Stay Safe and Perform Better – ACL Prevention Program

ACL

A couple weeks ago, I got the chance to dust off my golf clubs and go to the driving range. I hit 100 golf balls with four different clubs, and all of them went the same distance. I know that isn’t how it’s supposed to work, but hey, I never said I was good at golf. I just have the dream of hitting a hole in one, so I looked up the odds and it is about a one in 3,500 chance. Given that I can’t hit the ball like a pro, or even a good amateur, my dream will probably never happen, but I’m always going to prepare for the day by striking the ball whenever I get a chance.

From an odds standpoint, one in 3,500 is about .02 percent, which is a long shot, but accounts for approximately 100,000 people this year in the United States. These odds are the same as the possibility of tearing your anterior cruciate ligament (ACL). For the same reasons I go out year after year and practice hoping for a par, I’d encourage you to make a small effort to work on lowering your chances of tearing an ACL with an ACL prevention program.

ACL prevention programs have been created and mixed into teams warm-ups, cool downs and off-season lift programs and have been shown to be helpful. Research shows 75 to 85 percent less ACL injuries happen when athletes are on an ACL program. Programs are usually three-times per week and take about 30 to 45 minutes to perform or, in my experience, about 15 to 20 minutes of additional work onto the normal warm-up and cool down of a team sport. It’s no guarantee that you won’t tear your ACL, but if you can practice for your sport to get better, why not make a small investment in making sure you can potentially avoid a nine- to 12-month rehabilitation process, too?

A simple ACL program looks something like this:

  • Warm-up
  • Jogging – Two minutes forward, two minutes backward and two minutes of side shuffling
  • Stretching – Thirty seconds on each of these muscle groups:
    • Calf
    • Quad
    • Hamstring
    • Groin
    • Glute
    • Hip flexor

This should look similar to a basic high school gym class warm-up.

Agility Drills – During agility drills, look to maintain your balance. Have your knee stay behind your toes and do not allow your knee to sway toward the opposite side of your body.

  • Bend over and touch a ball on the ground in front of you 10 times.
  • Balance on one leg in a mini squat for 60 to 90 seconds while dribbling a basketball, playing catch or trying to kicking a soccer ball.

At this point, we added approximately five minutes to your warm-up, and you should be ready to perform your normal practice, pick-up game or workout.

Strength Portion – After your workout, perform strength exercises that reinforce proper mechanics of jumping and landing and help you control your body while you’re tired. Most injuries happen to people when they are tired or near the end of a game because they lose focus on controlling their body.

During this strength portion, you should be looking to stay focused, keep your knees from going toward each other during the landing and land softly and on the balls of your feet.

  • Squat jumps with two second hold at the landing 10 times
  • Tuck jumps 20 times
  • Lateral jumps 10 times each side
  • Lunge 10 times each side
  • Plank two times for 30 seconds front and each side

Cool Down – Perform your normal cool down or a nice foam rolling session.

An ACL prevention program doesn’t guarantee you won’t tear your ACL any more than me hitting the driving range three times per week to help fix my golf swing will guarantee me a hole in one, but it doesn’t mean I’m not going to go out and try. I encourage you to take a few extra minutes to help prevent an ACL injury, and I hope your extra work is fruitful to your sports performance and ACL injury prevention.

By: Bryce Vorters, M.S., ATC, LAT. Bryce is the head athletic trainer with NovaCare Rehabilitation 

Ice Hockey Injury Awareness and Prevention

By Brian Rog and Katie Christopherson, ATC for ATI Physical Therapy

Ice Hockey Injury Awareness and Prevention from ATI Physical Therapy

Behind any sport’s glory lies a complex algorithm so delicate that even the slightest miscalculation in training or performance can cut a practice, game or season short. High-intensity, year-long sports like ice hockey, adhere to a very complex set of rules due to the on-ice demands and endless fitness requisites. In keeping up with these standards, as a player, coach or parent, it’s important to be educated on gear safety, strength & conditioning, skating technique and return to play rehab protocols.

With the help of ATI Physical Therapy athletic trainer and seasoned hockey player, Katie Christopherson, we’ll take an inside look into common hockey injuries, injury prevention tips and stretching recommendations to help you relish the game and all its glory. Adding to this, our friends at ProStockHockey supplied us with an insightful upper body injury infographic , which underscores the importance of choosing the right equipment.

What are the more common hockey injuries treated in the clinics?

