acl prevention women
TRANSCRIPT
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ACL Injury Prevention
Training Female Athletes to Training Female Athletes to Beat the OddsBeat the Odds
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What is the ACL?
● Ligament that spans from the anteromedial tibia to the posterolateral femur.
● Provides primary stability to anterior tibial translation , internal tibial rotation, and hyperextension.
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How is it injured?
● ACL injuries occur most frequently in planting, cutting, and pivoting sports.
● Female athletes are 4 to 10 times more likely to injure their ACL compared to male athletes participating in the same sport (Hughston Health Alert, Hughston Sports Medicine Foundation. 2002).
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mechanism of injury...
● Twisting / pivoting
● Hyperextension● Landing on a
straight knee
Most Injuries Most Injuries are “non-are “non-contact”contact”
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Why do women suffer from an increased
incidence of ACL injury?● Theories:
• Anatomical Differences• Hormonal Differences• Ligament Laxity• Learned Factors (conditioning)
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Anatomical differences
● Intercondylar notch• women tend to have
a narrower intercondylar notch
• less room for ACL to move (esp. during twisting and bending)
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Alignment of the knee...
● Women have a wider pelvis = greater Q-Angle
● Twisting and valgus forces on knee tends to increase
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Hormonal Influences
● Estrogen?● Relaxin?
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Estrogen
● Preliminary research indicates “estrogen receptors” on ACL
● Current research is focusing on the incidence of ACL injury compared to phase of menstrual cycle.
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Relaxin
● Relaxin: Hormone released by pregnant women• Causes increase in ligament laxity
(allows for relaxation of pelvic girdle to accommodate fetal passage).
● Has been shown to have systemic effect and risks of ligamentous injury in pregnant women.
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Ligamentous Laxity
WIDER PELVIS FEMORAL ANTEVERSION GENU VALGUM EXTERNAL TIBIAL TORSION LIGAMENTOUS LAXITYOF OTHER SUPPORT
STRUCTURES
INCREASED "IMPULSE" ONLIGAMENTOUS STRUCTURES
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Learned Factors
● Muscular Strength/Power
● Jumping / Landing
● Cutting / Deceleration
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Strength/Power
● Men tend to have higher strength-to- weight ratios compared to women
● Men tend to have lower quadriceps-hamstring strength ratios compared to women
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...Strength/Power
● Quadricep / Quadricep / Hamstring Hamstring Strength RatioStrength Ratio• Males: 70%
• hamstring power & strength serve as agonists to the ACL
• Females: 50%
• depend on ligaments to protect knees on landing
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Jumping / Landing
● Experience?● Research indicates
that women land w/ straighter knees and hips compared to men.
● Women tend to land w/ genu-valgum (pivot -shifts the knee)
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Cutting / Deceleration
● Women tend to turn & pivot in a more erect position compared to men
● Lack of hip & knee flexion requires ligaments to absorb the force rather than the hip musculature.
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Training to Prevent Injury
● Focus on Strength / Power / Endurance
● Focus on Correct Landing Mechanics
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Correct Mechanics
● Knee should align with great-toe
● Force should be absorbed by powerful hip musculature.
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…common mistakes
● Due to increased Q-Angle, women often land from jumps in a “knock-knee” position
● COG moves downward, causing twisting of tibia on femur
COGCOG
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…common mistakes
● Again, knee position should be aligned with great toe upon landing
● Normal tibio-femoral relationship will exist
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How To Develop an Injury Prevention
Program For Your Team● Points to Emphasize:Points to Emphasize:
• Overall conditioning: most injuries occur late in practice/game
• Program periodization: adjust intensities and volume to account for in-season playing
• Multi-Phase Jump Training: you must allow for large learning curve and strength development.
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Overall Conditioning
● Cardiovascular and muscular endurance should be established early
● Flexibility training must be continually emphasized
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Overall Conditioning...
● Metabolic training: Training should be specific for metabolic demands of sport (i.e. do volleyball players ever run a mile continuously during a game?).
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Program Periodization
● Adjust training volume, intensity, and technique to allow for adequate recovery and adaptation
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Multi-Phase Jump Training
● Training should allow for several distinct phases• Strength Development• Deceleration Technique Training• Performance-Oriented Training
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Strength-Development Phase
● Include exercises for all body parts.● Volume should be relatively high
(reps: 8-12, sets: 3-6 transition to reps: 4-8, sets: 2-4)
● Abdominal “Core” training should be included during all phases.
● Include exercises which emphasize force absorption...
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Parallel SquatParallel Squat
Romanian Dead-Lift Romanian Dead-Lift (RDL)(RDL)
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Dumbbell LungesDumbbell Lunges
Glute-Ham RaiseGlute-Ham Raise
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Step-upsStep-ups
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Static & Dynamic Balance Training
Stork-StandsStork-Stands
Stability-Ball ProgressionStability-Ball Progression
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Deceleration Technique
● Continue with previous exercises
● New exercises should emphasize decelerating through the HIPS & Torso and Change-of-Direction
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Lateral LungeLateral Lunge
Step-DownStep-Down (emphasize (emphasize torso flexion through hips)torso flexion through hips)
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Lateral Step-DownLateral Step-Down
Squat-JumpSquat-Jump
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Jump To BoxJump To Box
Box-Drop & Box-Drop & HoldHold (freeze (freeze
@ 90°)@ 90°)
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Performance-Oriented Training
● Add exercises that emphasize explosiveness through hips & knees
● Focus on “Rebounding” from landing position
● Gradually shift to high-level plyometrics and unilateral movements
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Depth-Jump w/ reboundDepth-Jump w/ rebound
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Lateral Box-HopsLateral Box-Hops
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Zig-Zag Barrier-HopZig-Zag Barrier-Hop
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Depth-Drop w/ Change of DirectionDepth-Drop w/ Change of Direction
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Single-Leg Depth JumpSingle-Leg Depth Jump
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helpful hints...
● Never use Never use concrete landing concrete landing surfacessurfaces
● Proper footwearProper footwear-no running shoes, boots, or sandals!
● Allow for Allow for recovery!!!recovery!!!
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Remember...
● Always emphasize proper landing technique
● Allow for “learning-curve”
● “Teach” everyday!!!
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Questions ?Questions ?
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Thank You!