Monday, December 2, 2019

The Evolving Knowledge of Movement - Part III - What We Know Now

Over the course of the last couple of weeks, we have been discussing some of the things we are learning when we collect mass data related to movement in athletics.  When you read through the last couple of blogs, you may have asked yourself, where is the research on that?  Frankly, we don't have it yet.  However, we are working on getting some of this published.  Is that bad or make it less valid?  I don't think so.  In my opinion, this is the next generation of evidence based practice.  A generation where technology allows us to capture such large amounts of data that we have never had access to before and that we can now vet and easily identify what trends exist.  Sometimes this can be done years ahead of the research. 

As you may or may not know, many insurance companies are doing a very similar approach.  They capture data sets on an entire populations (10s of thousands) and/or communities and blend that with claim data information (disease states, family history, etc).  They have identified trends with lifestyle, where you live, insurance claims and disease states this makes you susceptible to.  Many are now making recommendations based on this information.  Offering different insurance products and benefits knowing the top 5 diseases you are most likely going to be susceptible to considering all your unique data points.  Insurance companies are doing this to be proactive in preventative medicine to help reduce the human cost and overall health care costs.

This is no different and the only difference is this is related to movement and demographic information in athletics.  The key is, we are collecting this in mass numbers so we become privy to this information often ahead of the research.  However, when collecting information like this, one of the things that is always important (besides blinding the data and maintaining HIPAA compliance) is whether or not the data you look at is "actionable data".  What I mean by that, is this data that we can learn from and implement some kind of strategy that will positively influence the outcome of the data.

All too often we get research or use technology which provides us some great data.  But this data is less meaningful if is is something I can't do anything about.  For example, if I collect mass MRI and athletic data on female athletes and find out that female athletes with narrow femoral notches rupture their ACL more in soccer, how am I supposed to change that?  Training can't change that.  On the other hand, if I find that athlete's who can't maintain core stability within 8 degrees of flexion/extension and rotation rupture their ACLs more, then this gives me something I can train with my athlete and change.  So, let't talk about some of this "actionable data" that we have and how this may influence how we train our athletes.   

Variance by Level of Play, Gender and Sport - Although this data is not quite clear yet, we are shooting to identify baselines for what puts a Division I female soccer player at risk versus a Division I male linebacker.  This will be extremely valuable for pre-season testing.  Just like performance testing done at the beginning of a season, we should eventually be able to use this data to provide us with a baseline from which we measure against to see the effectiveness of our interventions.  Further, we can have a training minimal goal to achieve for new recruits or those hoping to be recruited that once achieved, reduces their risk of injury during participation at this level. 

Variance in Multiple Sport vs. Single Sport - this should be simple, get your kids involved in multiple sports.  Rugg et al Am J Sport Med 18 showed NBA players who played multiple sports in high school not only played better in the NBA, but got injured less and had longer professional careers.   McGuine et al Am J Sport Med 17 showed that high school athletes that played multiple sports sustained less lower extremity injuries and the severity of those injuries suffered were less.  Why is that?  When an athlete trains in multiple sports, they are getting variations in the way that they train.  With that variation in training comes an increase in athleticism and agility.  What we see, is those athletes that are multiple sport have better frontal plane control of the knee and lower speeds of valgus.  What does that mean?  This means that when there is less frontal plane motion and better control of speed of frontal plane motion that kinetic energy transfer is better.  So when the player cuts to their left they are not only able to generate more power but that power is transferred much better to explosive power.   In addition, with this increased control of motion, there is less strain or force placed on the muscles, ligaments and joints in compromising positions.  This means less injuries.  So, take home actionable item here: Let your kids play multiple sports.  They will be better athletes and get injured less. 

Next week, we will talk about Speed Matters.  High speeds of valgus in single limb performance puts athletes at greater risk for lower limb injuries.  Knowing that, if we see that in an athlete, how do we train to control that speed?  Stay tuned as I am super excited to share with you.  If you enjoy this blog, please share with your colleagues, athletes and training partners and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #ViPerformAMI #ACLPlayItSafe

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 and ACL injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, 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 has also been training in Brazilian Jiu Jitsu for 5 years and complete BJJ junkie. 

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