Did you know that a human who moves better and has a system to test their movements, could be the key to preventing ACL injuries? While exercise is king, it's not just about a specific workout or technique, but honing your ability to move with intention. He looks at the rising incidence of ACL injuries in females due to anatomical and hormonal differences, driving home the importance of personalized assessments, especially for athletes. 

Dr. Alec Spano, PT, DPT, CSCS, Cert DN discusses the importance of movement screens to pinpoint potential problem areas, and the role of strength, mobility, and flexibility in ACL injury prevention. Females, in particular, tend to have more flexibility but also experience more ACL injuries, emphasizing the need for stability and strength in the full range of motion. Don't miss out on this episode, where Dr. Spano encourages proactive action and the importance of knowing your body's movement to prevent potential injuries. Get proactive and let's save some athletes from ACL injuries these upcoming seasons!

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ACL Injury Prevention Research Articles:

Nessler T, Denney L, Sampley J. ACL Injury Prevention: What Does Research Tell Us? Curr Rev Musculoskelet Med. 2017 Sep;10(3):281-288. doi: 10.1007/s12178-017-9416-5. PMID: 28656531; PMCID: PMC5577417.

Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012 May 2;94(9):769-76. doi: 10.2106/JBJS.K.00467. PMID: 22456856.

Podcast Transcript:

Welcome to the Hercules Performance and Physical Therapy Podcast. I'm your host, Dr Alec Spano, and today we're going to talk about injury prevention for ACL injuries. There's been a big push in the field for preventing ACL tears before they happen and there's a lot of back and forth on. Can we actually influence that, how to influence that, and what is it that we can believe with some of the literature that's out there? I think the best way to approach this is from a more of a common sense kind of perspective where, if we look at most things that have some physical nature to it sports, just general activity, and movement, higher level sports, no matter what it is exercise is king.

 Even if we're talking about health, blood pressure regulation, just being healthy in general has some degree of exercise, helps it. So when you look at literature that says, oh, it may help, it may not -think about it this way. Exercise is going to help you be a better, healthier human, it's going to help prevent ACL injuries. Now, the problem with that is where someone comes up to you and says I'm going to give you this one exercise that's going to prevent your ACL injury or it's this one specific thing, and that's just not true .In general, being a better, stronger mover is going to improve the likelihood that you won't injure your ACL, and there's some certain positions that we look at that may be more indicative. But the biggest thing is do you understand how to move?

So maybe you're a high school athlete or you know a high school athlete that's on the field cutting and what not. Have them get assessed. If they can't stand on a single leg, we can't hop equally on both sides. If we can't cut properly, if we're just weak in general, yeah, we're going to set ourselves up for an ACL tear, and the unfortunate part about it is, if we look at females versus males, females tend to have a bigger incidence due to some of the angles and hips and some of the hormonal differences between males and females. So it's extra important, especially for our soccer players or lacrosse players as well, to just get assessed. There's simple movement screens that can be done for anyone with anything, but especially for ACL injury prevention where we go hey, this looks a little off. Why don't we work on this a little bit and try as best as we can to create a plan that prevents us from tearing an ACL when we're a junior in high school and we're vying for that D1 scholarship where it could have just been hey, let's learn to cut a little better. Let's improve this single leg strength. Maybe you played a bunch of softball back in the day and you have one side that's stronger than the other. Let's make sure they're balanced right.

And again, there's more to that than just hey, am I strong enough on one side versus the other? There's general, am I just a strong mover? There is also mobility. Right, we're really stiff in the hips and we can't rotate that well through the hips. We might be putting our knee into compromised positions and I'd say that is probably a bigger thing that I see and I often use mobility in terms of hey, are you strong enough and flexible enough in that position? Not just hey, I have a ton of flexibility. A lot of the females that we work with in general have a little bit more flexibility in most of my males, but yet the ACLs tend to happen. ACL injuries tend to happen more in females. Again, it depends on the athlete, but it could be that they don't have stability through that hip. We don't have strength through that full range. So there's a lot of factors that go into it. But bottom line, you must be assessed. If you don't know how you're moving and how that translates, you could be sending yourself or injury or you're not doing everything you can. And it's not good enough to just go into the gym and do whatever. If you're vying for a spot, if you're trying to become elite at something or you really truly don't want to get hurt, you've got to approach this with a little bit more of a systematic manner and that's what I'd say.

