Dealing with Anterior Cruciate Ligament Injury

By Jess Walter

Anterior cruciate ligament (ACL) injuries are common in sports such as football, basketball, netball, and alpine skiing. They have a big impact on athletic performance, because approximately 79% of people go on to develop knee osteoarthritis after an ACL tear. A study by T Nessler et al called ACL Injury Prevention: What Does Research Tell Us? stresses the importance of ACL injury prevention as a way to avoid the long-term effects of this injury. It all begins in youth – programs which utilize neuromuscular training and strength training at a young age show the most promise in reducing ACL injuries.

What Does An ACL Injury Involve?

The anterior cruciate ligaments (ACL) is found inside the knee joint. It provides the knee with rotational stability and stops the tibia from sliding out in front of the femur. An ACL injury occurs when this ligament is torn, most during sports that involve sudden stops, changes in direction, or jumps. Its symptoms include a popping sensations in the knee, severe pain and inability to continue practicing sport, swelling, a reduced range of motion, and the knee giving weight when bearing weight or playing one’s normal sport.

How Can ACL Injuries Be Prevented?

As mentioned above, the earlier neuromuscular and strength training take place, the better. Prevention programs show a high success rate (52% in female athletes and 85% in male athletes) when preventive programs are adopted. There are six important components of a prevention program: early age; correct sports movements; consistency of sessions; frequency (sessions should last 20 to 30 minutes and commence pre-season), feedback; and exercise variety. There are three main components of an ACL prevention program: plyometrics (focusing on good technique in movement); neuromuscular training (which work on balance and stability); and strength training combined with resistance training.

What Treatments Exist for ACL Injuries?

Treatment for ACL usually involves several weeks of rehabilitation involving exercises provided by a physiotherapist. Injury is sometimes recommended for athletes who will need to perform jumping, pivoting and cutting movements regularly, or for those who have more than one ligament or cartilage injured. During surgery the damaged ligament is removed and replaced with a tendon graft taken from a donor or from another part of the knee. New tissue then grows over this graft. The process of recovery is long and can take between eight and 12 months of rehabilitation.

If you are a professional athlete, ACL prevention is key, simply because treatment is long and the reinjury rate is high. Studies have shown that around 2.3% to 13% of those operated can have a similar injury after surgery. The knee joint is a complex network of tendons, bones, and ligaments so if you are in pain, it is vital to determine the exact cause of the problem so treatment can commence. From an early age, athletes should undertake exercises focusing on strength, balance, and stability, to enjoy their sport in an injury- and pain-free manner.

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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.

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Snow Skiing as a Natural Anti-Aging Remedy

By Brian Rog for ATI Physical Therapy

Snow Skiing as a Natural Anti-Aging Remedy

Contributions by: Peter Braun MS, LAT, ATC, ITAT

The effects of time on one’s body are unavoidable and often substantial. Many of us in the field of medicine are in an endless search to find the perfect sport, activity or exercise that will unlock our physical potential, well into our years. Scientific research has found that there are certain factors that contribute to longevity and sustainability. Bone density, lower extremity strength, balance and cardiovascular endurance all play critical roles in maintaining a physically active lifestyle. With this, physicians make an effort to integrate these factors into exercise plans for much of our elderly population. But what if there was a simpler answer? What if we could prescribe involvement in a recreational activity that naturally addresses all these areas? As we unravel the details, we challenge the question; “Is there such a thing as an anti-aging activity?”

Snow Skiing and bone integrity

As we dive into the leading factors that affect our ability to remain physically active, it is important to begin by discussing the foundation of our musculoskeletal system: our bones. Proper bone integrity allows our joints and muscles to function at peak levels. As more research is released clarifying the comorbid factors associated with aging, we are realizing how important bone density truly is. As we get older, it is natural to lead a more sedentary lifestyle. This reduces the forces exerted on our bones and leads to less deposition and remodeling. Consequently, bones become weaker and more fragile.

There is also a threshold where forces may be too much for a bone to adequately tolerate. Therefore, we don’t see many 60 or 70-year-olds participating in heavy plyometric type activity that requires sprinting, jumping, or heavy lifting. What makes skiing so unique is that the peak force exhibited on the bone is achieved over a longer period of time compared to other activities. If someone is running, the peak force at heel strike happens instantaneously and stress is quickly translated through the bones. In skiing, this process is lengthened due to the natural mechanics of a turn. As we begin to turn while skiing, ground reaction force increases and it doesn’t achieve maximum force until the dynamic center of the turn, and gradually reduces as we bring the skis back underneath the body. There is no sharp or sudden spike in pressure or force. This allows for a healthy and acceptable loading of our joints and bones, which optimizes remodeling.

Snow Skiing and lower extremity strength

Lower extremity strength has been promoted by many as a key to upholding a physically active lifestyle and essential to healthy aging. The biomechanics of a skiing turn activate all lower leg muscles in a complex and symmetrically balanced fashion. The intrinsic muscles in the foot are important to control edge initiation and release. These muscles are also essential to foot rotation, which affects the degree and engagement of an edge throughout the turn. The muscles of the lower leg are important for staying balanced and continuously adjusting to the changing pressure and contact with the snow.

Even during various parts of the turn, the hip flexors, quadriceps and hamstrings help create dynamics and proper leg lengthening necessary to carve and ride the edge of the ski. The core, hip flexors, hip rotators, hamstrings and glutes all work harmoniously to transition our body from the initiation of the turn through to its completion. These muscles are stressed, more or less, depending on the size and shape of the turn, slope of the hill, and conditions of the snow.

