Should We Re-Think How We Look At Movement? - Part II

In last week's blog, we talked about how we are currently assessing risk & evaluating movement and what the current literature is telling us we should be looking at.  During this discussion, we highlighted where there are some discrepancies (what we are looking at vs. what we should be) and how we might leverage evolving technologies to assess in a more efficient and cost effective manner.  With the evolution of time of flight technologies and inertial measurement units, we are now able to look at assessing movement in a way we never imagined.
 
But, assessing movement and/or risk is only the first step.  The next step and the most critical step and that is how do you use that information to develop an intervention that will improve the movements known to put athletes at risk for injury?  Before we get into how exactly do we do that, we must first discuss the philosophy of injury prevention versus athletic performance.  Why?  Because studies have shown that compliance with injury prevention programs is much less than compliance with performance programs.  Both from the coaches perspective as well as the athletes perspective.  If a coach or athlete thinks the program they are doing is going to give them a competitive edge, then they are much more likely to devote the time and energy to the program.   

It is our responsibility to assist coaches, athletes, parents and health care providers understand how the mechanics pictured here not only put this athlete's ACL, patellofemoral joint, ankle and hip at risk, but how this also impacts her athletic performance.  For many of us, we can see how these movements add to risk in these joints and/or regions.  When we look at this with a critical eye, we can also see how these same movements lead to loss of kinetic energy across the system which equates not only to loss of power output (decreased vertical jump) but also decreased efficiency of movement.  The net result is a slower and less agile athlete with decreased ability to get to the ball and perform at their optimal potential.  So although our motivation is to help athletes avoid injury, the message we should tout to our coaches and athletes is the performance benefit that is gained when these movements are addressed.

So how do we put together a program that does that?  First we have to have a program that is based on the latest in movement science research.  To be truly impactful on risk and performance we need three things:

• Program that addresses movement based on the current literature
• Program that is laid out efficiently to improve effectiveness and compliance
• Program that is standard so can be easily scaled with similar results

To have a program that addresses the movement based on the current literature it must include: 

• Lower limb proprioception training– Hewett et al J Orth Res 16
• Single limb performance training – Myers et al Am J Sport Med  2012
• Training to improve limb symmetry – Rohman et al Am J Sport Med  2015
• Training to reduce lateral movement of pelvis in squatting – Atkins et al J Strength Con 2013
• Training to improve core performance – Frank et al Am J Sport Med  2013
• Training that emphasizes control of speed and magnitude of knee frontal plane motion during single limb training - Stearns et al Am J Sport Med  2014
• Training to improve endurance in single limb performance – Brazen et al Clin J Sport Med 2010

Once we have a program that addresses all the movement factors associated with risk, it has to be laid out in a way that improves effectiveness and compliance.  To do that, the program must:

• Include fatigue state training – Hewett et al J Ortho Res 2016
• Be no longer than 20 minutes in duration – Soomro et al Am J Sport Med 2015

In order for a program to be scalable with similar outcomes, it has to have ease of availability, standardized progression and standardized instruction.   As such, each ACL Play It Safe Program comes with:

• Standardized equipment
• Standardized progressive program (with four levels of progression)
• Standardized instruction (provided via written instructions include and an app or similar technology)

 

 

The ACL epidemic continues to impact the lives of thousands of athletes.  If we can develop intervention strategies that impact performance and risk and which can be implemented efficiently with consistency in outcome, then we will truly impact this epidemic. 

 

Dr. Nessler is a practicing physical therapist with over 17 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >3000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.