Monday, January 20, 2020

Make 2020 The Year Of Change - Part IV

In our last blog, we highlighted a previous research project with women's volleyball players.  This last study that we will talk about is with Division II women's soccer.

With all our projects, whether official research or just what we normally do as a part of our business of sports medicine, we are constantly trying to compare our results and see what we can do better.  This means:
  • Critically evaluate our processes for inefficiencies so we can constantly improve the process.
  • Track our results and see the impact on:
    • Number of total lower kinetic chain musculoskeletal injuries
    • Total number of days on the disabled list
    • Total number and dollar amounts spent on insurance claims
Tracking this information not only helps us do what we do better, but also provides the school/university with objective data that helps us show the value that we add to the school, the program and the athletes.

Historically, prevention programs have shown to have an impact on injury rates.  In a systematic review by Lopes et al Am J Sport Med 2017, the authors showed that performing injury prevention programs had an impact on improving the lack of frontal plane control of the knee.  This lack of control is one of the biomechanical factors that put the athlete at risk for injury.  This further led the authors to suggest that these programs maybe enhanced by targeting participants's baseline profile deficits.  Taking this knowledge, we have applied this to what we do.

During pre-season physicals, we perform baseline movement assessment on each athlete and based on their results on the assessment, we assign them to level I - IV on the ACL Play It Safe Program.  In the following project, this is exactly how we approached it.

Before we begin however, I must say one thing about injury prevention programs.  Simply stated, we have to STOP calling them injury prevention programs.  The reality of all this is that teams, coaches, athletes and parents are LESS compliant with an injury prevention program than they are a performance enhancement program.  I think we would all agree that the athlete pictured here is at risk for a knee injury (as well as ankle, hip and low back injury).  But this same athlete, with these exact same biomechanics is NOT going to maximize her vertical jump, explosive power or speed with those mechanics.  These biomechanics result in a significant lose of kinetic energy, force and power.  Considering this, this is the same biomechanics that are improved with a injury prevention program.  So, I say we stop focusing on injury prevention and start calling it performance enhancement.

In addition to the impact on the individual player, do you think these programs impact team performance?  The obvious answer is yes.  If you improve this individual players performance that will impact the team's performance.  But think of this.  Of the players on a team, which players are more likely to suffer injury.  What the research would tell us is that it is the athlete with more athletic exposures.  What athlete has more athletic exposures?  Obviously your better players because they are on the field more during practice, scrimmages and games.  That said, if you reduce injury rates then you end up keeping your better players in the game and season longer.  This means they are adding more to the team's overall seasonal performance.  So, let's all agree, in 2018, let make a move to move away from the term injury prevention and focus on the performance enhancement potential.

This study included 21 female soccer players ranging in age from 17 years old to 21 years old from 2016 to 2017.  All the athletes were scholarshiped athletes and were freshman to seniors in their academic career.  Each athlete went through a baseline movement assessment (ViPerform AMI) as previously described.

At the conclusion of testing all athletes, the 3D data and video was reviewed with the team athletic trainer and strength coach.  The evaluator then assigned each athlete to level I - level IV of the ACL Play It Safe Program based on a predetermined set of criteria for each level assignment.  16 of the athletes' results had them assigned to level I exercises and 5 athletes were assigned to level II exercises.  Throughout the season, the athletes performed the ACL Play It Safe exercises as previously described.

The exercises were performed under the direction of the team coach and athletic trainer and done two times per week.  Each athlete performed these exercises throughout the season and compliance was tracked via the coaches attendance log.  Injury and claim submission data was tracked through the team's athletic training EMR over the 016/17 season.


Hypothesis I - If a Division II soccer team performs ACL Play It Safe Program based on individual player VIPerform AMI results, there should reduction in days on the disabled list and recordable musculoskeletal injuries for the entire team.

For the purposes of this study and with a lack of a control group, the seasons with the intervention was compared with the previous 5 years of injury data collected for the football team.  When comparing non-contact musculoskeletal injuries, overall there was a 65.2% reduction in injuries to the:
  • Foot/ankle
  • Knee
  • Hip
  • Low back
This included sprains, strains, muscle pulls and ligamentous injuries.  As a result of the reduction in lower kinetic chain injuries, total number of days on the disabled list for the entire team was decreased by 69%.

In addition to the above results, there was also a significant reduction in health care claims submitted by the universities athletic department for this sport.  Comparing 2015 claims to 2016 claims, overall there was a $55,681 savings for the university.  Although this seems like an astronomical amount, considering the impact to non-contact musculoskeletal injuries and associated treatment and/or surgery, then it is easy to see how the cost savings adds up.

As with all our projects, it should be acknowledged that we identify and recognize several flaws with this study.  One is uncontrolled variables.  As with the other study, without a "true" control group, all we could do is compare results to the previous 5 years of injury data and claim submissions.  This introduces a lot of variables that are not controlled.  That said, the most important thing to us is that the university and the athletes see the benefit.  The results are what the results are.  The athletes are happy, the coaches are happy and the school is happy.  At the end of the day, research flaws or not, that is what matters.

So, as we close out this series, let me say, this is not the end all be all.  It is not rocket science.  It is simply the application of what the literature tells us and applying it.  Doesn't mean you have to use the ViPerform AMI or the ACL Play It Safe.  But you can take this approach and methodology and apply it with similar results.  Time and time again, it works.  We just have to do it.  So, how about you and I, work hand in hand and make 2020 the year of change.

Insanity = doing the same thing over and over and expecting different results.  

Stop the insanity and start doing things different today!  If you enjoy this blog, please share with your colleagues, athletes and training partners and please be sure to follow us on Instagram @ bjjpt_acl_guy and twitter @acl_prevention so we can continue to share some of the latest news.  If you happen to be at APTA Combined Sections this year, please come by and see us Thursday where we will be presenting on RTSport Following ACLR.  Train hard and stay well.   

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 also a Brazilian Jiu Jitsu purple belt and complete BJJ/MMA junkie. 

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