If someone digs a well only when thirsty, or forges weapons only after becoming engaged in battle, one cannot help but ask: Aren’t these actions too late?
– Huang Di Neijing
“Hard work pays off.” Many athletes, active individuals included, live by this age-old adage. It is, in a sense, an internal and unspoken mantra that can motivate a person to spend countless hours in the gym or on the field, trying to improve their skills. Imagine for a second that this athlete is you. Early morning practices, long-winded workouts…all for the sake of “getting better.” Fast-forward to the start of your season. It’s finally game time, your time to shine. Everything is feeling effortless and your confidence is sky-high. You are sprinting down the court, taking the rock coast-to-coast. A defender steps in front of you, making you to change your line to the rim. As you make your move, it happens. You hear a “pop” and you fall to the ground, fearing the worst. Your physician informs you that you have torn your ACL and are out for the rest of the season.
(View this article from SB Nation for an example of a non-contact ACL injury – http://www.sbnation.com/nba/2014/12/16/7402177/jabari-parker-injury-knee-torn-acl)
The work you put in was paying off, but this injury (rather any injury) can keep you from showcasing your “hard work.”
This extreme injury scenario is understandably dramatic but can be useful in prompting certain questions regarding athletic performance and injury prevention.
- Are these types of injuries preventable?
- If so, what can be done to minimize the risk of these injuries?
These questions will be addressed throughout this blog.
The primary purpose of this blog post is to raise awareness regarding the connection between an athlete’s movement patterns and their risk for injury. By providing an essential checklist, the goal is to generate discussion and to provide a general solution. This is targeted for all active individuals that are invested in their athletic development and are gearing up for a long and healthy career. This checklist is also applicable to parents and coaches who want their young athletes to be set up for athletic success and longevity.
Below are three questions you should be asking yourself before you or your child engages in any athletic endeavors.
In the words of the movement systems pioneer and physical therapist Dr. Shirley Sahrmann, “Proper movement strategy can optimize performance and minimize tissue injury. Faulty strategy can compromise performance and lead to tissue injury.” Simply put, bad mechanics = higher risk for injury. Is this always the case? Some would say yes, others would say no. Which is correct? In the literature, there is evidence to suggest that diminished strength or poor biomechanics can lead to overuse injuries 2, 3, 5, 7,8, 12, 16 and foot/ankle injury 4, 9, 10, 13. Regarding the topic of ACL injuries, a study by Hewett and cohort concluded that a non-contact ACL injury is 2.5 times more likely to occur when the knee collapses inward during a jump-landing task6. These are just a few articles that link poor mechanics to injury. Every year, there are new studies being published for the sake of understanding this relationship. I would say yes, improper movement mechanics can lead to increased risk for injury and reduced athletic performance. (IPIM will be periodically providing current articles and discussions in our blog and resources sections).
– There are movement experts that can assess your risk for injury.
Our bodies, much like a car, should be operated with care and precision. It is strongly recommended that a car owner should maintain their tire pressure at or above 32 PSI and rotate their tires every 6000-8000 miles (for most sedans). Where would (or should) a driver learn about proper vehicle maintenance? The answers: the vehicle owner’s manual and/or a certified automobile service expert. Unfortunately for us, a human body owner’s manual does not exist. Fortunately, however, there is an ever-growing body of research dedicated to understanding human movement and its relationship to injury and athletic performance. More importantly, there are human movement experts that are highly trained in movement diagnostics and treatment strategies. Orthopedic and/or sports physical therapists, along with athletic trainers and sports medicine physicians, comprise a comprehensive team of experts that can assess your injury risk and provide the athlete with evidence-based information along with ways to reduce your chance of injury.
(Side note: Not all physical therapists are created equal. Some are better than others, much like in any other profession. Generally speaking, physical therapists who are board-certified clinical specialists in orthopedics and/or sports tend to have more experience and expertise.)