The combination of all these components create an exceptional foundation for strengthening. In addition, skiing requires a diversity in motor activation patterns, therefore resisting motor specificity and repetition. The movements of skiing are so complex that when coupled with the aid of gravity and slope as we ski downhill, chronic injuries are minimized when compared to many other recreational sports-activities.

Snow Skiing and the role of balance

Balance is another function that tends to decline with age. The rate of falls and severity of resulting injury are often fatal in the elderly population. There are many contributing factors to one’s overall capacity to stay balanced. It is important to recognize that even as we challenge this system there may be limiting factors, whether centrally or peripherally, that inhibit our skills as we age. But there are few other sports that challenge the body in such a dynamic and functional way as skiing. Proprioception is arguably one of the most important skills in skiing. Awareness of our limbs in space allow us to successfully stay standing as we move down the hill. Even in a static fashion, as we click into our skis there is an immediate and drastic reduction in friction under our feet. This makes even the most finite movements more substantial and challenges our joint awareness and control.

As we begin the move down the hill and turn our skis, this skill becomes exponentially more difficult. Our movements, pressure, center of balance, turn dynamics, turn radius, as well as the snow conditions all affect how we need to position our body over our skis. Furthermore, the skier often must be reactive to many of these factors. To put all this in perspective, it would be like executing a balance exercise in the clinic wherein the surface that we are balancing on is changing, while simultaneously shifting weight from side to side, alternating single leg stance, and also reacting to a stimulus (such as catching a ball). Tremendously complex, right? If there are any benefits of proprioceptive training to improve overall balance as we age, you will definitely see the results if skiing is incorporated into your lifestyle.

Get active, and stay active

Individuals in the physical therapy profession and others in the medical field are continually trying to encourage others to enroll in an active lifestyle. We can all agree, regular exercise is important, but leading a life that incorporates consistent and regular activity throughout the days is the main goal – and it shouldn’t stop at 10,000 steps. What we are doing during the time we are not accumulating steps is just as important. When we observe the scope of different activities we can perform to stay physically active, none are quite as sustainable as skiing. Most skiers set aside an entire day to enjoy time on the mountain. Even other sports that are notoriously lengthy such as golf, hiking, or long distance biking and running, don’t even remotely match an eight hour day.

Although activity isn’t continuous, a single run on the slopes, which typically takes only a few minutes, is just enough time to increase the heart rate and stress the musculoskeletal system before resting on the chairlift. This is a perfect combination of rest and exercise that can easily fill an entire day. The sustainability of skiing is what makes it stand apart from most other sports activities. If the overall goal is to create a physically active lifestyle, skiing may be one of the few solitary solutions that can achieve this goal.

We will never be certain as to what is the best thing to do to resist the effects of aging. Our genetics, our bodies, and our history all have a role that is too intricate for us to predict. However, if there’s one thing that is definitive, it’s the positive impact that exercise and activities like skiing brings to someone’s well-being.

Dealing with a lower body injury?

Recognizing and assessing an injury is the first step in ensuring a speedy and effective recovery. Most individuals are led to believe that surgery or opioids are their only lines of defense when dealing with an injury. Instead, consider physical therapy as a first course of action, even if it’s only a screening, which are complimentary at all ATI locations. Recent research suggest that people who underwent physical therapy enjoyed faster recovery and less pain than those who chose alternative routes such as surgery and opioids. Give PT a try!

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Cross Country Skiing: Benefits and Injury Risk

By Tara Hackney, PT, DPT, OCS, KTTP for Athletico Physical Therapy

Benefits of Cross Country Skiingcross country skiing benefits and injury risks

Cross country skiing is a relatively low risk sport and is great for people of all ages. Skiers can perform this activity for fun or for a workout in winter months. Skiing provides both an upper body and lower body workout and is also a great cardiovascular workout. It is a great activity for aerobic fitness and calorie burning. Cross country skiing does not stress one muscle group more than others, therefore it is a good option for longer duration workouts with low risk for traumatic injury.

In contrast to downhill skiing, crashes and falls are less frequent in cross country skiing. Downhill skiers generally sustain more severe and complex injuries due to the higher speeds than cross country skiers.

Possible Injuries in Cross Country Skiing

Although cross country skiing is lower risk than downhill skiing, injuries can still occur. Low back pain can be a concern for cross country skiers due to the repetitive nature of the sport in a forward flexed position. Compared to control subjects, cross country skiers reported significantly more back pain than their counterparts, however the long term consequence of this is unknown and may not be an issue.

For those that are worried about low back pain while cross country skiing, a good core strengthening program can help protect the back. An easy way to strengthen the core at home is by performing planks. Planks require no equipment and activate the abdominal muscles that support and help protect the low back.

There is also a risk of lower body injury in cross country skiing. One study found the foot and the knee to be the most common area reported for injury in cross country skiing. Injuries to these areas are generally foot/ankle sprains or sprains of the knee. This could be caused by a fall where the leg is twisted.

Lastly, there is a risk for “skier’s thumb” in cross country skiing. Skier’s thumb is a sprain of the ligament on the inside portion of the thumb. This injury can occur when a skier falls with a pole in hand. There are thumb stabilizers available to help prevent this injury, but skiers can also avoid putting their hands through the ski pole loops unless absolutely necessary.

An Activity for Every Winter

Nordic skiing is in the spotlight with the Winter Olympics, however it is not only reserved for Olympic athletes. Cross country skiing is a great option for winter workouts. With a relatively low risk for injury, you can enjoy the benefits of this sport every winter.

Should an injury occur, please visit your nearest Athletico for a complimentary injury screen.

Schedule a Complimentary Injury Screen

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