Monday, July 21, 2014

Advancing the Science & Technology of Injury Prevention & Performance Enhancement


Over the course of the last 2 years, we have published weekly literature reviews on the latest research in biomechanics, injury risk, movement assessment and performance enhancement.  As a company, we want to educate parents, providers, coaches and athletes about how to use this information to prevent injuries and improve athletic performance.  As interesting and thought provoking as much of this research is, sadly it rehashes a lot of the same research that was done over 10 years ago.  The results are often identical to what previous studies showed us with little new knowledge gained.  So why the rehash?
Simply put is that the problem remains.  According to Dodwell et al, we are seeing even greater increases in injury rates among our younger athletes.  Dodwell’s study showed there has been a 189% increase in ACL injuries (17.6/100,000 vs. 50.9/100,000) in those 3 years of age to 20 years of age over the last 20 years.  For 17 year olds, there has been a 900% increase in ACL injuries (17.6/100,000 to 176.7/100,000).  So, if we know what the causative factors are and have for over 10 years, why are we still seeing these dramatic increases?  Again, simply put, we have failed to use the last 10 years of research to create standardized protocols to assess risk factor.    
For example, we know from work by Powers, Hewett, Myer’s and multiple others that there are certain movement patterns that are associated with risk.  In the May 2013 issue of the Journal of Strength and Conditioning, Atkins et al showed that lateral displacement of the pelvis during the squatting motion results in alterations in the way that ground reaction forces are attenuated through the lower kinetic chain.  This alteration changes force distribution during loading (a factor which increases risk) and results in suboptimal force production (decreased athletic performance).  In other words, the movement captured here in this high school soccer player shows a significant lateral shift (lateral displacement of the pelvis) leads to decreased performance and increased injury risk.  Not only does this result in altered force production and distribution, but also results in significant imbalances in quadriceps/hamstring strength and endurance between the right and left.  If this is the case and we know this, why do we not quantify this in a standardized assessment?
In March 2014 in the American Journal of Sports Medicine, Stearns et al showed that adduction in the frontal plane is directly correlated to adduction moment.  This adduction moment is directly correlated to forces distributed to the knee and hence injury risk!  If there are increases in the magnitude of adduction in the frontal plane then you increase the adduction moment and stress to the ACL as well as other tissues.  Along with that, you also alter the load distribution of all the weight bearing structures of the entire lower kinetic chain including the ankle, hip and low back.  In other words, the movement captured here in an NFL player not only puts him at risk for injury of the knee but also the ankle, hip and low back.  Along with that, as adduction moment increases, there is also a negative impact on kinetic energy transfer and decreased efficiency throughout the system which leads to decreased athletic performance.  If this is the case and we know this, why do we not quantify this in a standardized assessment? 
In January 2013 issue of the American Journal of Sports Medicine, Hewett et al showed that limb asymmetry in movement was strongly correlated to multiplanar movement which is associated with risk.  We also know that those who return to sport are at a very high risk of re-injury.  Therefore, assessing movement in single limb performance and comparing that to the contralateral limb is critical for not only determining risk but also for making return to sport calls.  In other words, the movement captured here in a MLS player, when compared to the non-operative side shows a significant imbalance in movement.  If this is the case and we know this, why do we not quantify this in a standardized assessment?    
Realizing these are rhetorical questions, the answer is simple.  We have possessed the knowledge but not a way to do this in a reliable fashion that is efficient.  Until recent advancements in technology, there has not been a way, or more accurately, an affordable technology we could use to do this in an efficient and reliable fashion.  However, that is about to change!  A.C.L.,LLC and Microsoft are advancing the science and technology of injury prevention and performance enhancement!  Completely outside the box and to an entirely new level!  Not that we want to make our blog an infomercial for a product we have created, but we do want to continue to educate people about injury prevention and performance enhancement.  As such, we feel it is important to educate people on what advancements are being made in this area.  With that, what is about to be released, we believe, will revolutionize the way we look at and assess lower kinetic chain dysfunction in athletes!  To meet our mission of profoundly reducing athletic injuries, then what we do must be completely outside the box!  Evolving with the research and evolving with technology is how innovation in injury prevention and performance enhancement occurs!  
Stay tuned for next week for Part II – Taking Gaming Technology To A New Level!
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™, 3D-DMA™  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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