Monday, April 30, 2018

Does Previous Knee Injury Impact Performance & What Can We Do About It? - Part IV

Throughout the course of this blog series we have been discussing if a previous knee injury impacts   We believe the answer to this question is pretty clear that yes, previous knee injury does impact current and future performance.  We know this to be the case in Division I athletics (Rugg et al Am J Sports Med 2014) and in professional athletics (Mai et al Am J Sports Med 2017).  We also know that football players are impacted to a greater degree than basketball players and hockey players respectively.  We further discussed what the literature indicates what we should be assessing to prevent these injuries (Johnson et al Am J Sport Med 2018) and whether or not fatigue plays a role in injury.  

This is all great information to have but if we don’t know what to do with this information or more importantly how to impact it, what does it matter?  In this week’s blog, we will dive into that question.  What can we do about it? 
future athletic performance.

In this discussion, we will look at two different recent studies.  The first looking at whether or not injury prevention programs truly impact injury rates.  Lopes et al Am J Sport Med 2018 performed a systematic review with meta-analysis on whether injury prevention programs impact biomechanics of landing tasks. 

The Effects of Injury Prevention Programs on Biomechanics of Landing Tasks: A Systematic Review with Meta-analysis.  

Purpose: Synthesize the evidence on the effects of injury prevention programs on landing biomechanics as they relate to ligament, quadriceps, trunk and leg dominance theories associated with ACL risk.

Methods:  Six databases were searched for studies that investigated the effects of injury prevention programs on landing tasks biomechanics.  Prospective studies that reported landing biomechanics at baseline and post IPP were included. 

Results: 28 studies met the criteria which included a total of 466 participants.  Most studies
  • Young female athletes
  • Bilateral landing tasks
  • Recreational athletes
Factors that improved after implementation of injury prevention program include:
  • Peak knee abduction moment decreased
  • Hip flexion angles at initial contact increased
  • Peak hip flexion angles increased
  • Peak knee flexion increased
  • Peak knee flexion moment decreased

Conclusion/Discussion:  Based on the results of this systematic review, the exercises used in injury prevention programs might have the potential to improve landing biomechanics.  Peak knee abduction moment decreased which indicates that injury prevention programs influence a desired movement strategy.  This may help athletes overcome movements which result in excessive frontal plane motion of the knee resulting in dangerous ligament loads.  The results of this study lead the authors to further suggest that the results of these programs may be enhanced when they are developed based on the athlete’s baseline profile deficits. 

Based on this current systematic review as well as previous literature, we know that injury prevention programs can have a significant impact on biomechanical risk factors.  That said, it would seem logical that some may work better than others.  We know from the previous Johnson et al study discussed in the previous portion of this series that we should be assessing the ability to control dynamic valgus in single limb performance.  Based on this, it would make sense that programs that focus on controlling this frontal plane motion would be more effective.  So, next week we will dive into that by taking a look at the by Omi et al Am J Sports Med 2018.  Also, please make sure to check out our new website at where our goal is to help you help others.  #ViPerformAMI

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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