At one point in history, anterior cruciate ligament injuries were career-ending for professional football players. Even today, they can sideline a player for an entire season. On the surface, this might seem like a topic relegated only to those interested in professional American football. But it really isn't. It's a topic that should be explored at every level and age of sport.
As an orthopedic surgeon, my job on paper is to repair muskuloskeletal injuries in patients once the damage has already occurred. As a physician, my fellow colleagues and I have an obligation and strong desire to prevent injuries from occurring in the first place, when we can. So my odyssey into preventive orthopedic medicine began more than 20 years ago, when my colleagues and I began evaluating and treating ACL injuries in increasing numbers of young female athletes. What fascinated us most was that many of these injuries weren't the result of a hard fall or other blunt force trauma. Rather, they seemed to be correlated with the way the player would jump, land or decelerate. In those players with hip and leg strength deficiencies, the upper legs would turn in, cause too much strain on the ACL and sometimes result in a tear.
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To address this pervasive ACL injury trend, we developed a preventive program consisting of a warm-up, plyometric and agility training to combat the possible deficiencies in strength and coordination of the stabilizer muscles that surround the knee joint. Because we knew that this program to Prevent Injury and Enhance Performance -- PEP for short -- had great potential for a number of sports, we made the agility portion of it sport-specific, so that more types and levels of athletes could benefit.
Whether it's teenage girls playing volleyball or grown men playing NFL football, it may not seem like attention to strengthening the hips, thighs and hamstrings is what should be done to protect the knees. But with two years of study data backing our theories, I can tell you that it works. In fact, after implementing a prophylactive injury prevention program for one group of athletes, the results indicated an 88 percent overall reduction of ACL injury per athlete compared to a control group matched for skill and age.
This training program promotes better strength, posture and control. Show me an NFL player (or any athlete, for that matter) who doesn't need all of that. In fact, I have worked with the team doctors from a couple of teams in the league to examine film of players who sustained ACL injuries during the course of a game. During this examination, we found 68 occurrences of ACL injuries that were not the result of contact and appeared instead to be the result of landing wrong.
The problem is, many football players train on their own in the off-season, and once they get back with their team, the focus is on training in fully-padded practices, which may not leave much time to correct possible issues with steering and neuromuscular control. But preventive injury training can work, and I've seen various aspects of it implemented sporadically throughout the NFL with some positive results.
As sports medicine evolves and teams and players become aware of the fact that a focus on biomechanical "steering" to prevent ACL injuries is just as important as speed and power, I think we will see a further reduction in tears and seasons lost to these otherwise preventable injuries.
Bert Mandelbaum, MD, is an orthopedic surgeon and co-chair of medical affairs at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles and author of "The Win Within: Capturing Your Victorious Spirit." He received his medical degree in 1980 from Washington University School of Medicine in St. Louis and completed his residency in orthopedic surgery at the Johns Hopkins Hospital. And he completed a fellowship in sports medicine at the University of California Los Angeles, where he also served as a faculty member from 1986 to 1989 before going into private medical practice. Dr. Mandelbaum has served as director of research for Major League Baseball and team physician for numerous collegiate and Major League Soccer teams, as well as for the U.S. Soccer Men's National Team. He currently serves as medical director of the FIFA Medical Center of Excellence in Santa Monica, as and on the US Olympic Committee National Medical Network Advisory Group. Visit his website or connect with him on Facebook or Twitter.