Saturday, November 29, 2014
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Goal-Oriented: How to reduce the chance of an ACL tear

Kevin's seen athletes suffer serious, career-altering knee injuries. Here's his advice on how to avoid joining the group.

Goal-Oriented: How to reduce the chance of an ACL tear

There are several theories as to why this may be the case, some of which may not be so obvious.
There are several theories as to why this may be the case, some of which may not be so obvious.

Have you ever suffered a serious knee injury? If so, what steps are you currently taking to ensure that you reduce your chances of hurting that same knee again? The unfortunate part of training and competing in sports is that injuries are a part of the game. Even athletes with the best training programs suffer season- ending injuries.

A hot topic over the past few years has been knee injuries and in particular ACL injuries. This year alone it’s estimated that 100,000 people will suffer an ACL tear with 30,000 of these people being high school athletes. We often hear how females are six to eight times more likely to suffer an ACL injury when compared to male athletes. Having worked with several high school female athletes,  I definitely agree that they are at a higher risk due to their lack of stability as well as their overall strength when compared to male athletes. However, I think everyone should make it a point to implement their own program to ensure that they REDUCE their chances of suffering a knee injury.

I stress the word reduce because often times coaches and trainers tell players that they need to implement an ACL prevention program. Personally I don’t like to use that phrase because unfortunately there is no way that you can prevent an injury but you can greatly reduce the chances of suffering a season ending ACL injury with a solid training program. I believe Coach Mike Boyle said it best when he said that ACL reduction is simply “good training”. By this what I believe he meant was that a solid year round program is the best medicine for reducing your chances of injury.

When it comes to reducing your chances of suffering an ACL injury here are a few key points that I believe need to be addressed in a solid training program. The tips and videos below do not cover everything when it comes to ACL reduction but if you follow some of these tips you will see good results in your training and more importantly your performance on the field, court or track.

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1. Get an assessment from a qualified coach

I would recommend before you start a training program that you get an assessment to see if there are any exercises that you should not be doing. There are many assessments to choose from. Here are a couple that I recommend that you check out:

FMS (Functional Movement Screen)

PRI (Postural Restoration Institute)

2. Start every training program with a good warm-up

A solid warm up should include the following:

Do your best to train in a neutral (pelvis) state. I learned these exercises from PRI (posturalrestorationinstitute.com). 

           90/90 breathing w/ foam roller

Foam Rolling and movement

·         Dynamic warm-up

Mobility work for your ankles, hips and shoulder

·         Wall ankle dorsiflexion

·         Groiners

Linear and lateral movements that progressively get faster as you progress the warm-up.

·         Shuttle runs

Anterior core training

·         Stability ball rollouts

A good warm-up could be accomplished in as little as 8-10 minutes if done properly. What I tell the athletes and weekend warriors that I work with is that this part of the program sets the stage for the training session. If you have been sitting at a desk all day long and then drive to the gym and jump into a “metabolic class/workout” without a proper warm-up you’re asking for trouble. Spend ten minutes warming up to reduce your chances of suffering a knee injury.

3. Learn to land and decelerate properly.

Most non-contact knee injuries happen when we stop rather than when we “take off” (Here is a video of a high school girl jumping at her assessmentWatch as she lands and notice her lack of stability as well as her shin angle when landing (Poor landing mechanics-knee). Before you start any advanced plyometric drills (i.e. repeat box jumps, single leg hurdle hips) I would recommend that you learn to land and stop properly. Here are three exercises that I teach early on in a training program.

·         line hops lateral view

·         Box jumps

·         Mini band knees lateral deceleration

It is very important that you learn to absorb force when jumping and landing. The coaching cues that I use for line hops and box jumps are “land soft” and “stick the landing."

4. Improve your overall strength

Most people would see tremendous benefits in their performance by simply implementing weights/bands into their program. I hear it all the time from athletes as well as weekend warriors the reasons why they can’t implement strength training into their program. Excuses like “it makes me sore” or “I don’t have the time because I am playing five travel games this weekend (that’s a problem in of itself and I will talk about in a future blog).

I’m sorry, but I am not buying any of these excuses. Strength training for the average person who is looking to get strong and reduce their chances of knee injuries does not need to be complicated. A solid strength program will include single leg training as well as bilateral lower body movements and upper body movements. For someone looking to start a strength training program here are a few exercises that would lay the foundation for a balanced and strong body.

·         Split squats

·         Sprinter step up

·         Trap bar deadlift side view

·         Inverted reach to med ball reach

·         Good KB swing

·         Push ups

·         band pull ups

Knee injuries can change your career in an instant. Even if you have no intentions of ever playing a sport again I would highly recommend that you implement some of the strategies mentioned above. If you are a high school coach or athlete I want to challenge you to take a look at your current training program and see if there are any “holes” in your system. A key point to remember is that you have to go through the proper exercise progressions when training.

Personally, I am always looking for ways to make my programs better for the athlete’s that I work with. I know I can improve and most good coaches are always looking to get better results for their clients. I challenge you to take your training to the next level and give yourself the best chance to stay injury free.

Good luck!

Kevin Miller is the strength and conditioning coach for the Philadelphia Union. For more on Miller and the Union, visit philadelphiaunion.com.


Read more Sports Doc for Sports Medicine and Fitness.

Kevin Miller Fitness Coach, Philadelphia Union
About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Martin J. Kelley, PT, DPT, OCS Advanced Clinician at Penn Therapy and Fitness, Good Shepherd Penn Partners
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Health Producer, Philly.com
Tracey Romero Sports Medicine Editor, Philly.com
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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