Monday, March 19, 2018

Supporting the NATA Position on ACL Prevention

Have you seen it?  The National Athletic Trainers Association published a position statement on ACL Injury Prevention.  One of the leading authorities in sports medicine and in injury prevention has come out with an official statement on preventing ACL Injures.

As stated in the NATA's position statement, lower extremity injuries account for 66% of all sports injuries with the knee being the most commonly injured joint.  ACL injures are quite common in athlete and unfortunately reconstruction and rehab do not prevent long term consequences.  Holm et al Am J Sport Med 2012 showed that 79% of those who have an ACLR end up with osteoarthritis in 12 years.  Considering this, the initial cost of an ACL injury is high but the down stream consequence is much higher than we currently know or can quantify.

Therefore, prevention of the primary ACL injury is critical.  According the the NATA position statement, a program should:

  • Have an impact on injury prevention and performance enhancement.  The program should include components of at least three categories (strength, plyometrics, agility, balance and flexibility).
  • Training intensity - the program should be performed at progressive intensity levels that are challenging and allow for excellent movement, quality and technique.
  • Training volume - the program should be performed during pre-season and while in season at least 2 to 3 times per week.
  • Programs are effective when implemented as a dynamic warmup or as a part of a comprehensive strength and conditioning 
  • Programs should target athletes who participate in high risk sports (basketball, soccer, Lacrosse) and especially females or those with a history of an ACL injury.
This is great that such a influential organization such as the NATA comes out and makes this position statement on ACL injury prevention.  We share a similar passion, preventing injuries in youth athletics.  For those that have followed this blog long enough have seen some discussion on the ACL Play It Safe Program.  Ironically, this was launched in 2016 and to date has been used with over 3000 kids across the US.  Ironically, it almost appears as if this position statement was written directly for the ACL Play It Safe Program.

For those not familiar with, the ACL Play It Safe Program is a comprehensive progressive program that is performed 2-3 days per week as a part of practice.  But let's break it down and see how this fits the NATA position statement.

  • The program is a multicomponent program including strength, flexibility, balance and plyometrics.
  • The program is progressive in nature with 4 levels of exercise to allow the athlete to progress in their movement training.  In addition, there is a video for each movement provided in a free app where technique with each is emphasized.
  • The program is performed 2-3 days per week as a part of practice and only takes 15 minutes.
  • The program is implemented as a dynamic warmup at the beginning of practice and also includes fatigue state training that is performed at the conclusion of practice.
  • This program targets all high risk sports and female athletes.
  • Our research is showing not only a reduction in all lower extremity injuries but also improvements in performance measures.
In addition to the above, the program includes standardized equipment for each athlete.  This way, we can provide resistance and the resistance that is provided is standardized and does not vary based on what is available that day to the athlete.  

The evidence is clear on what we need to do.  One of the leading authorities in the profession has come out and stated what these programs should include.  We all have access to the this program.  So, let's take action, implement and help our kids move better, perform better and last longer.

Stay tuned as next week we discuss exercise technique.  If your going to do it, do it right!  

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the founder | developer of the ViPerform AMI, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent is also a competitive athlete in Brazilian Jiu Jitsu. 

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