Over the course of this blog, I have attempted to present a
lot of research on injury prevention.
Although the majority of this has focused on mitigating risk for
anterior cruciate ligament (ACL) injuries, it has also extended to all lower kinetic
chain injuries from the foot to the spine.
You have also heard me talk about an athletic movement assessment
(ViPerform AMI) I created to assess these risk factors using a 3D wearable
sensor (called dorsaVi). This product
was commercially released in 2017 and has now been used to assess over 18,000
athletes across the US.
Part of the intention of developing this was to provide
clinicians, physicians and strength coaches with an efficient and reliable tool
to assess biomechanical factors that put an athlete at risk for injury and
which negatively impact performance. When
used in pre-season physicals, the hope is that this information could be used
to guide seasonal movement training which would improve results on this
test. This is not intended as a sales
blog but more what happens when you collect mass movement data utilizing
technology. With over 1,000 data points
per assessment, we now have over 18,000,000 variables related to athletic
movement. What this allows us to do is
identify trends in athletes that we may not see in the literature for some
time.
First, I would like to give a shout out to a colleague of
mine who has been using this system in DI athletics since its first prototype
in 2016. Her team just published their
first paper. Garner
et al Int J Kines Sport Sci 2020 used the ViPerform AMI to manage
risk of injury in a strength and conditioning program in DI volleyball
players.
Methods: In this
study, the authors performed an assessment on the volleyball players during
pre-season physicals. The results of the
test were then used to develop specific exercise program for the athletes that
they would perform 3x/wk for the entire volleyball season. The athletes were tracked all season long and
injury rates were compared to EMR (electronic medical record) data for the five
previous seasons. Although this is not
the ideal way, when you are working with a team, it is hard to use one group as
your experimental group and the other as your control. Most teams and coaches won’t go for this. Problem is, if there is a change in other
variables season to season (athletic training staff, strength staff, strength
programming, replacement of the court, etc) this can have an impact on the
injury rates. This was identified and no
other variables were changed season to season with the exception of the assessment
and specific assignment to a movement program based on the results.
Results: Compliance
with the program was greater than 90% with performance of the program at the
conclusion of practice 3x/wk. When
comparing to the previous 5 years of EMR for non-contact injuries, what the
results showed was a 67% reduction in hip injuries, 37% reduction in knee
injuries, 50% reduction in lower leg injuries and 67% reduction in thigh
injuries. There were no recorded ACL injuries
for the entire season for the first time in 5 years (this was not statistically
significant since the recorded ACL injuries for prior years was 1-2 per season). In addition, as a result of the intervention,
there was a >40% reduction in health care spend for the team that year (this
includes MD visits, x-rays, MRI, surgery and physical therapy).
Although this is the first paper, there are several studies
and papers in development. But this is
meeting our first goal which was to provide clinicians (PTs and ATCs),
physicians and strength coaches with tool to identify those at risk and use
that information to make meaningful changes to their program to impact. In addition this this goal, another goal of
this system was for it to be a venue by which we could collect mass data as it
relates to athletic movement. Collecting
mass movement data (>18M variables on >18K athletes) in this way has
never been done before. By vetting this
data, this allows us to identify trends in movement and risk prior to this
being identified in research. The key is
not to just identify it but more importantly determine what do you do about
it.
An example is
something we see in single limb (SL) testing.
Obviously one of the things we are looking for in SL testing is how
stable is your knee in the frontal plane.
Does your knee fall in towards mid-line (or valgus collapse) and does it
do that at a high rate of speed? We know
this is a risk factor and is well documented in the research. It is one of the key factors we measure. However, there are some athletes that are
good at controlling this motion of the knee.
However, when they do, some of them will lose control higher up the
kinetic chain at the hip. We call this a
loss of pelvic control and it can be represented in several different ways.
Trendelenburg – in a single leg squatting
position, this movement occurs when the hip on the opposite side you are
standing on falls. So, if the athlete is
doing a left single leg squat (as depicted here) the right hip will fall. This is an indication of weakness in the left
gluteus medius. If this muscle has full
strength, it would contract and prevent the right hip from falling.
In addition to the abnormal forces that are created along
the entire kinetic chain, it also tends to lend to an increase in loss of balance
during single leg activities. In
addition, the dropping of the hip creates a stress on the right left hip joint,
left sacroiliac joint and lumbar spine.
This can lead to a plethora of hip and low back problems during
athletics. Aside from injury risk, this
also has a huge impact on athletic performance.
There is a negative impact on maximal power production and agility.
Retro-trendelenburg – in a single leg squatting position, this
movement occurs when the athlete shifts their weight over the stance leg. So, if the athlete is doing a right single
leg squat (as depicted here) they shift their weight over the right hip. This is an indication of weakness in the right
gluteus medius on the left side. The
reason this is done, is this position creates stability by placing the femoral
head deeper in the socket (acetabulum).
This creates boney stability so the glute does not have to work as
hard. If this muscle has full strength,
it would contract and the athlete would remain more upright.
In addition to the abnormal forces that are created along
the entire kinetic chain, it also tends to lend to an increase in loss of
balance during single leg activities. In
this scenario, when the athlete (depicted here) do single leg hopping
activities, you will see her migrate to the right as the center of mass is
pulling in that direction. This puts a
lot of stress on the hip joint and lumbar spine facets on the right side. In addition, this has a negative impact on maximal
force production and agility.
Cork-Screw – one of the most devastating movements we see in the
hip is the cork screw. During a single leg squatting, this movement occurs when
the athlete’s hip drops and rotates. If
the athlete is doing a right single leg squat (as depicted here) the left hip
drops and there is rotation at the right hip.
This is easy to recognize by what the left foot (in this case) is doing. What you see is the left foot cross mid-line
and appears on the opposite side of the right leg. This indicates moderate to severe weakness of
the right gluteus medius as it is failing through its full range of
motion. With dropping of the pelvis and
the rotation that occurs at the right hip, this puts a tremendous amount of
shear stress on the labrum of the hip and can lead to hip pathology. This can also lead to problems in the SI
joint and low back pain.
In addition to the abnormal forces that are created along
the entire kinetic chain, it also tends to lend to an increase in loss of
balance during single leg activities. In
this scenario, when the athlete (depicted here) do single leg hopping
activities, you will tend to lose his balance a lot and as a corrective
strategy, often create a significant amount of rotation at the knee. Additionally there is a negative impact on maximal
force production and agility.
Keeping in mind, this is a trend we have seen in collecting
movement data on 18k+ athletes but has also something we have seen throughout
the years of development. Some might
say, well this is not proven because I have not seen that in the
literature. That is, until now.
Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment and ACL injury prevention. He is the founder | developer of the ViPerform AMI, ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject. Trent has performed >5000 athletic movement assessments in the US and abroad. He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams. Trent also a Brazilian Jiu Jitsu purple belt and complete BJJ/MMA junkie.
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