present before the sprain.

Powers and colleagues in the Journal of Athletic Training followed 210 competitive male soccer players after a preseason clinical examination (2017).  Athletes underwent multiple clinical tests, including a hip strength assessment prior to beginning their competitive season.  Authors report 12% of the soccer athletes sustained a lateral ankle sprain during the season.  Athletes categorized as high risk were unable to produce >34% of their body weight during the hip strength assessment.  These high risk athletes experienced twice as many ankle sprains as their stronger peers.   

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Repetitive Spinal Flexion Athletes Are Not At Higher Risk Of Low Back Pain

There is a current, albeit unproven, thought about the dangers of repetitive spinal flexion.   Those who repeat this unfounded belief feel repetitive forward bending places the spine in a less than optimal position leading to back pain or injury.  These thoughts have been disproven by the research and forward bending of the spine does not place undo harm on the spinal tissues.  In addition, these statements do not account for the majority of Americans and athletes who repeatedly enter into this range of motion without injury or pain.  

A study by Foss and colleagues examined the prevalence of low back pain symptoms among former endurance athletes (Am J Sp Med. 2012).  Athletes were grouped by the direction of loading required by their sport including flexion (cross country skiing), extension (rowing), and compared them to their age matched peers.  The authors found no difference between the athletes and the control group in regard to LBP recurrence over the previous 12 months.  Although the authors reported a training volume of >550 hours per year was determined as a risk factor for the onset of low back pain during the prior 12 months.   This article highlights the safety of repetitive movements in the spine.  

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Hip Weakness Shown To Be A Predictor For Future Ankle Sprains

Ankle sprains are one of the most common sports injuries we encounter in our Boulder Physical Therapy practice.  In our previous blogs we have written on the importance of early interventions such as manual therapy and proprioceptive exercise to help accelerate the recovery after these sprains.  Prior research has shown a higher recurrence rate in athletes who return to play without Physical Therapy, as well as, higher rates of hip weakness in athletes who have sustained an ankle sprain.  Recent research indicates hip weakness also increases the risk of future ankle injury in healthy athletes.

Powers and colleagues examined the leg strength of over 200 competitive soccer players prior to the start of their season (J Athletic Training. 2017).  Athletes were then followed over the season for any incidence of ankle injury.  Twelve percent of all the athletes sustained an ankle sprain with a higher rate of injury found among athletes with hip weakness.  This study highlights the injury risks associated with hip weakness.  Athletes are encouraged to participate in a strength training  program to both improve their performance and reduce their future injury risk.