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ACL Injury Prevention Programs

BOSU Ball used to train balance and help reduce ACL tears

BOSU Ball squats and balancing can help reduce ACL injuries by training joints and muscles to react appropriately.

A tear to the ACL (anterior cruciate ligament) in the knee can be one of the most detrimental injuries to an athlete. In order to decrease the chance of such an injury occurring, preventative programs should be performed by athletic populations. These programs can be done at home or during the beginning of a practice. ACL prevention programs can also be incorporated into a warm up, prior to exercise. The programs focus on plyometrics, balance, stretching, and strengthening exercises.

Plyometrics are described as rapid and powerful movements. These movements first cause a muscle to lengthen, then shorten. The combination of lengthening and shortening the muscle at a fast pace increases the power of a muscle. Plyometrics aid in the prevention of ACL injuries by training the muscles to react at a faster rate preventing the knee from shifting. Examples of plyometrics are single leg cone jumps, squat jumps, single leg bounding, and ladder drills. The goal when performing these drills is to jump immediately again after making contact with the ground. The exercises are generally performed for about 30 seconds, however when first starting the drills, a shorter time may be required to begin and then gradually increased with practice.

Balance and stretching are also key factors to preventing ACL injuries. It is important to thoroughly stretch the calf, quadriceps, and hamstring muscles. Stretching these muscles will ensure that the muscles are not too tight which could cause a muscular imbalance and increase your chance of injury. Balance or proprioception is also a goal in ACL prevention as it can allow muscles to work together to stabilize the body on various surfaces. If the body and knee cannot quickly react to surface changes, an ACL injury could occur. Balancing exercises can be performed on one leg, on uneven surfaces such as a BOSU Ball, and can incorporate throwing a ball while balancing to increase muscular stability and neurologic reaction time.

Strengthening is the final aspect of an ACL prevention program. It is essential to strengthen not only the hip and thigh musculature, but also the core. Strengthening the musculature of the legs allows for a more stable knee joint which decreases the risk of ACL injury. Core and leg strengthening can be done using the body’s weight through exercises such as walking lunges, squats, sit ups, and planks. Exercises such as walking lunges are also an adequate exercise to warm up and loosen the muscles before activity.

While performing ACL prevention programs, it is imperative to focus on technique more than the number of repetitions completed in the allotted time. When jumping during plyometrics, the proper landing technique is to bend at the knees and hips to absorb the force rather than keeping the knees and hips straight causing the force to compress the joints. The phrase ‘light as a feather’ is used to describe how to land, meaning land as softly and quietly as possible to absorb the shock. The toes are to remain pointing forward at all times, and the knees are to stay in line with the toes. This ensures that the muscles are functioning together providing the best stability for the ACL. Poor technique can lead to a muscle imbalance, decreasing the stability of the knee.

ACL prevention programs can be done in 15 minutes and research has found them to be beneficial to help prevent injury. These programs are recommended to be performed at least 2-3 times per week with at least 1-day rest between each session. A minimum of 6 weeks is needed to provide the best results. Although it appears to be a hassle, these programs only take a few minutes to perform and can be done using simply the body’s weight, while providing a decreased risk of a serious ACL knee injury.

Lateral Epicondylitis (Tennis Elbow) Causes, Symptoms, and Treatment

Tennis Elbow can be a Painful condition

Lateral Epicondylitis or Tennis Elbow is an overuse injury of the elbow.

Lateral epicondylitis is a painful condition that affects the tendons that attach to the bone on the lateral (outside) aspect of the elbow. Tendons are what attach muscles to bone.  When these tendons get irritated from repetitive wrist and arm use, they often become inflamed resulting in weakness and pain.  The most common muscle involved in lateral epicondylitis is the extensor carpi radialis brevis, which is responsible for wrist extension.  However, any forearm muscle that produces wrist extension or supination (turning the palm up) can be involved in lateral epicondylitis.  This condition is commonly referred to as “tennis elbow” because it is often seen in tennis players due to the excessive amount of wrist extension involved in backhand motions.

Although this condition is most commonly referred to as tennis elbow, lateral epicondylitis has many different causes. It is common in any sport that involves repetitively gripping an object, such as baseball, softball, racquetball, golf, javelin throwing, and fencing. It is also very common to develop this condition from non-athletic activities, such as meat-cutting, plumbing, painting, driving screws, and excessive computer mouse use.  Though this injury is traditionally seen from repetitive activities and overuse, it is also possible to develop lateral epicondylitis after a direct blow to the outside of the elbow, causing swelling and eventual breakdown of the tendons that attach to the lateral epicondyle.

The most common symptom associated with lateral epicondylitis is pain. The pain is usually isolated to the outside of the elbow, but may radiate into the forearm and wrist.  Due to this pain, it may be difficult for people to shake hands, turn a doorknob, or hold and lift everyday objects in their grasp. Initially, the treatment for lateral epicondylitis is activity modification. Understanding what motion is causing that pain, and decreasing that repetitive motion or learning the proper technique to the movement are keys.  Rest, anti-inflammatory medications and physical therapy are also recommended to help alleviate pain.

Tennis Elbow Brace

The GOSTRAP Tennis Elbow Strap can be an effective treatment for lateral epicondylitis.

