Over 200,000 injuries to the ACL (anterior cruciate ligament) occur in the U.S. each year. A tear to the ACL puts most people out of commission for quite some time. In fact, recovery from an ACL injury often requires surgical intervention and approximately one year of rehabilitation.

Can You Prevent an ACL Injury?

We cannot control our anatomy, but we can control our movements. ACL prevention programs work to improve how we move in order to help prevent injury. ACL programs typically focus in three area: plyometrics, neuromuscular training and strength training. Many ACL injuries happen when someone jumps and lands. As the person lands, one knee caves in towards the other knee ( an increased valgus knee position)

Prevention programs focus on plyometric training to teach you how to avoid this positioning. A good program helps you understand how you land from a jump by using feedback. You may watch your body positioning in a mirror or you may have a trained person verbally tell you. With practice, proper landing movement can be achieved.

Neuromuscular and Strength Training

Plyometric training teaches you to avoid vulnerable positioning. Neuromuscular and strength training must be included in order to ensure proper movement. When you move, your nerves communicate with your muscles in order to perform movement. With neuromuscular injury prevention training, you focus on correct muscle firing patterns when performing movements. (For example: One exercise might have you work to make sure your quads and hamstrings co-contract).

When we move, we need muscles to fire equally to control our dynamic movements. We need to ensure the muscles have the proper strength to do so. Often, a person’s quads are much stronger than hamstrings. When they contract at the same time, the quads always win the tug of war. A dominant muscle creates an imbalance that makes us more susceptible to injury. A good prevention program will focus on strength training from the core all the way to the feet.

How Long is the Program?

Research shows that the most effective ACL prevention programs are performed at least 3 times per week for 6 weeks. Start the program in pre-season. Continue some of the components during your sport’s season. Plan to spend 20-30 minutes in order for each session. Don’t rush it.  

Devote enough time to each piece of training. Blowing through the program, just to say you’ve completed it, will be ineffective.

Prevention programs are great for people of any age, but research has seen the best results with kids who start at a younger age, usually around 12. They should then continue the program yearly until they are skeletally and muscularly mature. There are several ACL prevention programs out there. We recommend two programs scientifically proven to reduce the risk of ACL injury – Sportsmetrics and Prevent Injury and Enhance Performance (PEP).

Many say that Colorado is home to some of the world’s best skiing and snowboarding, which also means our state sees a tremendous amount of ski injuries. Heavy snowfall and a vast variety of mountain terrain make Colorado ski resorts a terrific choice for skiers and snowboarders of all levels. Colorado also offers unparalleled ski schools, sunshine, and historic ski towns.

Being active in sports has many positive health effects. It can help prevent cardiovascular disease, diabetes, cancer, hypertension, obesity, depression, and osteoporosis. Besides the beneficial health effects of being active, sports participation is of course also associated with a risk of injuries. Being aware of the risk of injuries while skiing and snowboarding is important, as well as making sure that you are protecting yourself, whether it is a knee brace while skiing or wearing a helmet on the slopes.

Do you have knee pain while skiing? Should you use knee support?

A lot of people ask whether they should use a brace when they ski, much like some football players are urged to use a knee brace to prevent injury. After conducting further research on knee pain while skiing, we were surprised with our findings

For skiers with prior ACL injuries, there was a significant reduction in re-injury rate when using a functional, hinged knee brace. So, if you have ever hurt your ACL, stop by and we will evaluate your degree of laxity and what specific braces would be the best for you.

At Integrative Sports Medicine, we stock but do not sell knee braces, and we have no financial interest in bracing, so our advice is objective. From personal experience, I have chosen to use a knee brace while skiing after a football injury and have seen improvements in my ability to maneuver on the slopes. In addition to that, it drastically reduces the risk of re-injuring my knee due to the stability that knee braces can provide.

Human joints need stability. If you are concerned about the impact skiing or snowboarding may have on your knees, or other joints, come visits us. At Integrative Sports Medicine, we will be able to evaluate your joints and help you make the best decision to enjoy your time on the slopes.

Potential of Concussions from Skiing

In snow sports, helmets really do matter. As a fairly late adopter of helmet use while skiing, I was lucky enough to leave the slopes without any severe injuries. After seeing my navigate down Big Chute at Crested Butte, my wife mandated I purchase a helmet. As we’ve seen, many skiers and snowboarders choose not to wear a helmet, for various reasons. At Integrative Sports Medicine, we recommend all skiers and snowboarders wear helmets on the slopes, regardless of your skill level.

We tend to see the majority of concussions stemming from two groups, males and snowboarders. This statistic can be explained easily by their behaviors, and their lack of desire to change them. Over the past four decades on the ski slopes, we have noticed a slight improvement in the amount of males and snowboarders adopting helmets. An injury on the ski hill is capable of causing a traumatic injury to your brain, including concussions or even worse.

Interesting Ski and Snowboard Injury Facts

• In the terrain park, the number of turns or spins made correlates with injury more so than the distance traveled.
• Landing on a flat surface or the knuckle of the pipe increases the rate of falls.
• Staying within your ability level will reduce the risk of injury while skiing/snowboarding.
• Collisions are a major cause of ski and snowboard injuries. Find runs that are not as crowded, and are less likely to have multiple riding styles can reduce that risk.
• New ACL-Preventing bindings compliment your body’s biomechanics and can be a potential way to reduce ski injuries.

Overall, when skiing or snowboarding, it is important to be aware that a major injury can always happen. Be mindful of various risks on the slopes.

So, have a great and safe day on the slopes! Brad Abrahamson, MD

Brad Abrahamson, MD is the designated Northern Colorado Affiliate of Stop Sports Injuries. Here are some additional tips from them.