When it comes to hockey injuries, regardless of age and skill level, we commonly see injuries to the head, shoulders, hips, knees, feet, and ankles. Injuries linked to the body parts mentioned above can be assessed and rehabbed in a physical therapy clinic. Head injuries are an exception to this as most rehab clinics are not staffed with head injury specialists. However, at select ATI locations, we have specialists credentialed to treat head injuries and their accompanying hindrances.

Within the sport, hockey injuries are traditionally classified as either chronic (overuse) or acute (more traumatic). So when you hear of a player suffering ‘an acute concussion’, you’ll know the level of injury the athlete is dealing with. Looking deeper into these common hockey injuries, here’s a breakdown of the top-4 and their contributors:

Shoulder injuries

It is common to find rotator cuff and glenohumeral (ball and socket joint) injuries being treated in clinics.  The rotator cuff is a group of stabilizing muscles that are frequently used with stick handling in hockey.  Shoulder dislocations and AC joint sprains are common due to checking in hockey as well and require physical therapy to correct.

Hip injuries

In the hip, you will find a lot of groin muscle strains due to a misstep in skating or getting caught up in the boards or another person’s leg or stick.

Knee injuries

In the knee, our clinics more commonly see MCL sprains and/or meniscus tears, which result from twisting of the knee or direct impact to the outer side of the knee.

Head injuries

Given the full-contact nature of hockey, it’s no surprise we see a steady stream of head injuries such as concussions. Head injuries can have very serious consequences and require immediate medical attention, so don’t ignore the warning signs.

How can a hockey player lessen the risk of injury? 

To help lessen the risk of injury, a player must undergo proper training, wear sized-appropriate protective gear, and follow proper rehab protocols when returning from an injury.  Before tackling this checklist, it’s important to know that roles will vary according to a player’s position on the ice, whether it be a forward, defensemen or goalie.  These roles vary by position, so following position-designated strengthening, skating technique, gear, and return-to-play rehab protocols will help you better adapt to role-specific scenarios.

For instance, if you are a forward, the position does not demand as much backwards skating as a defensive position, however both positions utilize forward-skating crossover techniques, so in some cases you’ll borrow tactics from other positions.

Irrespective of position assignment, it’s strongly suggested that as players move through the ranks they should work towards a versatile role, meaning they can assume the duties of a defenseman (or forward), if needed. Doing this helps a player better adapt to varying on-ice challenges, both physically and mentally. The anomaly to this versatility rule is, of course, the goalie, since this position will never assume the role of a d-man or forward. On the flip side, you won’t see a skater step into the crease, unless of course you are Kris Russel of the Edmonton Oilers who holds the record for most blocked shots in one game at 15.

Since we are talking goalies, which is by far the most unique and laborious position on the ice, let’s take a look at what we know and have seen as far as injuries and conditioning strategy. Given the dynamic duties of a goaltender, we most commonly treat hip injuries resulting from squatting positions, quick side-to-side transitions and knee-to-ice movements that necessitate major hip rotations.

Similar to a forward or defenseman, a goalie must also understand the mechanics of the position and the levels of mobility needed to meet the grueling demands of the position. What makes this position even more unique is that on top of recognizing one’s own mechanics and strategies, a netminder must also learn the mechanics and strategies of a skater to better prepare their physical responses.

Once you’ve identified your role on the ice and importance of training and rehabilitation guidelines for each position, it comes time to establish a more thorough, role-specific training and injury-prevention program. For a forward or defenseman, this program must combine a focus on strength, speed, flexibility and endurance. With a goalie, their program should be similar to their teammates, however, he/she must follow a program that has an increased focus on flexibility, strength and endurance.

Avoiding injuries with the proper gear

The main thing to remember when outfitting yourself (or someone else), is to make sure the gear is appropriate for the position (i.e., skater vs. goalie) and that it fits properly. With this, you must also consider proper stick lengths and shape as well as the way a hockey skate fits and the skate’s blade radius. And yes, even the sharpness of the hockey skate blade can affect the player due to on-ice variables such as one’s position and softness/hardness of the ice.  Making yourself and others aware of these things and taking appropriate action can help to lessen the severity and occurrence of on-ice injuries. For helpful tips on properly outfitting your equipment, check out this hockey equipment fitting guide from the experts at Dick’s Sporting Goods.

