Monday, August 3, 2015

We Are On The Edge - Will We Take The Jump???

For this series, I am going to stray from my traditional route of literature review and share more of a personal perspective.  In the last month I have been blessed and humbled with opportunity to take a new and exciting direction in my professional career as a national director of one of the nation’s largest sports medicine programs.  This opportunity is providing me with the exposure to some really exciting things happening in our respective professions.  Things which, I hope, will forever change the world of sports medicine.  Forever change the way we, as coaches, athletic trainers and physical therapists and physicians approach and look at our athletes.

Back in 1998 -2000 I felt a true calling and passion to do something about youth athletic injuries.  It was the 22 ACLR patients that came into my office over a 2 week period that inspired me to do something about this horrific epidemic.  Since then, I have written numerous articles, published papers, authored a college textbook and developed a technology to assess movement in athletes to reduce risk for injury.  All of this with little personal gain other than knowing that I am serving the calling that I was called to do.  To know that in some small way, I may contribute to one child not suffering a non-contact ACL injury makes this whole journey worth it. 

Throughout the last 15 years, what I have learned is that the long term health impacts are devastaing and that we cannot leave it up to someone else to come up with a solution but we must drive the innovation and solution ourselves.  If you have followed this blog, what I hope you find is research based education which you can take back to the mat and apply with your athletes.  But reading alone is not enough.  WE have to be willing to make the jump!  This is my call to action for you.  To impact this epidemic, we must be willing to push ourselves to the next level and do something different if we ever expect to change the current trends.  The research is clear.  It has been out there for over 15 years.  WE know what we should do, now IT IS THE TIME TO DO IT!

One thing I would ask you to consider, is question the logic.  So many times we rely on others to come up with the solution.  We take courses from them, we read their books and buy their materials.  But many times there is the question lingering at the back of our heads of does this make sense.  Sometimes it does not and yet we want it to make sense.  Often in these situations we find ourselves defending the logic despite the research indicating the opposite.  Perfect example is I recently tweeted the following tweet:

I received a back lash of messages from people loyal to this test but the reality is this, this test is not sensitive to measuring asymmetry.  This test also does not measure the number one indicator that the literature tells us that puts athlete’s at risk for injury.  Myers et al, AJSM 2012, showed that single limb performance is the best indicator of non-contact injury risk.  Kristinaslund et al, AJSM 2013, showed that single limb performance best represents how the limb will respond
during athletic participation.  More recently, Rohman et al, AJSM 2015 showed that limb symmetry index is the best indicator of limb ability in sport and good for injury prediction.  So why is it that we are not assessing this in a profound way?  We also know from Tong et al, Phy Ther Sport 2015 that the endurance plank test is a valid, reliable and practical test for assessing global core muscular endurance in athletes.  Yet one of the most common test we use is the rotational stability test.  Yet, support for the rotational stability test’s correlation to core stability let alone correlation to sport is not supported in any peer reviewed journal.  If this is the case, why are we not looking at plank testing in athletes. 

So, it is not that I am for or against this particular test, but I am for what the research tells us.  What the research clearly tells us is that there is a better way of doing things.  Just because that is the way we currently do it or have done it does not mean it is the way we should continue to do it.  Research tells us what we should be looking at.  The interesting thing is that what the research is telling us make sense when you think about it.  So, do we continue to do what we have been doing with limited results or do we break out of the box and truly look to change the way we assess and treat our athletes. 

The beauty of 2015 is the technology revolution that we are in.  If you are not using technology in your sports medicine practice, you will soon be outdated.  Technology affords us new, more efficient and much more reliable ways of assessing what we should be looking at.  Study after study shows that the eye ball is good but intra/inter-rater reliability with many of today’s movement assessments is just not there.  If we can integrate movement assessment with technology, would we see a more dramatic reduction in injury rates?  Or are we content just doing it the same way we always have despite the research and the tools that are available to us?

I hope you sense the passion.  But what I really hope is that what you will see over the course of the next 12-18 months is some serious change in the way that we do things.  In this new role, we will use the research to drive the interventions that we provide.  We will directly measure the outcomes of the athletes we treat and use those outcomes to drive future education and innovations in the way we treat our athletes.  We will be cost conscious to the health care expense and at the same time drive improved outcomes, improved athlete experience, reduced recitivizm (rate of re-injury) and improve athletic performance!   

As basic as it sounds, to truly change movement, we must change the way that we think.  And although it is not 100% data driven, it is 150% science driven.  Over the course of the next month, I will be providing excerts from our textbook to help us all understand better the sciences behind movement and why we should do what we should do.  And that is, assess it better.  Move better, feel better, perform better and last longer.  That simple!   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 National Director for Sports Medicine for Physiotherapy Associates.  He serves as an injury consultant and is actively involved in movement research.  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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