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150116 1 IDENTIFYING RISK FACTORS AND PROGRAMMING FOR INJURY PREVENTION ACL INJURY / RE-INJURY PREVENTION 2014-12-16 PhD Candidate, Faculty of Medical Science, University of Calgary Director of Strength and Conditioning, Canadian Sport Institute-Calgary Director of Sport Science | Sport Medicine, Canadian Alpine Ski Team MATT JORDAN, M.Sc., CSCS PRESENTATION OVERVIEW Identify modifiable (trainable) risk factors for ACL injury Consequences of ACL injury Programming for ACL injury / re-injury prevention © Matt Jordan 2014 A database of ski racers with French Alpine Ski Team was analyzed Of 379 athletes registered, 28% suffered at least one ACL injury 50% of top ranked skiers suffered ACL injury (Pujol et al., 2007) © Matt Jordan 2014 More than 30% of top ranked skiers suffered ACL re-injury (Pujol et al., 2007) © Matt Jordan 2014 ACL ACL TIBIAL FRACTURE TIBIAL FRACTURE TIBIAL FRACTURE ACL RE-INJURY NON-CONTACT ACL INJURY Anterior Cruciate Ligament Female athletes at greater risk (4-6x male counterpart) (Arendt et al., 1995; Myer et al., 2009; Prodromos et al., 2008) Non-contact injury occurs in transitional zones (i.e. deceleration of the BCM) (Beynnon et al., 1998) Increased risk for non-contact ACL injury attributable to risky biomechanics and altered intermuscular coordination (Hewett et al., 2005; Zebis et al., 2009) © Matt Jordan 2014

ACL INJURY PREVENTION - Jordan Strength · 2015-01-16 · PREVENTION ACL INJURY / RE-INJURY PREVENTION 2014-12-16 PhD Candidate, Faculty of Medical Science, University of Calgary

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Page 1: ACL INJURY PREVENTION - Jordan Strength · 2015-01-16 · PREVENTION ACL INJURY / RE-INJURY PREVENTION 2014-12-16 PhD Candidate, Faculty of Medical Science, University of Calgary

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IDENTIFYING RISK FACTORS AND PROGRAMMING FOR INJURY

PREVENTION

ACL INJURY / RE-INJURY PREVENTION

2014-12-16

PhD Candidate, Faculty of Medical Science, University of Calgary

Director of Strength and Conditioning, Canadian Sport Institute-Calgary

Director of Sport Science | Sport Medicine, Canadian Alpine Ski Team

MATT JORDAN, M.Sc., CSCS

PRESENTATION OVERVIEW

§  Identify modifiable (trainable) risk factors for ACL injury

§  Consequences of ACL injury

§  Programming for ACL injury / re-injury prevention

© Matt Jordan 2014

§  A database of ski racers with French Alpine Ski Team was analyzed

§  Of 379 athletes registered, 28% suffered at least one ACL injury §  50% of top ranked skiers suffered ACL injury

(Pujol et al., 2007) © Matt Jordan 2014

§  More than 30% of top ranked skiers suffered ACL re-injury

(Pujol et al., 2007) © Matt Jordan 2014

ACL

ACL

TIBIAL FRACTURE

TIBIAL FRACTURE

TIBIAL FRACTURE

ACL

RE-INJURY

NON-CONTACT ACL INJURY

Anterior Cruciate Ligament

§  Female athletes at greater risk (4-6x male counterpart) (Arendt et al., 1995; Myer et al., 2009; Prodromos et al., 2008)

§  Non-contact injury occurs in transitional zones (i.e. deceleration of the BCM) (Beynnon et al., 1998)

§  Increased risk for non-contact ACL injury attributable to risky biomechanics and altered intermuscular coordination (Hewett et al., 2005; Zebis et al., 2009)

© Matt Jordan 2014

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FORCES THAT LOAD THE ACL

Prodromos, (2008). The Anterior Cruciate Ligament: Reconstruction and Basic Science © Matt Jordan 2014

