Injury Prevention

This chapter opened with the scenario of one of the most common injuries in sports, a non-contact sprain of the ACL. The large numbers of injuries to young female athletes has resulted in considerable research on how these injuries occur in landing, jumping, and cutting. Many biomechanical factors have been hypothesized to be related to increased risk of ACL injuries in sport: peak vertical ground reaction force, knee flexion angle at landing, hamstring strength, and balance. A large prospective study of the biomechanics of landing in female adolescent athletes who then participated in high-risk sports has recently identified several variables that are associated with risk of ACL injury (Hewitt et al., 2005). The variables that were associated with girls that became injured were greater knee abduction angle (lower leg valgus), and greater ground reaction force and knee abduction moment. It is possible that as girls enter adolescence the increased risk of ACL injuries comes from dynamic valgus loading at the knee that results from a combination of factors. With adolescence in females the limbs get longer and hips widen, if strength at the hip and knee, coordination, and balance do not keep up with these maturational changes it is likely that risk of ACL injury could be increased.

While sports medicine professionals have qualitatively evaluated the strength and balance of patients in single leg stance and squats for many years, recent papers have proposed that simple two-dimensional measurements of frontal plane motion of the lower extremity in single leg squats might be a useful clinical tool for identifying athletes that may be at a higher risk for

ACL injury (McLean et al., 2005; Wilson, Ireland, & Davis, 2006). While this test is not as dynamic as landing, it is likely a safer screening procedure that also can be qualitatively evaluated. If screening suggests an athlete may be at risk (poor control of knee in the frontal plane), research has shown that preventative conditioning programs can decrease the risk of ACL injuries (see review by Hewitt, Ford, & Meyer, 2006).

Figure 12.5 illustrates the position of the lower extremity at the bottom of a single leg squat for two young athletes. If you were an athletic trainer or physical therapist screening these athletes before a competitive season, which athlete would you be most concerned about for a higher risk of ACL injury? Could you draw on the figure lines along the long axes of the leg and measure an angle representing the valgus orientation of the lower leg? What conditioning would you suggest for this athlete?

Would there be any special technique training you would suggest to the coach for jumping, landing, and cutting during practice?

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