Corrective stretches that can help to minimize injury risk 

Research has proven that including dynamic (mobility stretches) and static (stationary stretches) stretches will not only improve your endurance and balance, but will also lessen the risk of injury. While the aforementioned benefits are well known across the athletic community, the timing of the stretches (warm up/post-game) are commonly up for debate. ATI’s physical therapy experts suggest focusing on dynamic stretches before hitting the ice and static once finished, which include:

Dynamic stretches before hitting the ice

Dynamic hockey warm-ups, which are great for getting the heart rate up and enhancing range of motion and power, can be done on land (without gear) or can be done once you hit the ice.  Some beneficial flat-land warm ups include exercises such as high knees, hip swings, arm swings, butt kicks, karaoke, side steps and ankle hops. For dynamic on-ice exercises, consider hip circles, arm circles, leg swings, Cossack squats and trunk rotators.  The warm-up should take around 15 to 20 minutes all together and does not need to include static stretches as this will not help elevate your heart rate, which is an essential ingredient to priming the muscles for activity.

Static stretches after a game or practice 

Hockey players of all levels incorporate some form of static stretching after a game or practice without gear. The post-activity stretch is key in preventing injuries as it helps with maintaining flexibility and lowering recovery time. Examples of static stretches include, reaching for toes (hamstring), butterfly (groin), hollywood or secretary stretch (low back), flamingo (quads), lunge stretch (hip flexors), piriformis (hip/glutes), and IT band stretch (side of leg/hip).  These are all important in supporting flexibility and helping stay injury-free.

Preventing an overuse injury

There are multiple steps a skater can take to help prevent an overuse injury.  First off, as is the case in all sports, proper training is the cornerstone for achieving peak performance and fitness levels. In doing this, avoid going from minimal levels of activity to a high level as your chances of injury or muscle strain are significantly increased.

When training, also pay close attention to your form when doing cross-overs, skating backwards, and working on shooting technique. Over time, improper form places unnecessary loads on the muscles, causing them to break down. As a result, recovery times become lengthy and rehab programs exhausting.

This brings us to our last point on the role warm-ups and post-activity stretching play in shielding your muscles from injury. Including some form of dynamic warm-up before activity as well as static stretches afterward can be very beneficial for muscle sustainability, wellness and recovery. It’s been stated that well-structured warm-ups and stretches will get your heart rate and muscles ready to handle a heavy load while post-activity stretching allows your heart rate to decrease, causing your body to idle down into a resting state.

Managing hockey injuries, aches and pains

ATI experts strongly encourage athletes to take care of any minor aches and pains before they compound and get worse.  This can be as simple as heating for 20 minutes before activity and icing for 20 minutes after activity when the athlete feels soreness in one particular area.  If the pain persists, it might be a good idea to call your physician or visit your nearest ATI physical therapy clinic. In fact, at ATI, we offer complimentary injury screenings, so stop in and see what we can do for you.

TISSUE BANK EMPLOYEE BECOMES TISSUE RECIPIENT

RECIPIENT OF: PATELLA LIGAMENT ALLOGRAFT

H.C. Martensen works in the AlloSource tissue processing core where he is faced with the powerful realities and possibilities of tissue donation and transplantation every day. He also has the utmost confidence in the allografts that he and his tissue bank colleagues produce, so much so that he recently requested one for his own transplant.

Over the summer H.C. returned to his former university, Colorado College in Colorado Springs, for an alumni soccer game. He played on the team in college, and since then remained very athletic, participating in triathlons and skiing. However, at the time of the game, it had been a while since he’d played soccer. Following a cutting motion on the field he felt his leg let go below the knee. H.C. instantly knew what had occurred, not only because of his work, but also because a close friend had sustained a torn ACL just
three days prior.

Shortly thereafter a surgeon confirmed it – H.C.’s ACL and lateral meniscus were torn
and he needed surgery and an allograft transplant. Although the surgeon did not
historically use allografts from AlloSource, H.C. made a special request to have his
graft come from the tissue bank. His surgery required a patella ligament bone-tendon-bone graft, which he received from a 33-year-old male donor.


“Just a few years older than me,” H.C. said. “It added to the perspective that I’ve had.

I’m presented with the reality of the business we’re in everyday. Seeing young donors come in is hard. Now that I’ve personally benefitted I’m further grateful for the gift of donation and even more aware of what we do.”


Since his surgery in June, H.C.’s recovery has been progressing very well and he just
completed his final functional evaluation in physical therapy. Although his knee isn’t yet 100%, he knows it shouldn’t be back to normal this soon after the injury, and his road to recovery has been swifter than other patients with similar injuries. Of course, H.C. intends to make the most of his gift of life – he will be training for triathlons.

Considerations for Returning to Soccer after ACL Surgery

By Dan Czajkowski, PT, DPT, ATC, CSCS for Athletico Physical TherapyConsiderations for returning to soccer after ACL surgery

You’re almost there. The initial ACL injury you sustained months ago seems so distant. You’ve endured all the time healing from the surgery, the rehab, and now you are pushing ahead to get better, stronger and faster. You can almost taste the grass, outperforming your opponents, and scoring a goal in the final minutes of the game.

