Posted by Stephen Messineo on Sun, Nov 29, 2009 @ 08:00 AM
One of our primary concerns when treating any of our patients who are athletes is further injury prevention.
More specifically, what we do within our treatment plans to help
our athletic patients decrease their risk for other common yet traumatic injuries. One
such common injury is an anterior cruciate ligament (ACL) tear at the
knee. The ACL prevents anterior translation of the tibia in respect
to the femur during walking, recreational, and sport related
activities. These types of tears occur as a result of both contact and
non-contact movements where the increase in force of the movement is
too much for the ligament to hold. The movement event places increased
stress on the knee joint, typically with forces in both rotational and
horizontal planes in respect to the knee, which causes the ACL to tear.
Research
has shown that athletic women suffer this type of injury on average of
3 times more than men competing in the same sports. It has been
suggested that women are more susceptible to ACL tears due to the
differences in hip and knee alignment they go through during
adolescence. As a result, they are more susceptible to the rotational
and horizontal forces mentioned above during sports participation,
especially during cutting movements, quick direction changes or when
landing from a jump.
One recent study by Imwalle et al., published in the Journal of Strength and Conditioning Research looked at the possible link between cutting movements and non-contact ACL injuries using a subject sample of high school women soccer players.
The study compared rotational forces placed on the hip and knee during
45 degree and 90 degree cutting movements. The researchers found that
hip and knee internal rotation were increased more during the 90 degree
cut versus the 45 degree cut. As a result, the subjects’ knee
abduction increased during a 90 degree cut, putting the subject at
greater risk for an ACL injury. The researchers concluded that
targeted neuromuscular strength training to the trunk and hips may
improve the athletes’ ability to control knee and hip internal rotation
during cut movements, and therefore decrease their risk for ACL injury.
Our patient strength and conditioning plans fall in line with this research. Our
programs focus on core strength with target areas that include the low
back, gluteus maximus, gluteus medius, and abdominals. Targeting these
muscle groups improves the participants’ ability to control hip and
knee internal rotation during cutting movements. Furthermore, our therapists look at our patient/athletes’ form during agility and plyometric
activities that put greater stress on the knees, then correct that form
via verbal cues and other training techniques. The take home point is
an increase in strength and conditioning to target muscle groups helps
our athletic patients avoid common non-contact injuries after they are discharged from physical therapy.
Reference:
Relationship Between Hip and Knee Kinematics in Athletic Women During
Cutting Maneuvers: A Possible Link to Noncontact Anterior Cruciate
Ligament Injury and Prevention. Lauren E. Imwalle, Gregory D. Meyer,
Kevin R. Ford, and Timothy E. Hewett; Cincinnati Children’s Hospital
Research Foundation Sports Medicine Biodynamics Center and Human
Performance Laboratory, The University of Cincinnati College of
Medicine, Cincinnati, OH, and Graduate Program in Athletic Training,
Rocky Mountain University of Health Professions, Provo, Utah. Journal
of Strength and Conditioning Research: Volume 23, Number 8, November
2009, pgs. 2223-2230.