Monday, May 4, 2015

Where Are We Now?

In this blog, I will break for a moment from our standard format as I would like to start off this blog series by saying thank you to you, our followers.  Since starting this blog, we consistently see 80-100 followers a day and have seen over 32,000 followers in the last 18 months alone.  To date, we have over 13 countries represented with US, Ukraine, UK, France and Canada representing ~60% of our followers.  This blog is not something I am paid to do but it serves as a venue by which I can share with everyone what I feel is my calling in life.  A calling to do something profound to decrease preventable athletic injuries.  To provide evidence based education so that others can use what is learned to have a positive influence on injury rates in those they work with.  And to provide those with the opportunity to share the passion for prevention with their colleagues and clients. 
The last 8-10 years have provided me with a very unique perspective which has been an instrumental part in my own professional development.  During this time I have immersed myself in the research related to movement, injury prevention and performance enhancement.  I have also been blessed to integrate research foundation with the opportunity to assess the movement of 1000s of athletes, active individuals and patients using various forms of technology.   Finally and most importantly, I have been blessed to work and interact with some truly amazing people.  Physical therapists, atheltic trainers, physicians, strength coaches, coaches and athletes who have taught me some amazing things.  What I provide in these blogs is not me, per se, but rather the collective knowledge from people much smarter and versed in movement blended together and shared with all.  What all of this has done for me is profoundly changed the way I look at movement and dramatically changed my approach. 
First and foremost, it has taught me that to really understand movement and to prevent injuries, you have to commit yourself to be a student of life.  Humility!  We don’t know what we don’t know and if we pretend to know it all, you will never know more than what you know right now!  For me, I must walk into each experience knowing that I do not know it all and that I will learn something from every experience.  To do so with humiltiy opens you to learn from anyone and everyone.  You never know where your next clinical pearl may come from.  Whether it is the athlete or the strength coach, everyone contributes something.  It has also taught me that although some may be well versed in the research does not mean they know movement or how to influence.  Research is defined by specifics, controlling variables with very stringent protocols and procedures.  That is not life and that is not athletics.  Research is great but there is a great barrier dividing what is done in  research and how that may be integrated into the clinical world or athletic settings!   
Finally, it has taught me that technology is the future!  Embrace it!  Think how technology has revolutionized sports medicine.  MRIs, arthroscopes, computer guided surgery and diagnostic ultrasounds.  All of these combined the research sciences with clinical applications in a way that forever changed they way we diagnose and treat certain conditions.  Yet, despite the plethora of research and explosion of movement technologies, we are often hesitent to integrate this in assessing movement for injury risk or performance limitations.  Today, we are on the cusp of revolutionizing the way we look at, interpret and correct human movement. It is not whether this technology is replacing us or our ability no more so than an MRI or US is replacing the physician.  It is simply a tool to improve our efficiency and reliablity of what we already know and already do.  It simply allows us, through improved efficiency and reliabilty, to expand our reach and influence 100 athletes versus the 50 we previously could.
But the other thing is that technology allows us to learn things we never knew or maybe that we suspected but now, because we can capture more data and compare, we can prove and address.  Real time evidence based practice.  Why should I wait on a paper if I have the research I need at my finger tips?  More importantly than proving is that we can do something about it to positively influence the lives of those we work with.  Case in point.  There is a current study being conducted looking at movement analysis in soccer players from 11 years of age to Division I collegiate players.  The purpose of the study is to indentify movements known to increase injury risk and which also negatively impact performance.  From the results of the assessment, each player is grouped into an intervention group and trained using a program targeting the known risk factors.  At the conclusion, the athletes will be remeasured to assess the impact of the intervention on the known risk factors and performance measures (vertical jump).  That said, there are some correlations that have been made as as result of the data being collected in this study that until recently had not been seen or recognized.
Before I get into what those correlations are, let’s look at a recent study by Howell et al in the March 2015 issue of the American Journal of Sports Medicine
Methods:  In this study, the authors performed gait analysis on concussed adolescent and young adult athletes and compared those results to the non-concussed control groups.  The authors specifically looked at the subject’s ability to control whole-body center-of-mass (COM) medial and lateral displacement velocity and anterior velocity during gait and while simultaneously performing a cognitive task.  Each group was compared to a like group of controls.  Concussed athletes were assessed at 72 hours post concussion and at 1 week, 2 weeks, 1 month and 2 months. 
Results:  What the study found was at 72 hours hours post concussion, adolescents displayed significantly less control with COM medial/lateral displacement and young adults displayed COM significantly less anterior velocity compared to controls.  Across the two months of testing, concussed adolescent athletes demonstrated significantly greater total COM medial/lateral displacement compared to controls and concussed young adult athletes did not significantly differ. 
So what does all that mean?  Well, you’ll have to wait till next week.  But, know this, the ramifications are huge and what we can learn from this will change the way we look at ACL risk from now on.  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.  #MovingToChangeMovement and help us spread the passion.

Trent Nessler, PT, MPT, DPT:  Physical Therapist | Author | Educator |Innovator in Movement Science and Technology.  Dr. Nessler is a physical therapist and owner of Athletic Therapy Services.  He serves as a practicing clinician and movement change consultant for practices and organizations looking to develop injury prevention initiatives and strategies.  He has been researching and developing movement assessments and technologies for >10 years is the author of the textbook Dynamic Movement Assessment: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.  You can contact him directly at

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