As part of a comprehensive treatment, a brace is also often recommended to help reduce pain.  The most effective type of brace is a counterforce brace.  Unlike the traditional one strap tennis elbow brace, a counterforce brace, such as the Comffit GOSTRAP Tennis Elbow Support, uses straps above and below the elbow to help carry the load placed on the elbow while simultaneously reducing the tension placed on that area. This brace is effective because it provides a counterforce in the opposite direction of the wrist extensors (muscles causing pain).  In addition because of its two strap design, the straps do not have to be applied very tight to provide support, so it is comfortable to wear all day and does not restrict elbow motion.  When dealing with lateral epicondylitis, a Comffit GOSTRAP Tennis Elbow Support is an affordable and effective addition to a comprehensive treatment and therapy plan.

Ankle Sprains: Anatomy, Symptoms, and Treatment

One of the most common injuries in athletics is a lateral ankle sprain. This occurs when the foot is inverted (foot twists and inside arch is facing up) and one or more of the ligaments on the outside of the ankle is damaged. There are different grades of ankle sprains depending on severity as well as the ligament that is injured. The signs and symptoms of the injury help determine the grade, treatment and healing time of the sprain.

Anatomy

Ankle Sprain

Lateral ankle sprains are one of the most common injuries in athletics.

There are a couple reasons why lateral ankle sprains occur so often. First, the anatomy of the ankle provides a bony block on the inside, which forces the ankle to lean to the outside. Second, the musculature and ligaments on the inside of the ankle are much more secure and thicker than those on the outside. Finally, in a normal walking pattern, or gait, most of the weight is placed on the outside of the foot when it is placed on the ground, naturally causing an inversion at the ankle joint.

In a typical lateral ankle sprain, the most common ligament that is damaged is the anterior talofibular ligament. The
name describes exactly where it is; it connects the talus bone of the ankle to the fibula in the lower leg. In a more severe sprain, the calcaneofibular ligament may also be injured. Two other ligaments, the anterior and posterior tibiofibular ligaments, may be injured as well. When these ligaments are sprained it is known as a high ankle sprain. The deltoid ligament is located on the inside of the ankle and is stronger and less often injured than the other ligaments of the ankle.

Signs and Symptoms

There are generally 3 grading classifications of ankle sprains. However, different texts, clinicians, and physicians may have or use different scales. Commonly, most ankle sprains result in some amount of swelling and bruising, loss of range of motion, and moderate pain.

  • Grade 1 Ankle Sprain– The ligament is stretched, causing microscopic damage to the tissue. There is generally only a limited amount of swelling and pain. Most patients can put some weight on the foot and don’t need crutches, however, they most likely will not be able to run or jump. On average grade 1 ankle sprains, with proper rehabilitation will heal in about 7 to 10 days.
  • Grade 2 Ankle Sprain– This level of ankle sprain is more severe and there is a greater amount of pain. The injury results in a partial tear of one or more ligaments and causes moderate swelling and bruising in the area. Crutches are often needed because of the irregular gait and pain with weight bearing. Depending on the severity, a patient with a grade 2 ankle sprain can take anywhere from 2 to 4 weeks to heal and return to previous levels of activity.
  • Grade 3 Ankle Sprain– A complete tear of one or more of the ankle’s ligaments. There may be severe bruising, swelling, and little or no range of motion in the ankle joint shortly after an injury. Patients that have completely torn the ligament sometimes need surgery. The ankle may be very unstable and crutches and/or a walking boot usually are needed. At least 4 to 6+ weeks of rehab and treatment will be required for proper healing.

Treatment

It is extremely important to give the proper treatment immediately after an ankle injury occurs. Often an increase in swelling causes more pain and a longer healing time. To prevent ankle swelling, the “RICE” technique is used. ‘R’ stands for rest.  The patient should refrain from activity for a minimum of one day to prevent more damage. Using crutches is a form of resting the ankle. ‘I’ is for ice. Ice is used to decrease blood flow, resulting in a decrease in swelling when used immediately. Ice should be used 20 minutes out of every 2 hours for at least the first 48 hours after injury. Never heat a freshly sprained ankle. The ice also helps to numb the area and decrease pain levels. ‘C’ is for compression. Putting pressure on the entire ankle will help prevent and push any swelling out of the area. Use an elastic bandage and wrap from the toes all the way to the calf. Overlap the elastic wrap and do not leave any holes in the heel or elsewhere, as swelling will occur in these spots. Finally, the ‘E’ is for elevation. Gravity plays a large role in the amount of ankle swelling that occurs. Keeping the ankle elevated, preferably above the heart, assists in keeping extra blood flow and fluid out of the area.

Over time, atrophy can occur in muscles if they are not used to move the ankle joint. Muscle atrophy and weakening can occur within days of injury so it is critical that the patient does rehabilitative range of motion exercises in the first few days after injury. Examples include spelling out words by making the shapes of letters with the foot, or basic up and down ankle pumps. In time, the pain will decrease and more rigorous strengthening exercises should be implemented, as well as continuing towards obtaining full range of motion. When returning to sports or fitness activities after rehabilitation is completed, an ankle brace, or daily ankle tapings can be beneficial to prevent re-injury. Research has shown that both of these preventative actions help decrease the patient’s chances of re-injuring the ankle.

By: Allison Fretthold, ATC
Allison graduated as a certified athletic trainer from the Mercyhurst University Sports Medicine Department in 2011. She has worked at various levels of athletics, varying from small high school settings to major Division 1 universities. She attended Ohio University for her master’s degree and currently works as an athletic trainer at River Valley High School in Gallipolis, Ohio.

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