Monday, May 12, 2014

Is It Old ALC News or New ACL News?

Over the course of the last couple of months, there has been an abundance of media attention on the rise of ACL injuries among youth athletics.  This is great and brings light to a very serious and escalating problem in youth athletics.  With more publicity, we hopefully see adoption of more realistic and viable solutions which can impact these trends.  With publicity comes increased awareness, increased public pressure and funds which can make real and significant changes.  However, many parents, administrators and doctors are up in arms as if this is all something new.  Is this really anything new?  Frankly and sadly, no.  According to the studies and the data, the rise in ACL injuries has been well documented for the last 10 years.  It is the reason that we, at A.C.L., LLC, felt called to this mission to do something about it.  Sadly, this current and new information is information that we have known about for quite some time.

Great example is a recent report published by LaBella et al in the American Academy of Pediatrics outlining the current state of knowledge on epidemiology, diagnosis, treatment and prevention of ACL injuries in children.  This paper is an excellent review of the last 10 years of data and vital information for pediatricians to know.  But sadly, it is knowledge that has been well accepted in the sports medicine and orthopedic literature and fields for some time.  Sadly, it has taken 5+ years to disseminate to pediatricians.  The frustrating part, so what?  Not so what, who cares?  But so what!  Using this information what are we going to do differently about it?  Are we simply going to state the same facts over and over again for the next 5 years, continue to do things the same and hope it changes over time?  Are we going to continue with the insanity or are we going to do something about it? 
Recently there has been several papers published citing neuromuscular retraining as an effective technique to reduce ACL injuries in athletes.  Again, is this new?  A review of the literature shows that in 1981, Paulos et al published a paper in the American Journal of Sports Medicine outlining knee rehabilitation after ACL reconstruction and noted that neuromuscular retraining was a key and critical aspect that must be included in the rehabilitation process.  In 1991, Paulos et al further refined these recommendations and again cited the importance of neuromuscular training in the rehabilitation process.  Ok, so it made sense in the rehabilitation, why not in prevention?  In the late 90s, we started to see papers coming out highlighting the impact that neuromuscular and proprioceptive retraining could have on preventing injuries.  Mandelbaum et al published a paper in 2005 showing a massive reduction in ACL injuries with a prevention program focused on neuromuscular retraining and proprioceptive retraining.  Yet, Bollars et al recently published a paper that compared seasonal injury rates prior to implementation and post implementation of an injury prevention program.  The injury prevention program consisted of the FIFA11+ which is a combination of neuromuscular retraining and proprioceptive training.  They also saw a significant reduction in injury rates.  So, we have proved once again that neuromuscular and proprioceptive retraining works at reducing injuries.
So the simple question is, if we have known this for 10 years and it works, why aren’t we using it?   This is a complex question but I think it comes down to three key things:

1.      What is the impact on performance?  Until we tie it to performance, coaches are going to be more resistant to implement prevention programs.  If you are looking to win the next game or potentially reduce an injury you may or may not have, you are more likely to focus on the winning the game.  BUT IT DOES IMPACT PERFORMANCE.  Case in point, this clip is of an Olympic athlete performing a lift.  The same mechanics that put her at risk for knee injury are also limiting her kinetic energy transfer and force production during this lift. 

2.      Does training equate to improved mechanics?  Training does not mean training right.  Unfortunately, even professionals can and will train athletes incorrectly.  Case in point, this clip is of a U16 soccer player trained by a high level performance coach in plyometrics.  Net result is movement which places the athlete at risk and which impacts performance.

3.      If you don’t assess the movements associated with risk, you don’t know if you have improved.  This Olympic athlete was assessed with a movement screen and her training program based off of.  But her movements did not improve because the movements associated with risk & performance issues were not assessed.  Simply doing so resulted in improved performance and reduced risk.
Is this new information, no.  But let’s stop the insanity and do something different with it.  Let’s make changes based on it and see how we can impact this epidemic!

Build Athletes to Perform…Build Athletes to Last!™

About the author: Trent Nessler, PT, DPT, MPT is CEO of A.C.L., LLC and is a practicing physical therapist with 15 years in sports medicine and orthopedics. He has masters in physical therapy and doctorate with focus in biomechanics and motor learning. He is the founder/developer of the Dynamic Movement Assessment™, Fatigue Dynamic Movement Assessment™ and author of a textbook “Dynamic Movement Assessment™: Prevent Injury and Enhance Performance”. Trent is also associate editor of the International Journal of Athletic Therapy and Training and Member of the USA Cheer Safety Council.  For more information, please see our website at




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