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ACL Tear prevention in female athletes

Nicole Pecoraro October 21, 2012. ACL Tear prevention in female athletes. Two bands Anteromedial band is tight in flexion Posterolateral band is tight in extension Courses from femur to tibia Prevents anterior translation of the tibia on the femur

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ACL Tear prevention in female athletes

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  1. Nicole Pecoraro October 21, 2012 ACL Tear prevention in female athletes

  2. Two bands • Anteromedial band is tight in flexion • Posterolateral band is tight in extension • Courses from femur to tibia • Prevents anterior translation of the tibia on the femur • Provides passive stability to the tibiofemoral joint The Anterior Cruciate Ligament

  3. Stabilizers around the acl • Muscles • Quadriceps • Hamstrings • Popliteus • Gastrocnemius • Pes Anserine group • Gracilis • Semitendinosus • Sartorius • Other Ligaments • PCL • MCL • LCL • Joint Capsules • Anterior capsule • Posterior capsule

  4. Large valgus or varus force while the foot remains planted in the ground Hyperextension of the knee Patient will typically hear popping sound and feel and tearing sensation How is the acl torn?

  5. ACL tears occur 4-8 times more frequently in females • Four primary factors • Neuromuscular differences • How muscles contract and react • Less force and torques can be generated in the hamstrings and quadriceps muscles in females • Anatomical differences • Females have wider hips resulting in a larger Q angle • Women rely on the use of their quadriceps muscles heavily, adding a lot of stress on the knee, whereas men rely more on their hamstrings. • Hormonal differences • Ligaments tend to be more lax in females due to hormones • Bio-mechanical differences • Increased knee abduction and valgus torques in females • Females have a higher lateral trunk motion • Majority of the body’s weight is shifted onto one leg • Foot remains planted in surface and is displaced from the center of mass Why are females at a higher risk of tears?

  6. Strengthen muscles • Particularly hamstrings, gluteal, and core muscles • Correct any abnormal movement patterns in their gait • These could be adding stress to the joint • Exercise programs that include stretching, strengthening, coordination and plyometrics How can you reduce the risk of injury?

  7. The PEP Program has shown to reduce injury up to 41% in female athletes • Study done by the NCAA including 1,435 Division 1 female athletes • Designed by physical therapists at the Santa Monica Orthopedic and Sports Medicine Group • Addresses potential deficits in neuromuscular coordination and strength in the stabilizing muscles around the knee joint • 5 parts • Warm-up • Strengthening • Plyometrics • Agilities • Stretching • Approximately 15-20 minutes Prevent Injury & Enhance Performance(PEP)

  8. 1½ minutes • Promotes blood circulation to the muscle tissues • Reduces risk of injury • Example: Jog from line to line(cone to cone) •  Make sure the athlete’s hips/knees/ankles are in  straight alignment   Warm-up

  9. 3 minutes • Strengthening the muscles surrounding the knee will make the joint more stable • Example: Walking Lunges • Strengthens the quadriceps muscles strengthening

  10. 2½ minutes • Improve power, strength, and speed through explosive exercises • Proper, soft landings are crucial • “softly accept your weight on the balls of your feet slowly rolling back to the heel with a bent knee and a bent hip” • Example: Scissors Jump • Increases strength and power of vertical jump plyometrics

  11. 3 minutes • Each of the 3 activities has a different purpose • Example: Lateral Diagonal Runs • Purpose: Increases dynamic stability in the ankles, knees, and hips. • Prevents a “knock knee” position from occurring which puts the ACL in a vulnerable place Agilities

  12. 5 minutes Improves or maintains mobility and range of motion Reduces stiffness in joints and post-exercise soreness Example: Figure-4 hamstring stretch Stretching

  13. Video by the NCAA on the PEP program • Demonstrates some of the exercises • http://www.youtube.com/watch?v=t_yz7yWLo5o • The entire PEP Program • http://smsmf.org/files/PEP_Program_04122011.pdf Additional information

  14. APTA. (2008). PTs: Appropriate exercise can help prevent ACL injuries in females. Retrieved 10/12, 2012, from <http://www.apta.org/Media/ Releases/Consumer/2008/9/25/> Hewett, T. E., Myer, G. D., Ford, K. R., Paterno, M. V., & Quatman, C. E. (2012). The 2012 ABJS nicolasandry award: The sequence of prevention: A systematic approach to prevent anterior cruciate ligament injury. Clinical Orthopaedics and Related Research, 470(10), 2930-2940. Neumann, D. A. (2012). Kinesiology of the musculoskeletal system (second ed.). St. Louis, Missouri: Mosby, Inc. Noyes, F. R., & Barber Westin, S.,D. (2012). Anterior cruciate ligament injury prevention training in female athletes: A systematic review of injury reduction and results of athletic performance tests. Sports Health, 4(1), 36-46. The Santa Monica Sports Medicine Research Foundation.The PEP program: Prevent injury and enhance performance. Retrieved 10/12, 2012, from <http://smsmf.org/files/PEP_Program_04122011.pdf> references

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