Monday, January 19, 2015

Are We Insane or Can We Learn From Our Mistakes?

“Insanity – Doing the same thing over and over and expecting a different result”
Albert Einstein
The following 2 blogs are just as much a commentary as they are literature review.  The inspiration for these blogs comes from numerous recent articles, blog postings and comments we hear and read about training and injury prevention.  Many will say we are too obsessed with injury prevention and that we just need sound training principles.  Totally agree.  Others will say we focus on what the athlete can not do versus what the athlete can do.  Agree with that to an extent.  Yet, others will say we rely too much on technology.  On that one, I disagree. 
Reading all these raises the question; ff we based everything on sound training principles, would injury rates go down?  Some would say yes based on subjective and anecdotal data.  The validity of that is questionable.  However, common sense would tell us that they would go down.  Would they go down 20%, 30% or 50%?  What if we could make them go down 80% by looking at things a little differently?  It would make sense that practitioners who are more versed in these sound training principles that they would get better results.  But what percentage of people who are training others does that represent.  Is it 80%, 50% or just 1%.  The fact is that there are over 250,000 anterior cruciate ligament (ACL) injuries every year in high school athletics.  Over 60-80% of these ACL injuries, depending on the author, are non-contact in orientation.  Meaning there was no contact with another player.  The common theory is that the majority of these can be reduced with proper training or sound training principles. 
The question then becomes, if the mass majority of training that is applied uses sound training principles, then wouldn't we see these numbers go down.  With increased knowledge of the biomechanical factors associated with these non-contact ACL injuries, then application of sound training principles would see some level of impact on these over the last 20 years.  However, what we see is just the opposite.  Dodwell et al in 2014 showed that we have not only seen a moderate increase in ACL injuries over the last 20 years but an alarming rate of increase and most notably in those 17 years old.  This is alarming for several reasons.  According to Holm et al in 2012, over 20% have a re-injury in 2 years and 79% have osteoarthritis in 12 years.  So we know if they have an injury, they are also more susceptible to another injury AND their future joint health is compromised. 
But here is little unknown fact about kids who suffer an ACL injury or knee injury.  Rugg et al showed in 2014 that athletes who have a knee injury or surgery prior to their Division I college athletic career are at a 8 to 800 fold increased risk of having knee surgery during their Division I career.  Those same athletes will also consume 50% more time on the disabled list (DL) than previously non-injured athletes.  The alarming fact of this study is that a lot of athletes will miss out on higher education opportunities.  Based on the fact that these athletes will cost an athletic program more money and contribute less to the team’s overall performance means that universities are selecting not to spend scholarship dollars on those individuals.  Why would they?  There is a higher probability of injury, cost and they are less likely to add to overall seasonal performance.  Why is there such a high risk?  Simply stated, for the non-contact injury, many times the “root cause” of the injury was not addressed.  If sound training principles were the standard, then none of these numbers would be what they are.
The Rugg study touched on an interesting point but a point that was not made real clear.  The point was that those who have had a previous knee injury also spend more time on the DL.  Reality is, you are bringing them on to perform and yet those players are not contributing to overall team performance as much as you anticipated.  This is a well known fact but also one that is not talked about a lot in professional sports.  If you take the 2014/15 NFL Season as an example, you can see this much clearer.  In 2014/15 NFL Season (current numbers as of 1/14/15 from injury reports) there were 141 NFL players who suffered knee injuries that resulted in lost time (missed a practice or game as a result of their knee injury). If you compare teams with the highest knee injury rates and percentage of wins to teams with the lowest injury rates, you see an interesting trend.  Teams with the highest injury rates won 33.9% of their games compared to teams with the lowest injury rates which won 52.7% of their games.  Just like Rugg’s study suggest, increase in knee injuries does have a significant impact on overall team and seasonal performance. 
Stay tuned next week as we continue our discussion.  We hope that you found this blog insightful and useful.  As we stated previously, stay tuned and if you like what you see, SHARE THE PASSION!  It is the biggest compliment you can give.  Follow us on Twitter @ACL_prevention and tweet about it.  #DMAOnTheMove and help us spread the passion and #Evolve.
Build Athletes to Perform…Build Athletes to Last!™
Trent Nessler, PT, MPT, DPT:  CEO/Founder ACL, LLC | Author | Innovator in Movement Science and Technology.  Dr. Nessler is a physical therapist and CEO/Founder of ACL, LLC.  He is the researcher and developer the Dynamic Movement Assessment™, Fatigue Dynamic Movement Assessment™, 3D-DMA™, author of the textbook Dynamic Movement Assessment: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training. For more information, please see our website at

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