It is one thing to consider this conceptually, but another to put this in practice. If you were to put this in practice, what kind of results can you get? Although there is not much in the literature on, what we know through our own research is this can have a huge impact on your outcomes. This is one of the things we have been evaluating for the last 8+ years. Although our research is not published, all of it is IRB approved and is developed under the process of "Proper Discovery". This simply means that in each study, we take what we learn and apply that for process improvement and re-evaluate what kind of impact this has. It is the purest form of applying research to clinical practice and is what we do every day in the clinic.
Before discussing what we see, we should reiterate with this level of testing there are some clear guidelines that should be followed. Prior to implementation with post op patients, the following should be met:
- >24 weeks post op if ACL
- Full pain free ROM
- <1+ effusion with stroke test
- >70% symmetrical quad strength
- Cleared for plyometrics
- Cleared for lateral/diagonal movement
- Cardiac History
- High blood pressure
- Sickle Cell Anemia
- Low risk
- Minimal risk
- Moderate risk
- High risk
Scenario I: All athletes performed a movement assessment consisting of:
- Full squat test
- Step up test
- Single leg squat test
- Single leg hop test
- Plank test
- Bilateral side plank test
Scenario II: All athletes performed the functional agility short term fatigue protocol (FAST-FP) and then performed the movement assessment as described above. Each athlete was scored on each test and based on their overall score provided a risk rating.
When looking at the data, this is what we found:
- Non-fatigued state
- Average RPE 6/10
- 25% of athletes categorized as "at risk"
- 2% of the athletes categorized as "high risk"
- Average score on core was 7.5 for all subjects
- Fatigued state
- Average RPE 8.5/10
- 5% of athletes categorized as "at risk"
- 36% of athletes categorized as "high risk"
- Average score on core was 4.5 for all subjects
- 100% reduction of non-contact ACL injuries Y1&Y2
- 60% reduction in the number of days on the DL
- 58.2% reduction in the number of non-contact LKC injuries (foot, ankle, knee, hip and low back)
- $200K reduction in claim submissions over a 2 year period
Keeping in mind this was only an N=42, the reduction in ACL injuries is not statistically significant. But the number of days on the DL, the overall reduction rate in LKC injuries and the cost savings is. From a research perspective, we should have compared intervention based on fatigued data and non-fatigued data. However, based on the fatigue state data and wanting to do the best thing for our athletes, we chose to only do based on fatigued state data. Although this is a criticism from a research perspective, from a clinical perspective it was the right thing to do and in the end, helped a lot of kids.
Next week, we will discuss how we apply this concept of fatigue to our movement assessment in the absence of a pre-fatigue protocol. If you enjoy this blog, please share with your colleagues and follow us on instagram @ bjjpt_acl_guy and twitter at @acl_prevention. #ViPerformAMI #ACLPlayItSafe