But wait. Despite finishing rehab and being cleared to progress to sports specific activities, you haven’t even run on grass yet. You haven’t tried cutting at full speed. You haven’t practiced your best moves or even shot at a goal, let alone scored against anyone. You can see the finish line of your recovery, but you don’t really know exactly what you need to do in order to get there.

Many soccer players coming back from an ACL surgery don’t always know the best way to get themselves back on the field safely. However, the secret is simple – start small, stay consistent and progress slowly. Here are a few things to take into consideration as you work toward getting back onto the field:

1. Start by getting fit.

Soccer is a unique game that includes sprinting, changing direction and endurance. You need to train all these factors to be successful, especially when coming back from an injury where you haven’t trained in months. You will need to train yourself in a variety of ways. A few examples are listed below:

  • Interval sprinting and jogging progressions (i.e. jogging for three minutes, sprinting for two minute and repeating for 30 minutes total)
  • Deceleration and Acceleration (i.e. sprint 5 yards and back to endline, sprint 10 yards and back to endline, etc)
  • Endurance running (i.e. 2-4 miles long run)
  • Agility (i.e. sprinting in Box Shape, agility ladder, 5 or 10 yard zig-zag sprints with cones)

2. Start small with your ball skills and progress very slowly

Even though this is usually the most fun aspect of training for soccer, your knee will need time and practice to get used to manipulating the ball. Start by doing simple moves (i.e. turning, using in/out of foot, tic tocs, roll-overs, etc). Gradually increase your speed of the movement as well as sprinting a few steps after finishing your move.

The same progression goes with passing, crossing and shooting. Start out with kicking the ball in place or using a wall to perform short one and two touch passing. Gradually increase your distance as you get more comfortable, and then start passing while you jog, followed by passing while you sprint.

3. Always work on and perfect your cutting/jumping mechanics.

Just because you are training on your own does not mean that you neglect your responsibility to progress, which can help to prevent future injury. As you get stronger, you will need to learn to control your body and keep your knee stable. ACL Injury prevention programs that focus on improving landing and cutting strategies as well as neuromuscular control have been shown to reduce the risk of injury. The trick with these drills is to land with a soft-landing and maintain a half squat position (i.e. slight forward lean, knee bent and knee aligned over ankles). Practice performing two-leg and one-leg jumping in a variety of directions, including forward, sideways, diagonally and over hurdles. Doing 5-10 reps in each direction can help improve your performance and decrease the risk of injury.

4. Perform SAFE strength training under fatigue.

Soccer is a demanding sport. You will be in situations when your body is tired and fatigued, but you don’t want to let your knee become unstable due to this. Performing strength training after you run or perform a workout that fatigues your body can help improve your knee stability. You can perform a 5-10 minute high intensity sprinting workout and then perform body weight or light weight exercises. Some useful exercises include single leg squat, Bulgarian split squats, side walking with a theraband, or single leg balance on an unstable surface. It is import to make sure you have excellent form (keeping trunk stable, knee aligned forward and behind your toes, etc) when performing these exercises. Keep in mind that strengthening routines can also be performed prior to fatigue and have still been shown to reduce re-injuries as well.

Getting Back on the Field

The journey to returning to sport is long, tiring mentally and physically, and takes a lot of hard work. However, many athletes are successful in this journey and you can be too!

Make sure to consult your physical therapist if you have any questions about your recovery process or how to effectively return to sport during your journey. For information about Athletico’s ACL 3P  Program, which can help athletes minimize the risk of ACL injury as well as help those who have experienced an ACL injury progress after surgery, please email ACL@athletico.com.

TISSUE RECIPIENT COMPETES IN IRONMAN TRIATHLON

Rachel was a typical college athlete: focused, intense, and determined. When a knee injury threatened her ability to complete in her final soccer season, she simply played through the pain.

It wasn’t long before Rachel discovered she could no longer “grin and bear” her meniscus injury. She had to have the injured tissue replaced with an allograft – sidelining her for months from any physical activity.


“It was a difficult decision,” recalls Rachel. “But movement is everything to me. I knew I had to have the procedure.”


Today, Rachel went back to competition. In fact, she completed the Hawaii Ironman 70.3 Triathlon in May 2009, something she only dreamed of prior to her allograft meniscus replacement.

Inspired by her experience, Rachel chose orthopedics as her field of specialty in medical school as an MD candidate at Rush University Medical Center.