Physical therapists are evidence-based movement experts that are trained to diagnose and treat movement impairments. They can identify any movement-related issues that may be contributing to your pain or impaired performance.
It is common knowledge that to achieve the optimal gains in any program, whether it is for weight loss or kicking a bad habit, sticking to it will yield the expected results. This also holds true in the injury prevention field. A study performed by Mandelbaum and colleagues in 2005 suggested that undergoing a sport-specific injury prevention program can reduce an athlete’s risk for ACL injury by up to 88%11. Another study showed that children as young as 9 or 10 can effectively improve their balance ability and vertical jump by completing an injury prevention program. The program was brief, requiring only 10 to 15 minutes of time, 3 days per week for 9 weeks, and easily substituted as a team warm-up activity1. With the documented success of these programs, are they being implemented into high school athletics? A study performed by Marc F. Norcross and colleagues from Oregon State University suggests that 52% of the coaches are aware of the injury prevention programs (IPP) and 21% have implemented an IPP with their teams. For the coaches who did not adopt an IPP, these key reasons as to why they did not implement an IPP were found:
- Efficacious IPPs do not offer a relative advantage over coaches’ existing practices
- IPPs do not align with coaches’ needs (compatibility)
- IPPs are difficult to implement in their setting (complexity)
What then is the solution? The authors recommended that increasing awareness is not enough. They suggested that coach education should “directly address issues related to relative advantage, compatibility, and complexity.15”
Another study performed by Myklebust and company in 2003 found that compliance rates influenced the effectiveness of an ACL prevention program. For those who were 28-44% compliant with the program, the ACL injury rate was unchanged. With those who were highly compliant, the decrease in ACL injury risk was substantial14.
It is evident that high compliance to an injury prevention program can greatly reduce an athlete’s risk for non-contact injuries. However, proper education and practical solutions must be provided to the coaches and training staff for improved adherence.
What do the terms “proactive” and reactive” actually mean? According to the Merrian-Webster dictionary, the word proactive is defined as “controlling a situation by making things happen or by preparing for possible future problems.” Reactive, on the other hand, is “doing something in response to a problem or situation.” Although this may be obvious, I want to bring in again the analogy of a car to highlight my point. You are driving along the freeway and all of the sudden the “check tire pressure” light flashes on. At your next destination, you take a survey of your car and find out that your front left tire is a little flat. You think to yourself, “Should I fill up the tire now or later?” Here is your dilemma: Are you going to: stop by at the next gas station and fill up the tire? Or, continue on driving around on a partially flat tire? The experts at TireRack.com weigh in. “Correct tire inflation pressure allows drivers to experience tire comfort, durability and performance designed to match the needs of their vehicles. It also helps to optimize tire performance and fuel economy. On the other hand, if a vehicle’s tires are underinflated by only 6 psi it could lead to tire failure. Additionally, the tire’s tread life could be reduced by as much as 25%.”
Will you be the proactive type and fill up your tire now? Or will you be the reactive type and wait until something happens (while compromising the health of your tires at the same time)?
Being proactive can take on many different forms. At the highest professional level, NBA players are being monitored for soreness, fatigue, quality of sleep and other factors that relate to recovery and performance. Beyond that, players are also now being monitored via wearable technology in practice and are having their movement patterns tracked in games. Any sign of decreased performance coupled with reports of fatigue can assist the coaching staff in determining whether that player needs to be rested or not (http://www.cbssports.com/nba/writer/ken-berger/25203846/warriors-wearable-weapon-devices-to-monitor-players-while-on-the-court). Director of Athletic Performance for the Golden State Warriors Keke Lyles agrees that most overuse injuries are fatigue-related. By using the latest technology, NBA teams are able to predict a player’s risk for injury and make the proper adjustments before any overuse injury can occur.
To a smaller degree, an athlete’s risk for injury can be assessed with use of questionnaires and functional movement assessments performed by a trained healthcare professional (insert link). All a person would need to do is take the initiative and be proactive about it.
