Knee injuries....

I have had posts previously about knee injuries, especially anterior cruciate ligament tears.

Those posts noted that:

• injuries might be prevented through balance or proprioception training;
• women's knees are more prone to injury (also here);
• stretches should be avoided prior to exercise;
  
• the inflammation associated with problem knees interferes with healing and
  
• stretching can actually promote knee stability;

I was reminded of all these posts earlier today when I read a story from the New York Times as it came through my RSS reader: Big-Time Injury Strikes Little Players

In the article the journalist notes the incresing incidence of ACL injuries in children and the difficulties in treating them in those whose bones are still growing:

The standard and effective treatment for such an injury in adults is surgery. But the operation poses a greater risk for children and adolescents who have not finished growing because it involves drilling into a growth plate, an area of still-developing tissue at the end of the leg bone.

Although there are no complete or official numbers, orthopedists at leading medical centers estimate that several thousand children and young adolescents are getting A.C.L. tears each year, with the number being diagnosed soaring recently. Some centers that used to see only a few such cases a year are now seeing several each week.

It is not an overuse injury from playing one sport too intensively, like shoulder injuries in young pitchers. Instead, doctors say, the injury occurs simply from twisting the knee, and diagnoses are on the rise partly because it can now be easily detected and partly because the very nature of youth sports has changed.

These are serious injuries that can ruin a kid's sporting life, fitness and future health and the article emphasised to me the need to keep health and function at the forefront of your concerns when training. Whatever else are training should be doing, it should be making us more resilient not more fragile. So that means balance training and stretching, plus - as Lou Schuler has pointed out - strength training.

Vern Gambetta has written an excellent article about this:

On Guard: Multiple-plane, multiple-joint workouts are the key to an effective defense against ACL injuries.

The emphasis on ACL prevention needs to be on multiple-plane, multiple-joint work that puts a premium on balance and proprioception in functional, sport-specific positions. Instead of focusing on the knee alone, we need to address the entire kinetic chain to better reduce force on the joint. We must shift our thinking away from traditional exercises and training methods that emphasize force production to a more balanced program involving force reduction and proprioception. The emphasis needs to be on training integrated movements, not isolated muscles.

An important but often ignored fact is that 70 percent of knee injuries, regardless of gender, are non-contact. The typical mechanisms of these non-contact injuries are planting and cutting, straight-knee landing (no flexion on landing), hard one-step stops with the knee hyperextended, pivoting, and rapid deceleration. These are all movements that occur with high force and at high speed, and though they usually happen very quickly, athletes can be trained to make them more efficiently as part of a comprehensive prevention program.

Gambetta suggests some programmes, but his conclusions are worth restating:

All of the successful ACL-prevention programs share a few key components: mechanics of movement, proprioception, plyometrics, and strength training. They can be translated into the following five modules:

• strength/power, including basic strength, core strength, elastic/reactive strength (plyometrics)
• balance/proprioception
• agility, including body awareness, footwork, and change of direction
• dynamic flexibility
• sport-specific conditioning.

I've said before that such training doesn't have to be complicated - build it into your day. For example stand on one leg when putting your socks on, or when combing your hair.

Just to finish off the post, here is a quick video of some balance/proprioception training. I am really interested in balance at the moment, so if you spot any interesting balance videos or resources, please let me know.