ACL Injury Reduction Program

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Women playing soccerMADISON - With anterior cruciate ligament (ACL) injuries, some things are out of an athlete's personal control.
Gender, for instance. Female athletes are four to six times more likely than men to tear their ACLs, for reasons that many have speculated about but no one has fully explained.
Some researchers point to the width of a person's femoral intercondylar notch (the place where the ACL passes through the knee joint) as a possible predictor of ACL instability. Again, no definitive conclusion has been reached.
With so many unanswered questions, UW Health physical therapist and licensed athletic trainer Dan Enz has decided to focus on what is known about ACL injuries. In the one-on-one ACL Injury Reduction Program he leads with fellow sports physical therapist and athletic trainer Doug Grovergrys, Enz will study the physical habits of program participants to determine whether a movement flaw predisposes them to serious injury.
"We focus on what we can control," he says. "Movement coordination can reduce the risk of ACL injuries - how well somebody moves and more specifically how well somebody changes direction."
The ACL, one of four knee ligaments connecting the upper and lower leg, provides the knee with rotational stability and thus is heavily taxed during activities that involve frequent starting, stopping and cutting. Basketball, soccer and football players are extremely susceptible to ACL injuries, because the physical requirements of the sport put a natural strain on the knee.
"More than two-thirds of the time, people will tear their ACLs with a non-contact injury," says Enz. "Most of the time you're making a cut on your own and changing direction, and it almost always occurs as a person is slowing down."
Teaching athletes to move in a way that reduces the risk to the ACL, then, will go a long way toward preventing serious injury and avoiding rehabilitation regimens that can last many months if reconstructive surgery is required.
"What usually makes athletes excel at sports that are high risk for ACL injuries is how well they can move in a confined space, or how well they can change direction," Enz says. "We try to train the mechanics of slowing down and landing from jumps, cutting and pivoting."
During program sessions, Enz puts athletes through a progressively complex series of athletic movements. They start with simple walking and then incorporate basic cutting and shuffling drills. From there, high-force activities such as sprinting and explosive jumping are added to the repertoire.
With the help of videotape, Enz can pinpoint peculiarities of movement most people wouldn't think significant but that are red flags to a physical therapist, such as the knee losing its alignment with the ankle and hip during walking. Then he makes suggestions for correcting the flaw.
"When we see something that may put someone at risk, we try to disseminate why it's happening," Enz says. "If it's a strength issue, we'll work on strength. If it's a motor learning issue, we use repetition-based motor learning movements to correct that."
ACL Injury Prevention Program sessions are held twice weekly - from 7:30-9 am Thursdays at the UW Health Research Park Clinic and from 3-4:30 pm on Tuesdays at the UW Health Rehabilitation and Athletic Performance Clinic.  The $190 fee includes a one and one-half hour evaluation, a customized exercise program and a 45-minute follow-up visit. Additional follow-ups are available for $80.
For more information or to make an appointment, please call the Research Park Clinic at (608) 263-4765 or the Rehabilitation and Athletic Performance Clinic at (608) 265-7500.

Date Published: 04/18/2008

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