Once you are informed, consistent, and adopt the proactive lifestyle, your risk for injury can be reduced dramatically (backed by research and science). With movement precision and awareness, your hard work will pay off and keep you in the game for the long haul.
- DiStefano, LJ, Padua, DA, Blackburn, JT, Garrett, WE, Guskiewicz, KM, and Marshall, SW. Integrated injury prevention program improves balance and vertical jump height in children. J Strength Cond Res 24(2): 332–342, 2010
- Dolak KL, Silkman C, Medina McKeon J, Hosey RG, Lattermann C, Uhl TL. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther. 2011 Aug;41(8):560-70. doi: 10.2519/jospt.2011.3499. Epub 2011 Jun 7.
- Earl JE, Hoch AZ. A proximal strengthening program improves pain, function, and biomechanics in women with patellofemoral pain syndrome. Am J Sports Med. 2011 Jan;39(1):154-63. doi: 10.1177/0363546510379967. Epub 2010 Oct 7.
- Friel K, McLean N, Myers C, Caceres M. Ipsilateral Hip Abductor Weakness After Inversion Ankle Sprain. J Athl Train. 2006; 41(1): 74–78.
- Hawkins D, Metheny J. Overuse injuries in youth sports: biomechanical considerations. Med Sci Sports Exerc. 2001;33:1701–1710.
- Hewett TE1, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, van den Bogert AJ, Paterno MV, Succop P. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005 Apr;33(4):492-501. Epub 2005 Feb 8.
- Khayambashi K, Mohammadkhani Z, Ghaznavi K, Lyle MA, Powers CM. The effects of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2012 Jan;42(1):22-9. doi: 10.2519/jospt.2012.3704. Epub 2011 Oct 25
- Khayambashi K, Fallah A, Movahedi A, Bagwell J, Powers C. Posterolateral hip muscle strengthening versus quadriceps strengthening for patellofemoral pain: a comparative control trial. Arch Phys Med Rehabil. 2014 May;95(5):900-7. doi: 10.1016/j.apmr.2013.12.022. Epub 2014 Jan 16.
- Kulig K, Popovich J, Noceti-Dewit L, Reischl S, Kim D. Women With Posterior Tibial Tendon Dysfunction Have Diminished Ankle and Hip Muscle Performance. J Orthop Sports Phys Ther 2011;41(9):687–694. doi:10.2519/jospt.2011.3427
- Leetun DT, Ireland ML, Willson JD, Ballantyne BT, Davis IM. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc. 2004 Jun;36(6):926-34.
- Mandelbaum BR et al. Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing the Incidence of Anterior Cruciate Ligament Injuries in Female Athletes. The American Journal of Sports Medicine, 2005; Vol. 33, No. 7
- Mascal CL, Landel R, Powers C. Management of patellofemoral pain targeting hip, pelvis, and trunk muscle function: 2 case reports. J Orthop Sports Phys Ther. 2003 Nov;33(11):647-60
- McHugh MP, Tyler TF, Tetro DT, Mullaney MJ, Nicholas SJ. Risk factors for noncontact ankle sprains in high school athletes: the role of hip strength and balance ability. Am J Sports Med. 2006;34:464-470.
- Myklebust G1, Engebretsen L, Braekken IH, Skjølberg A, Olsen OE, Bahr R. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med. 2003 Mar;13(2):71-8.
- Norcross MF1, Johnson ST2, Bovbjerg VE2, Koester MC3, Hoffman MA2. Factors influencing high school coaches’ adoption of injury prevention programs. J Sci Med Sport. 2015 Apr 1. pii: S1440-2440(15)00081-X. doi: 10.1016/j.jsams.2015.03.009. [Epub ahead of print]
- Stull JD, Philippon MJ, LaPrade RF. “At-risk” positioning and hip biomechanics of the Peewee ice hockey sprint start. Am J Sports Med. 2011;39(suppl):29S–35S.