A baseball parent recently came into our clinic with his son. The 9 yr-old pitcher was experiencing shoulder pain in the top and back of his dominant throwing arm, but only when he was throwing a ball. Because he played on an active club team,  his arm had few days off from throwing and catching.

While playing the battery makes you an effective baseball player, it can be hard on the body. That’s because this position combines both pitching and catching, resulting in the most throws per week of any position combination in baseball.

To figure out what was going on, we brought the young ball player into the Integrative Sports Medicine office for a throwing and pitching analysis using his own baseball equipment. Our analysis led us to some very interesting observations.

Throwing and pitching analysis

We asked the young boy to bring his baseball gear and demonstrate an authentic throw and catch that he may do during a game or practice session. During the assessment we asked him tons of questions so we could understand the full context to his situation.

What was uncovered:

1. Muscle overcompensation
   Lackluster power generation in the thigh, butt and back muscles led to an overcompensation in the shoulder. He also tended to drop his elbow and throw with more displacement of the elbow when tired or unfocused. This was creating increased stress on the shoulder and elbow. An imbalance of arm velocity is developmentally normal for a 9/10-year-old and is fixable in a gifted and coachable student-athlete.
2. Chronic shoulder pain and problems
   Physical exam findings consistent with mild, chronic and repetitive shoulder impingement, likely as result of sloppy arm control during follow through set up by imperfect mechanics from cocking phase through delivery. He also has congenital shoulder laxity (multidirectional instability or MDI). This is consistent with his mother being a hitter in volleyball and also consistent with his ability to put his shoulder through a large range of motion, which in part correlates with arm and ball velocity.
3. Regular ultrasound results
   A basically normal ultrasound showed mild fluid in the joint but nothing severe. There were no torn structures.
4. Back to baseball basics
   By asking lots of questions about his past training, we could tell that he knew the basics of how to throw a ball. Due to his age-appropriate brain development, he did not actually realize that he had already gotten pitching coaching but had not consciously linked the throwing elements into a sequence during his pitching motion. He didn’t realize that the purpose of his coach’s drills were for which is completely normal for a 9/10-year-old kid. In fact, when he followed the fundamentals that his coaches had already taught him and put them all together, he had a very good to excellent motion and no pain at all.

The most interesting part of the throwing analysis was that the patient was able to correct his throwing “errors” simply by getting him to remember his deliberate coaching. His coaches have come up with cleverly worded drills to get players to use other muscle groups that activate supportive muscle groups, such as the gluteals, to throw from the lower extremity and back.  For example, when the player incorporated “fart and flush” and “towel drill” together within the same pitch, there was less force on the shoulder and elbow and yet the pitch came in with excellent pace and accuracy. Another observation is that the patient reported a history of throwing for a radar gun, which is common, but in modern Sports Medicine is recommended for all student-athletes at all times.

Raising student athletes

This is a student-athlete who is lucky enough to play in a very sophisticated system of baseball. By dissecting his coaching tips, linking them into a single throw and correcting a tendency to drop his elbow when fatigued or not paying attention, his throw was completely fixed (for now) and he threw better and with less shoulder pain.

It is difficult for a coach to have time to spend large amounts of time with every individual thrower on the team to assess where the player is cognitively in understanding what he is being taught and how to use it.  There are literally not enough hours in the week when dealing with schedules, rosters, parents, and leagues, not to mention the other jobs and family responsibilities coaches have.  However, it is possible for a 9/10-year-old to understand and correct a throw when the coaching base is there and a thorough examination and analysis are turned into a conversation with the student-athlete coupled with actual throwing in real time.

Our success this time had everything to do with having a well-coached student-athlete with very supportive parents with great communication skills and not excessive pressure on the child.  All that made my job a lot easier. It’s important to keep the long-term in mind and not this year’s radar ratings and winning percentage/ERA and championships at the forefront.  I struggle with this myself as a parent.  These are children, not professional athletes and it can be hard to remember (just not in this case) how young they are at times.

From our research-filled and parent and coach friendly website, https://www.stopsportsinjuries.org/ with which I am the official affiliate for Northern Colorado, the max pitches you are allowed to throw per day at this age is 75 pitches, with outings being 4 or more days apart.  This is based on a lot of guesswork and common sense about what we are seeing, admittedly, and not particularly rigorous, hard data.  Despite our shortcomings as scientists, it is fair to agree with the book The Arm by Jeff Passan.  We are in an epidemic of shoulder and elbow injuries occurring at younger and younger ages.  Jeff Passan’s book mainly deals with the epidemic related to Tommy John surgery, so it can be more featured in a future article about the ulnar collateral ligament, but the epidemiology of injury also applies to shoulder overuse injuries in throwers.

Further commentary: there is no role for corticosteroid injections.  These student-athletes need healing time and activity modification, not a drug that shuts down healing, weakens connective tissue of the body and masks injury.  For an older player, regenerative medicine could be appropriate.  A 10-year-old has plenty of growth factors and stem cells in the area of any injury, so changing the biomechanics of the throw and allowing time for healing should be completely sufficient and no medical procedures should be needed.

This player was returned to play on a limited but increasing schedule to be supervised by parents and coaches, including the use of pitch counts and frequent check-ins with the player as to whether he is experiencing discomfort.  If we have learned nothing else over the past 100 years of baseball in this country, it is that injuries can start with minor discomfort, which if ignored can become major injuries with just a few more pitches.  Communication between players and coaches needs to be nurtured into an environment of comfort, honesty, and complete transparency.  We all know that is a major feat when dealing with pre-teens and teens, but it might be the best thing we have to prevent minor injuries from becoming life-changing injuries.

Check out:

https://www.stopsportsinjuries.org/STOP/Prevent_Injuries/Baseball_Injury_Prevention.aspx?WebsiteKey=22144c04-3260-4510-b318-8b5768345a42