Monday, September 14, 2020

2020 Sports Season: Proceed With Caution - A Clinical Commentary

As a sports medicine physical therapist, I have been blessed to work with high school, collegiate and professional athletes for 24+ years.  As most of you know, I have devoted the majority of my professional career to a calling.  The calling of prevention.  Although it started in ACL prevention, it has expanded to all preventable lower limb injuries.  This started over 20 years ago and is a part of what I do every hour, every day.  With the commercial launch of the DorsaVi ViPerform AMI (athletic movement index), adoption in professional, collegiate and sports rehabilitation, this has allowed access to a level of data that previously was unobtainable in our industry.  With this work and associated research, this has afforded me the opportunity to travel and work with the industries best orthopedic surgeons, physical therapists and athletic trainers in the US.

COVID-19 has impacted all our lives in ways we may not full realize yet.  One thing that happened across the US, was that there were 10s of thousands of athletes who had ACL reconstructions (ACLR) who were no longer able to continue with their one on one physical therapy.  Most had access to their therapists via telehealth.  As good as that may be, it is never as good as one on one physical therapy.  For some athletes, this was only a minor inconvenience lasting only a couple of weeks.  However, for 1000s of our athletes, this meant months of no one on one therapy.  These athletes had to rely on what their PT could see over the computer, instruct over the computer and the hope that the athlete continued with their individualized program correctly.  One of the things we do prior to returning an athlete to sport is we run them through a series of tests (ViPerform AMI).  This test measures how stable the athlete is through a series of sport related movements.  This gives us a good indication on whether or not the athlete is physically ready for the rigorous demands of sports and stable enough to not stress their reconstructed ACL.  

For definition purposes, I am going to refer post-COVID.  What I mean is athletes who have been undergoing rehab via telehealth and not had traditional regular pre-COVID PT.  This DOES not refer to athletes who have had COVID.  Having defined that, if we compare our athletes who have been tested at 6 months, 9 months and 12 months post ACLR pre-COVID to those who we testing now post COVID, we see an alarming drastic difference.  Those athletes who we are testing post COVID have much greater quadriceps deficit, much less control of dynamic valgus in single limb performance, much greater speeds of valgus in single limb testing and less pelvic and core control.  These athletes, on the average, are 3-4 months behind what we see in pre-COVID test results.  This is extremely alarming since these athletes think they are at 6 or 9 months post ACL when in reality, they are functionally where they are typically at when at the 3 to 6 months post op mark.  

I don't ever preach what someone should do but as a parent of an athlete and someone who functions in this area 24/7, if my child had an ACLR and their rehab was done during COVID-19, I would seriously consider taking a season off to prepare for next season.  Statistics for re-injury with return to sport are not great.  Mark my words, this year, it will be 2 to 3 times what it has been in the past.  In addition to the ACLR athlete, we also have a high incidence of ACL injuries in athletics in the US during a normal season.  This year, we are starting seasons with 1/2 of the normal conditioning time coming off an unprecedented time in our history when athletes did NOT have access to training facilities.  For 80-90% of athletes, this means they are going into a season in a deconditioned state.  One thing that the research is very clear on is if you take a deconditioned athlete into a normal sports season with normal preseason conditioning, the likelihood of injury is high.  Now you shorten the pre-season conditioning and you compound that problem even more.  

I don't say this to discourage athletics this season.  I say this to encourage us to think through what this should look like on an athlete by athlete basis.  I, as well as many of the leading experts in sports medicine, have a great fear of the injuries we will see this year.  We think we are about to see an unprecedented number of ACL injuries and concussion.  That is why I am devoting the next two series to The Dreaded ACL Injury and Concussion.  I will put screenings you can do with your athlete as well as some exercises to improve performance.  For those looking to get their athlete assessed, there are over 400 providers across the US using the Viperform AMI.  Feel free to DM on instagram @bjjpt_ACL_guy or twitter @ ACL_prevention.  I hope you enjoy this series, God Bless and keep safe.


Dr. Nessler is a practicing physical therapist with over 23 years sports medicine clinical experience.  He is a nationally recognized expert in the area of athletic movement assessment and injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program, author of a college textbook on this subject and published researcher.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He is the President of Rebound Vitality providing injury prevention services for the tactical athlete 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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