Skill acquisition for ACL Injury Prevention explained

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 There is plenty of research talking about studies to help prevent ACL injuries, so I am going to reference from a bunch of articles I have read and talk about then how I do this in my coaching.

Your First Job – A COACHING SURVEY: 

A study by Petushek et al (2015) has developed a survey for coaches to take to help estimate the risk of an ACL Injury by observing an athlete take a drop jump test.  Take the following survey and see how you go.
I took this test and I achieved 84% so clearly I need to do more work on my observation skills to further improve as a coach.
Take this test BEFORE reading the rest of the article. It takes about 5mins.

http://survey.acl-iq.org/index.php
Making yourself (if an athlete less likely to sustain ACL Injury) and if a coach, making your athletes less likely to sustain an ACL injury. 
 
I am going to quote a number of interesting findings and some different methods used by some different research studies and then put this into a practical sense to help you take away some of the most important coaching cues and tools for ACL injury prevention.

A study by Root et al (2015) on evaluating landing technique and performance measures pre and post a specific warm up program revealed that whilst landing technique improved, there was no demonstrated increase OR decrease in physical performance after ONE ACL Injury specific warm up protocol.  A total of 60 young athletes were utilised in the study, so the sample size is very good.

The Injury Prevention Program (warm up) consisted of the following:
  1. Dynamic Flexibility
  2. Strengthening
  3. Plyometric
  4. Balance (proprioception)
The researchers stated they really emphasised good technique in each of the warm up drills.
The compared this program to a static warm up and normal dynamic flexibility warm up.
The specific warm up that was used in the research is very similar to the warm up program that has been provided as an online program as part of the ACL Injury Prevention Program.

A study by Petushek et al (2015) examined the efficacy of an injury risk estimation survey that was created to try to help coaches, allied health, parents, athletes and medical personnel predict or know when an athlete is at risk of knee injury.

What was found is that people within a medical, coaching or allied health background were generally much better at determining correct risk.  The factors that contributed to lower scores included waiting the importance of knee/thigh motion lower and weight and jump height higher.

The relevance of this study is that we, as coaches and as performance coaches MUST be educating beyond the athletes we coach. We need to educate parents, sport coaches and anyone who works with athletes to help them understand the specific nature of how ACL injuries happen and to help them identify risk factors so they know when to refer someone to get help with their landing techniques OR to focus more on the technique in a warm up drills that specifically target landing technique.

An Article by Benjaminse et al (2015) focused on the specific feedback techniques that could be utilised to enhance motor learning to help decrease injury risk.

This article discusses the internal versus external focus of attention when coaching a new skill, especially injury prevention drills.

Motor learning refers to the long-term acquisition of motor skills.  The stages of learning are said to be: Cognitive, Associative and Autonomous.

The cognitive stage is a learner’s conscious attempts to determine what exactly needs to be done, step by step. This stage needs a distinct attentional capacity.

The associative stage begins when the learner has acquired the basic movement pattern, where the pattern is more reliable and movements more consistent, automatic and economical.  Now the learner can direct more attention to other aspects of total performance.

The autonomous phase is reached after extensive practice.  This stage is characterised by the seemingly effortless way a skill is performed. Movements are accurate, consistent and efficiently produced.  This phase refers to the “automatic” production of the skill and requires little to no attention.

The internal focus – in motor skill coaching refers to instructional or feedback that is about the process. Feedback like: “land with your feet shoulder width apart.”

External focus in motor skill coaching refers to feedback that is provided that refers to the outcome of the action.

Research has shown that having an external focus in feedback provision stimulates better transition through the three learning stages.

The argument against using internal focused feedback is that it makes you consciously focus on what you are doing with your body, and that is not going to be transferable across to when you are playing sport.

The research indicates that the more specific and the LESS feedback given, the better the outcome and the faster the learning cycle will be when acquiring motor skills that need to be transferred to sport.

This study is one of the best I have seen, having taken a wider and more comprehensive view of how athletes learn and how important it is to target the quickest, most effective learning pathway to achieve a better performance outcome for athletes.

Finally, an article by Toscano and Carroll (2015) talks about how to prevent ACL injuries in Females.  I think this article/educational tool is a really good read for coaches and I have included the web link for you to read if you coach female athletes.
It gives a very balanced approach to ACL injury prevention, discussing neuromuscular (Skill acquisition) and Strength Training equally.

What are the key principles of ACL Injury Prevention?  