Anterior shear load on the tibia ***

Valgus loading

Tibial internal rotation

FORCES THAT LOAD THE ACL

0-30° and 90° + knee flexion

Prodromos, (2008). The Anterior Cruciate Ligament: Reconstruction and Basic Science

Aggressive quadriceps contraction / hamstring inactivation

© Matt Jordan 2014

§  Rapid eccentric deceleration (landing jumps / changing direction) high risk sport movement

§  Hard landing (Hewett et al., 2005)

§  Greater posterior vGRF

§  Small angles of knee flexion / quad strength dominant (Demorat et al., 2004 ; Colby et al., 2000; Myer et al., 2006)

§  Time frame of injury < 50 ms (Krosshaug et al., 2007)

§  Highlights importance of pre-activation strategies and rapid muscular force development

© Matt Jordan, 2013

ACL RISK FACTORS: LANDING MECHANICS

Prodromos, (2008). The Anterior Cruciate Ligament: Reconstruction and Basic Science

0

1000

2000

3000

51.0 51.5 52.0TIME (s)

FOR

CE

(N)

vGRF RIGHT vs LEFT

0

30

60

90

120

51.0 51.5 52.0TIME (s)

EMG

RM

S

VASTUS LATERALIS

0

30

60

90

51.0 51.5 52.0TIME (s)

EMG

RM

S

VASTUS MEDIALIS

0

30

60

90

51.0 51.5 52.0TIME (s)

EMG

RM

S

SEMITENDINOSUS

0

30

60

90

51.0 51.5 52.0TIME (s)

EMG

RM

S

BICEPS FEMORIS

§  Female athletes may have

altered H/Q activation and reduced hamstrings strength (Huston & Wojstys, 1996; Prodromos et al., 2008; Zebis et al., 2009; Zebis et al., 2011)

§  ACL injured females increased VL-ST activity difference (Zebis et al., 2009)

§  ACL injured females had lower hamstrings strength but no difference in quadriceps strength compared to matched male controls (Myer et al., 2009)

§  Quadriceps dominant landings linked to increased ACL loading (Bessier et al., 2003; Demorat et al., 2004; Markolf et al., 2004)

ACL RISK FACTORS: HAMS / QUADS

Semitendinosus

Biceps femoris

§  Hamstrings important ACL agonist (decreases ACL loading) (Mac Williams et al., 1999; Markolf et al., 2004)

§  Assists by preventing anterior translation of tibia b/w 30-90° flexion but not in extension (Mac Williams et al., 1999; Markolf et al., 2004)

§  Medial hamstrings / medial quadriceps (VM) important for ACL unloading and medial joint compression (anti-valgus) (Zebis et al., 2009)

§  H/Q co-contraction increases valgus/varus stiffness (Mac Williams et al., 1999)

HAMSTRINGS – AN ACL AGONIST

© Matt Jordan 2014

(Gio Auletta, Pentaphoto)

© Matt Jordan 2014

MECHANISMS OF INJURY

Page 3: ACL INJURY PREVENTION - Jordan Strength · 2015-01-16 · PREVENTION ACL INJURY / RE-INJURY PREVENTION 2014-12-16 PhD Candidate, Faculty of Medical Science, University of Calgary

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SLIP AND CATCH

(Bere et al., 2011)

-10

0

10

20

30

40

50

60

70

0 80 160

KN

EE J

OIN

T A

NG

LE

TIME (ms)

Knee Flexion

Valgus

Internal Rotation

INJURY PERIOD (60 ms)

SLIP AND CATCH MECHANISM

Bere et al. The American journal of sports medicine 41.5 (2013): 1067-1073.

§  Rapid increase in knee flexion 26° to 63°

Barone et al. Skiing Trauma and Safety, 12th Edition (1999): 63-81.

