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DR BARRY TRIESTMAN, D.C.

11464 E Ridge Rd

Truckee, CA 96161

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Tel: 530-550-1688

Fax: 530-550-1688

The ACL anterior cruciate ligament for skiers and snowboarders

 

I was reading this article about skier racers and thought that it applied to a lot of us skiers and snowboarders in the Tahoe Truckee area. I know most of us are not racing but most of us are fitter, have more skill and ski a lot more then the average Joe/Jane skier/snowboarder so I think we can use the info on prevention of a first or repeat ACL injury. The article is Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review   it was published in American Journal of Sports Medicine in March of 2017. 

The takeaways that I got to prevent  injury and prevent re injury are:

  • ACL injury rates are high 13% percent of athletes.

  • Core strength deficits are important and we need to work more on the front of the core i.e planks and ab wheel role outs then on the back of the core i.e. supermans. This imbalance may be more important for the regular Tahoe skier/snowboarder then the elite.

  • That the quad hamstring strength ratio is important. We need strong legs but the hamstrings are not strong enough compared to the quadriceps. One of the best exercises  to strengthen the hamstrings is the nordic hamstring curl and it works the knee part of the hamstrings as opposed to the hip part. Which I think is more important in knee injury.

  • Fatigue is a component in injury. So general fitness is important and realizing when it is time to take a break or call it a day.  Recovery is also important, think multi-day storm cycle. So sleep, hydrate and nourish well. Watch the alcohol intake. Contrast baths, legs up the wall pose and do some light cardio after some nutrition and rest. 

  • Early development of osteoarthritis post ACL is common. This should be worked on by decreasing our compressive load. We do this by doing as much water workouts as we can. Doing as much low impact land based exercises as we can like bike and elliptical. Doing heavy isometrics with a 45 second hold. Learning to use our muscles to land softly when doing jumping exercises. Think deceleration drills and eccentric exercises.

  • Knee valgus is a possible risk factor(that means your knees collapsing inward and the lower leg turning in to the center). Knee valgus is most directly controlled by your hip abductor muscles. We strengthen these by doing clam shells, monster walks and side planks.

  • If you have an ACL injury you are at increased risk of doing it again. This is the case with most injuries because we don't correct the problem that were caused by the injury and the factors that created it. This is best researched on ankle sprains, that most people never get the proper control of the body back and continue to restrain the ligaments.

  • Leg strength asymmetries are a factor and we test this by looking at vertical jump takeoff and landing forces. We need a force plate to measure those. Which should be coming to our local gym, Julia Mancuso Performance Center in Truckee. They already have them at the Altis Barton Performance Center in South Lake Tahoe. We are be able to use vertical  jump and reach and 3 single leg hops but these are not accurate. A trained eye from a coach, personal trainer, chiropractor or physical therapist may be able to see landing asymmetries.

  • Neuromuscular training helped and consisted of exercising on wobble boards and balance mats with 5 levels of progression

  • Rehabilitation following ACL reconstruction and prehab should be ski-specific, like at the apex a ski turn the athlete generates 3.5 times body weight on a single limb so we need to have that strength plus more in our gym exercise to emulate that. How long does a run take? It takes me 7 minutes to ski the west face on a big powder day so I need to not be fatigued after 7 minutes similar activity. 

  • The younger an athlete is when ACL injury occurred the better the outcome. Makes sense we heal and recover better when younger. But hopefullt are smarter and wiser as we get more mature.

These statements seem to be conflicting

  • "Only 55% of ACL injured athletes manage to return to preinjury performance levels after ACL reconstruction".

  • "ACL injured ski racers have longer and more successful ski careers compared to those without ACL injury".

  • "Not only did the group of skiers with ACL injury have longer careers than the skiers in the noninjured group but also they achieved more podium finishes and higher international rankings".

If you want a ton of info on ACL injury prevention, the knowledge in these journal articles will make you smarter then most.

  • JOSPT Clinical Guideline https://www.jospt.org/doi/10.2519/jospt.2018.0303

  • Knakentroll (Swedish Group) - https://blogs.bmj.com/bjsm/2016/11/02/football-injuries-prevention-swedish-football-injury-warriors-martin-markus/

  • FIFA11+ https://bjsm.bmj.com/content/49/9/577

  • The Santa Monica Sports Medicine Research Foundation – The PEP Program: Prevent injury and Enhance Performance http://www.aclstudygroup.com/pdf/pep-program.pdf Implementing Injury Prevention – Aspetar Journal - http://www.aspetar.com/journal/viewarticle.aspx?id=406#.W6TYAf4zbEY

  • Reference to Implementation Studies by Dr Alex Donaldson & colleagues in AFL https://www.ncbi.nlm.nih.gov/pubmed/30217833

  • Even though this is  a review of female ACL injuries it is still applicable to everybody Dosage Effects of Neuromuscular Training Intervention to Reduce Anterior Cruciate Ligament Injuries in Female Athletes: Meta-and Sub-group Analyses https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969416/

  • Look at this article for the actual exercises  that we would call neuromuscluar training. A pilot study to determine the effect of trunk and hip focused neuromuscular training on hip and knee isokinetic strength  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003571/

     

     

Matt Jordan  PHD  Presenting on the Noraxan system with ACL injuru prevention and decreasing the risk of ACL re-inury

https://www.noraxon.com/vertical-jump-asymmetry-testing-webinar-post/

 

OK? Now go to the gym and train to get ready. The squirrels are digging holes like crazy at my house, so they think it is going to be a big winter, lets get ready!

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