Monday, January 26, 2015

Are We Insane or Can We Learn From Our Mistakes? - Part II

Last week we looked at several research studies highlighting injury rates with leading toward the same basic question.  Is the training methods we are doing today having a profound impact.  The discussion was concluded with the Rugg study which looked at injury rate in collegiate athletes who had a previous knee or ACL injury.  We also looked at the current data from the 2014/15 NFL Season which compared teams with high injury rates and wins to those with low injury rates and wins.  The data was clear and reconfirmed Rugg’s work.
So the Rugg study suggest and the NFL data confirms there is an impact on team performance, but what about individual performance?  We have all heard the stats on athletes returning to sport post ACL reconstruction.  80-90% return to play.  But does return to play mean you are returning to play at the same level you were before?  In 2012, McCullough et al showed that there is a significant impact on individual performance after an ACL reconstruction.  This study showed that high school and college players who suffered an ACL injury were able to return to sport.  But, of those who returned to sport, only 45% were able to return to their prior level of performance.  In this particular study, performance was measured via sprint speed, vertical jump and player confidence.  Power output is compromised as well as player confidence!  In sports, this is a horrible combination.  So the question arises, if using sound training principles is the standard of practice, would these numbers be different?  Is practice of sound training principles practiced at even the highest level of athletics – professional sports?   Simply looking at this one case (NFL player above), if he is jumping like this and is being trained day in and day out, is this what the current standard of practice leads to?  Could the 1st ACL have been prevented or could the 2nd ACL have been prevented? 
No one really knows that answer and it is always easy to be judgmental in retrospect.  That is not the point.  The point is that the numbers have not gotten better and as a matter of fact they have gotten worse.  Much worse.  One thing everyone can agree on is that a training program should be individualized.  Individualized to the person and to the sport.  However, in athletics, individualization simply means applying a standard program program used for that sport to the individual by modifying training volume and intensity that is appropriate to that individual.  When you look at a lot of these programs, few actually apply sound training principles that address the biomechanical factors known to put athlete’s at risk for injury as well as performance issues.
If we simply go back to the basics, exercise physiology 101.  We know that every athlete’s training program should be based on a sound assessment of the athlete.  This does not mean just measuring their vertical jump and sprint speed. It means assessing their flexibility, strength, endurance and movement.  From all this data, we can then structure a program that is truly individualized to the athlete, based on their sport and which targets their areas of opportunity.  Over the course of the last 15 years, there has been a plethora of research articles published looking at biomechanical factors that put an athlete at risk for injury.  But are these factors addressed with the standard of practice of sound training principles.  The simple reality is no.  This ODP athlete training at a well respected high level performance center for 6 months.  Performing an extensive history followed by assessment of the athlete clearly shows why he complained of both the symptoms and performance issues he did.  Is this focusing on what he cannot do?  No.  Rather it is looking at how he moves and optimizing that so that he can do what he does even better!
If movement is important, how do we look at.  Not everyone has extensive background in exercise physiology, anatomy and biomechanics that is needed to evaluate movement in a truly meaningful and profound way.  So how do we do?  Technology!  For decades the gold standard of biomechanical analysis has been the Vicon camera system.  These systems are hundreds of thousands of dollars and require high level of personnel to run and a lot of money to maintain.  Reality is, most cannot afford nor have the space for this kind of technology.  But what if there was technology out there that could replicate that?  In 2012, Weber et al looked at the Microsoft Kinect and compared it to the Vicon system to assess accuracy in measurement of frontal plane motion.  What the authors found is that the Kinect had an acceptable accuracy in measuring frontal plane motion.  In 2013, Stone et al compared the Microsoft Kinect to the Vicon system to assess the reliability of the Kinect in assessing adduction in the frontal plane (major risk factor for ACL injuries) and found it to be a very reliable tool.  Both of these studies used the MS Kinect and not the latest version, Microsoft Kinect v2.  The MS Kinect v2 was just released in November 2014 and has a much higher degree of accuracy with tracking motion.  That said, although the studies are not out yet, it would make sense that if the Kinect 1 was good that the Kinect v2 will be even better.
What if this technology was programmed to assess the movements we knew put athletes at risk?  We know from Atkins et al work in 2013 that asymmetry in the squatting motion results in alterations in loading to the lower kinetic chain which can increase injury risk.  We also know from Stearns et al work in 2014 that the magnitude of adduction in the frontal plane is directly correlated to the adduction moment (which is one of the risk factors for knee injury).  So, what if you could program a technology like the Microsoft Kinect v2 to not only capture all those known risk factors but also quantify them?  This would then provide anyone with a basic level of understanding of exercise the ability to accurately and reliably assess an athlete’s movement for both injury risk as well as potential performance improvement.  Doing so, would allow us an efficient way to assess and develop sound training programs that address not only their individual sport but also their individual deviations.  If we could do this and scale it so that it could be used by the masses rather than the 1%, could we have a more dramatic impact on performance and injury rates?  The answer to that question is not yet known.  What we do know is that it is INSANE to keep doing things the way we always have and expect different results.  It is time to #Evolve and think outside the box.  It is time to embrace technology and blend it with the biomechanical sciences so we can have even better outcomes.  It is time to change!
Progress is impossible without change, and those who cannot change their minds cannot change anything!
George Bernard Shaw

Stay tuned as we continue to look at this and other fascinating topics in the coming year.  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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