Joint solution: Injury prevention must begin at early age

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Females have a much greater risk of tearing their anterior cruciate ligaments than male athletes. But this is not a problem without solutions.
While it is never certain that particular training methods will completely negate the chances of tearing an ACL, there are training programs that have proven to be effective in injury prevention.
“We can decrease ACL injury risk, and we have to get that word out,“ said Dr. Timothy Hewett, director of the Sports Medicine Biodynamics Center at Children’s Hospital Research Foundation in Cincinnati and one of the most respected orthopedists in the world.
Dr. Tim Hewett discusses possible prevention measures:
“That’s the good news in all of this.“
Several recent studies published in the American Journal of Sports Medicine demonstrate risks to ACL tears can be reduced greatly through the use of preventative training.
In six studies completed by 26 doctors from 1999 to 2007, five resulted in lower extremity risk in female athletes, four decreased risk of knee injury and three specifically decreased ACL injury risk.
Hewett has conducted a personal study with 897 athletes — 463 received injury prevention treatment and 434 were control subjects.
The first group completed a six-week training program based on plyometrics, strength and flexibility training.
The trained athletes had a 72 percent lower incidence of ACL injuries than the control group, according to Hewett.
Plyometric exercises are a key component. Plyometrics focus on series of jumps, sometimes over or onto objects. Spinning during jumps is also incorporated.
“Doing those types of exercises teaches kids not to be ligament dominant,“ Hewett said. “Doing that training addresses those (differences) female athletes have.“
But before doctors or coaches can educate them, female athletes must understand they are vulnerable.
Of 13 female athletes who have torn ACLs interviewed by the R&L, 12 said they were not aware of the predisposed risks females have — and that’s hardly their fault.
“Females don’t realize they are allowing their knee to collapse inward, that they are more susceptible to injuries,“ Hewett said. “You have to tell them.“
All 12 of those athletes, all said they were made aware of those risks after their injury happened, when it was far too late.
“I didn’t even know what an ACL was when I got hurt in eighth grade,“ Lake Norman High School senior Lindsay Mannion said. “I really wasn’t aware. After I got hurt, my doctor informed me of all that stuff. It was a big shock.“
The chance of tearing an ACL, Hewett said, skyrockets for females around age 11 during puberty when they hit a growth spurt.
Females get a physical growth spurt but not a neuromuscular spurt, which causes severe imbalances that lead to ACL tears.
“We have to get to those girls at about age 11 or 11 1/2,“ Hewett said. “That’s junior high school. How do we do it?
“We have to do it in the schools.“
Hewett implements programs at several schools in Ohio and some schools out of state.
He once received a frantic phone call from a girls basketball coach in Illinois who was distraught because four of his five starters blew out their ACLs during the season.
“The town was ready to string this coach up,“ Hewett said with a chuckle. “He called me up and we got in there and instituted programs. Over the next three years, they not only did not have any more ACL injuries, they won a state championship.“
Hewett’s training program and others like it not only reduce the chances of an ACL tear, they make athletes more conditioned and more coordinated.
But having advanced training within the school system is an advanced concept.
Very few high schools in the nation have such programs. Iredell County is no exception.
“Are there any established programs to train and teach that in our area? No, not really,“ director of Rehabilitation Services at Iredell Memorial Hospital Carl Dunkin said. “If an individual comes into my clinic, then I can teach an individual a protocol. I think our physical therapy practices, our coaches, our trainers, need to have more education on being able to develop these programs in the schools.
“Secondly, if we see some issues with poor mechanics being performed, we need to sit down and ask ourselves if this individual should be participating at the level they are participating in. We shouldn’t be asking them to do (certain) things ... without seeing if they are physically capable of doing those things.“
All 13 athletes with torn ACLs interviewed by the R&L said any sort of preventative knowledge, or even basic statistics, would have been beneficial to them, and can still be beneficial to current area athletes with healthy knees.
“In terms of stretching methods or ways to prevent it, that would be really helpful,“ said Lake Norman junior Megan Brantley, who tore the ACL in her right knee playing soccer in November 2006. “It happens to so many girls, and no one has any idea how it happens to them.
“And coaches ... know the players the best and how they work. It would be a lot easier hearing that information coming from a coach than from a doctor.“
To get coaches and school officials that information, Hewett is one doctor who travels the world.
Hewett’s schedule in October has him going from Spain to Minneapolis, Cincinnati to New Zealand and West Virginia to Japan.
He’s on the road teaching and informing, trying to promote solutions and save futures.
He’s seeking others to join him.
“We have answers to this problem,“ Hewett said. “We still have so far to go to educate people and, more importantly, get this implemented into the school systems. And it just hasn’t been done. Most Division I colleges have some kind of program. The problem is, we may be getting at it way too late there.
“Most high schools have nothing. We have a lot of work to do. We still have a long, long way to go with this.“