Based on my reading of research and my experience, these are the top 3 factors that coaches and athletes MUST first be aware of, and then work to constantly improve on.
 
  1. Internal rotation or Valgus at the knee joint. My assessment of someone starts as soon as I see them.  I watch them as they unconsciously go about walking towards me, getting up or down and in any task I give initially.
    1. INSERT PICTURE HERE TO SHOW
  2. Hip Abduction strength – Gluteus Medius and Gluteus Maximus.  Most athletes NEED to improve the strength and muscle coordination or activation timing of their Glutes.
  3. Learning Style and Motor Learning (Skill Acquisition) ability relevant to landing, cutting, running, jumping and squatting mechanics that will be applicable to the sporting field.

Vector Health has 3 pre-set programs for ACL Injury Prevention: 

  1. Strength Training basics
    1. Increase Hip Abduction Strength and Hip Extension Strength as a focus.
    2. Calf Strengthening
    3. Quad especially the medial muscle in the quad, the VMO.
  2. Movement Preparations
    1. Specifically to help reduce valgus action on jumping, hopping, landing and running/cutting.
    2. Proprioceptive training to improve balance in sports specific stances
    3. Much more skill acquisition based than strength training.
  3. Active Warm Up basics
    1. base strength work of Glutes, calf and quads
    2. Balance and proprioception
    3. Dynamic flexibility
    4. Running and movement orientated actions for sport that focus on the outcome of movements rather than internally focused processes.

If you would like to purchase these programs if you mention this article you are able to receive these in an online portal for just $39.95.

REFERRAL – do you know someone with an ACL injury, or who plays or coaches a sport involving running or jumping?

We operate on a referral network, especially for courses like this. We run this program to drive better performance through less ACL injuries to all athletes across Australia and around the world.

Please, if you believe this program will help someone feel free to refer them to the program!

Referrals can be sent straight to me glenn@vectorhealth.stagingarea.net and we will contact them to arrange a program for them to attend.

Thanks again for your attention.  Appreciate any feedback you have and especially your questions!

REFERENCES 

Mandelbaum, B. R., et al (2005). Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing Anterior Cruciate Ligament Injuries in Female Athletes: 2-Year Follow-up. American Journal of Sports Medicine; 33; 1003. Web link – https://www.researchgate.net/profile/William_Garrett2/publication/7852030_Effectiveness_of_a_neuromuscular_and_proprioceptive_training_program_in_preventing_anterior_cruciate_ligament_injuries_in_female_athletes_2-year_follow-up/links/00b7d5191c0f323eab000000.pdf

Patterno, M. V. et al (2010). Biomechanics Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport. American Journal of Sports Medicine, Preview published on August 11, 2010. Web Link to article: http://www.atlasmedic.com/documents/en/Trainings/Complements/Timothy%20E.%20Hewett%20-%20Understanding,%20prevention%20and%20rehabilitation%20of%20ACL%20injuries%20in%20athletes/Paterno,%20M%20,%20Am%20J%20Sports%20Med,%202010%20-Biomechanical%20Measures%20During%20Landing.pdf

Toscano, L. & Carroll, B. (2015). Preventing ACL Injuries in Females: What Physical Educators Need to Know. Shape America; 86;1. Web Address: http://www.shapeamerica.org/publications/journals/joperd/upload/JOPERD_ACL.pdf

Root, H. et al (2015). Landing Technique and Performance in Youth Athletes After a Single Injury-Prevention Program Session. Journal of Athletic Training; 50(11):1149-1157. Web link: http://www.natajournals.org/doi/pdf/10.4085/1062-6050-50.11.01

Petushek, E. J., Ward, P., Cokely, E.T. & Myer, G.D. (2015). Injury Risk Estimation Expertise. Interdisciplinary Differences in Performance on the ACL Injury Risk Estimation Quiz. Orthopaedic Journal of Sports Medicine: Nov ; 3(11). Web Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687839/

Benaminse, A., Gokeler, A., Dowling, A.V. & Myer, G. (2015). Optimisation of the Anterior Cruciate Ligament Injury Prevention Paradigm: Novel Feedback Techniques to Enhance Motor Learning and Reduce Injury Risk. Journal of Orthopaedic and Sports Physical Therapy:45(3):1-46. Web Link: https://www.researchgate.net/publication/271600014_Optimization_of_the_Anterior_Cruciate_Ligament_Injury_Prevention_Paradigm_Novel_Feedback_Techniques_to_Enhance_Motor_Learning_and_Reduce_Injury_Risk
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