That's where I'll say there's been some meta analysis and I'll attach them in the show notes below. Meta analysis is a fancy way of saying there's a bunch of studies and they compiled them and basically what they found was that exercise, specifically neuromuscular reeducation, which is a fancy way of saying, hey, do we know how to move? Can we actually put ourselves into position? So think about some big, stiff athlete who moves very poorly. We've all seen them in a gym. They can't squat below parallel, they don't know where their body is in space. They're strong, but they really look awkward moving Neuromuscular reed goes hey, can we take this strong athlete and make them move better, make it look better, and can they control that? I think that's a big part of it. Can you actually feel what you're trying to do. If we can improve that, that can lead to better outcomes. In terms of hey, can we reduce injury at this point? Can we reduce ACL tears, which is huge? So, using that model of hey, can we have the motor control? Can we move well to save ourselves from injuries down the line? That's big. The one thing they did say in there was there's no, and I said this earlier, I alluded to it. It's an exercise that determines whether you'll not have an injury or not, and that goes for anything, but specifically for ACLs, because I think we see a lot on the internet about I just improved my quad string, I'm good If I just can balance on one side, if I can just this and this and this, and that's not true. It's a whole body approach. There's even been things that come out that say the way your core activates and the sickness you can create in pelvic position can actually help your hip move better, which can help the stabilize the knee better, et cetera, et cetera.

Look, just make the whole body move better, right? If you can't get in the certain positions, you can't get into the bottom of a squat and you're running around playing lacrosse. That might be a good indicator that your hips don't move well and you don't have enough strength to express it when you were more expressing it with more force on the field, right. So that's a long way of saying basically. All these studies say hey, we can reduce the likelihood of injury, especially in ACLs and younger athletes. However, there's no one approach fits all. It's creating a system of movement where we go hey, you move like this. This is what I normally see with athletes who are good, move well and appear to have the qualities of someone that won't injure themselves down the line. It's making look like that, within your anatomy limits, so that you can become not only a better athlete on the field cut harder, move faster but we're also in better position. So that way we give your knee, your ACL, the best fighting chance it has in those moments that it needs to turn on right.

 I think one of the things that ACL brings up is what is the ACL for? ACL is sort of the brakes on your knee where we get into a certain position and at the last moment we're cutting really hard, specifically when we push off and we're cutting in. That's easier to see on video, obviously, but for planting the foot and cutting. Let's say you plant with the left and cut to the right. There's times where our hip can stabilize our knee, can knee musculature can do what it needs to to keep the knee in a good position. But there's also times where, hey, we're not thinking we have the ball, we're cutting, we're about to be tackled and we're just not in a good position. That's where the ACL takes over. To try to block that. The problem comes when we're in really bad positions. We do that all the time. We could be setting ourselves up for an injury and that's where we go. Hey, let's see how we're actually cutting. Maybe this is something I can cue you for, or, better yet, you just don't have the strength in that hip to be able to put yourself into a good position. Let's at least be able to get into that good position. That way we can most of the time, utilize that mechanism.

So again, injury prevention for ACL is totally possible. Is it a 100% thing? No, there's nothing that exists in that capacity. But will it reduce the likelihood? Absolutely. Is there better systems than others? Not, according to research. But if you're moving well and you're strong throughout your body and you look like an athlete on all limbs and positions, you're going to set yourself up for good things ahead. So I think I've covered a lot of how injury prevention can help with ACL. Meaning, if you're in the off-season and you're an athlete that cuts you're a lacrosse player, a football player, I'll even go as far as to say football definitely football. But I'll go as far as to say baseball, even volleyball, sports like that Just get assessed in the off-season and create a plan that not only makes you stronger and perform better on the field because there's a lot of people who are doing that but hey, we need to see how you're moving and let's see you're moving safely. And if you have indicators that you're not, let's work on it. Let's create a plan, and that's a structured plan that goes hey, let's use Sally, sally, your hip isn't strong enough. You don't have enough mobility on that side. In general, you can't even balance on that leg, but somehow you're cutting on the field. Let's address that in the off-season that when you get into game time we don't have a catastrophic injury that takes us out.

So if you need help assembling that, if you need help testing that, reach out to us. I'll link my discovery call below and let's see if we're a good fit to help you. Especially in the off-season would be an ideal time to do this, but again, if we're in season and you know that there could be indicators, simple things can be done right in the moment that can again cue you to be in better positions, that can help to stave off that Career ending, possibly college sports ending injury. If you have any questions on preventing ACLs, some of the protocols that we use, some of the testing, reach out to us at that link below Schedule discovery, call with us and if not, we'll see you next time on the podcast. All right guys, have a great rest of your day and as the holiday season approaches here, I hope I wish you best of luck in your endeavors, travels and celebrations. All right guys, till next time.