© Matt Jordan 2014

§  Skier out of balance and backward in flight

§  Lands on ski tails

§  Boot and knee extensor torque cause anterior translation of tibia

LANDING BACK WEIGHTED

© Matt Jordan, 2013 (Bere et al., 2011)

FHAMSTRINGS

FANTERIOR SHEAR

(Barrata et al., 1988; Herzog & Read, 1993; Mac Williams et al., 1999; Markolf et al., 2004; Prodromos et al., 2008)

FACL

IMPORTANCE OF THE HAMSTRINGS

FHAMSTRINGS

FPT

FANTERIOR SHEAR

(Barrata et al., 1988; Herzog & Read, 1993; Mac Williams et al., 1999; Markolf et al., 2004; Prodromos et al., 2008)

FQUADRICEPS

FACL

IMPORTANCE OF THE HAMSTRINGS IMPORTANCE OF THE HAMSTRINGS

© Matt Jordan 2014

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SUMMARY OF MECHANISMS

§  Range of knee flexion

§  Skier out of balance

§  Lateral to medial knee joint loading (valgus loading)

§  Twisting load (internal rotation of tibia)

§  Back to front load on tibia (anterior displacement of tibia)

§  Time frame of injury (< 60 ms)

© Matt Jordan 2014

RISKS FACTORS FOR ACL INJURY

§  Equipment §  Speed

§  Changing snow conditions

§  Course setting

§  Physical factors (e.g. fitness, strength)

(Spörri et al., 2012) © Matt Jordan 2014

(Bere et al., 2011; Bere et al., 2011; Ferguson, 2009; McConkey, 1996; Natri et al., 1999; Pujol et al., 2007)

THE INJURY / RE-INJURY CYCLE

Pre-Injury Factors!

Extrinsic!Intrinsic!

Modifiable!

Fatigue!Strength / Fitness

Factors!Technical Ability!

INJURY!!

RETURN TO SPORT

ASSESSMENT!

Graft Strength /

Knee stability!

EARLY RETURN TO SPORT??!

Athlete Confidence!

Medical Team

Subjective Opinion / Consensus!

Accepted Timelines!

Fitness!

Functional Neuromuscular Assessment / Envelope of Function!!

EARLY PHASE REHAB!

LATE PHASE REHAB!

RETURN TO

PODIUM!

SURGERY!

Time from Injury!

Secondary Injury!

Meniscus!

Articular Cartilage!

Multi-ligament!

Bone Bruise!

Capsule!

Complications?!

Active/Passive ROM!

Muscle Recruitment!

SLeg Weight Bearing!

MID PHASE REHAB!

Closed Kinetic Chain (SLeg, DLeg)!

Balance!

Thigh Muscle Mass!

Return to Sport Training!

Reactive Strength!

Explosive Strength!

Sleg and !DLeg Muscle

Power!

Bilateral Symmetry!

Thigh Muscle Maximal Strength!

Procedure!

ABC’s / Pivoting!

0-2 Mnths! 2-5 Mnths! 5-8 Mnths! 8-12 Mnths! 12-36 Mnths!

RETURN TO SPORT PHASE!

Quantify Training Load!

Neuromuscular Monitoring!

Stabilization of Fitness Factors!

On Snow Technical !

Re-Acquisition!Advance Through

Milestones!!

Graft Vulnerability!!

Re-injury?!

Perceived vs. ACTUAL!

readiness??!

Increasing Cognitive and Physical

Demands!Concentric/Eccentric Symmetry!

Maximal and Repetitive Load

Tolerance!

Mvmnt!Strategy!

Subjective Knee Form / Giving Way?!

RETURN TO SPORT

MONITORING!Training Load!

Adaptive!Potential! FNS! Technical

Ability!

Snow Performance!

Psych!

Performance Stabilization!

Performance On Demand! Risk Taking!

Recovery and Regeneration Strategies!!

Ecc Decel / Landing Mechanics!

Mechanism!

Fear of Re-Injury! Psych!

Factors!

Psycho-Emotional!

0

100

200

300

400

500

600

700

800

900

1000

15.2 15.7 16.2

FOR

CE

(N)

TIME (s)

ACL-R Limb Unaffected Limb

(Jordan et al., 2014) © Matt Jordan 2014

FUNCTIONAL ASYMMETRY

Page 5: ACL INJURY PREVENTION - Jordan Strength · 2015-01-16 · PREVENTION ACL INJURY / RE-INJURY PREVENTION 2014-12-16 PhD Candidate, Faculty of Medical Science, University of Calgary

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0

200

400

600

800

1000

15.2 15.7 16.2

FOR

CE

(N)

TIME (s)

0

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400

600

800

1000

12.5 13 13.5 14

FOR

CE

(N)

TIME (s)

ACL-RECONSTRUCTED SKIER UNINJURED SKIER ACL-R Limb Unaffected Limb

Left Right

(Jordan et al., 2014)

FUNCTIONAL ASYMMETRY

Noraxon MyoVideo Report

Project Project 1First Name HannahLast Name LomasSex Female

PatientName CMJ_HANNAH_21OCTOBER2013Date Measured 10/21/2013 4:56 PMNumber of periods 1

Record

2

Record Comments

Patient Comments

Report at 11.9 secLogitech HD Pro Webcam C920

Parameters

Report at 12.1 secLogitech HD Pro Webcam C920

Parameters

LT Knee, Logitech HD Pro WebcamC920, deg 0.33

RT Knee, Logitech HD Pro WebcamC920, deg 7.29

Report at 12.4 secLogitech HD Pro Webcam C920

Parameters

Report at 12.7 secLogitech HD Pro Webcam C920

Parameters

LT Knee, Logitech HD Pro WebcamC920, deg 9.41

RT Knee, Logitech HD Pro WebcamC920, deg -9.70

Noraxon MyoVideo Report

Project Project 1First Name HannahLast Name LomasSex Female

PatientName CMJ_HANNAH_21OCTOBER2013Date Measured 10/21/2013 4:56 PMNumber of periods 1

Record

2

Record Comments

Patient Comments

Report at 11.9 secLogitech HD Pro Webcam C920

Parameters

Report at 12.1 secLogitech HD Pro Webcam C920

Parameters

LT Knee, Logitech HD Pro WebcamC920, deg 0.33

RT Knee, Logitech HD Pro WebcamC920, deg 7.29

Report at 12.4 secLogitech HD Pro Webcam C920

Parameters

Report at 12.7 secLogitech HD Pro Webcam C920

Parameters

LT Knee, Logitech HD Pro WebcamC920, deg 9.41

RT Knee, Logitech HD Pro WebcamC920, deg -9.70

Noraxon MyoVideo Report

Project Project 1First Name HannahLast Name LomasSex Female

PatientName CMJ_HANNAH_21OCTOBER2013Date Measured 10/21/2013 4:56 PMNumber of periods 1

Record

2

Record Comments

Patient Comments

Report at 11.9 secLogitech HD Pro Webcam C920

Parameters

Report at 12.1 secLogitech HD Pro Webcam C920

Parameters

LT Knee, Logitech HD Pro WebcamC920, deg 0.33

RT Knee, Logitech HD Pro WebcamC920, deg 7.29

Report at 12.4 secLogitech HD Pro Webcam C920

Parameters

Report at 12.7 secLogitech HD Pro Webcam C920

Parameters

LT Knee, Logitech HD Pro WebcamC920, deg 9.41

RT Knee, Logitech HD Pro WebcamC920, deg -9.70

Noraxon MyoVideo Report

Project Project 1First Name HannahLast Name LomasSex Female

PatientName CMJ_HANNAH_21OCTOBER2013Date Measured 10/21/2013 4:56 PMNumber of periods 1

Record

2

Record Comments

Patient Comments

Report at 11.9 secLogitech HD Pro Webcam C920

Parameters

Report at 12.1 secLogitech HD Pro Webcam C920

Parameters

LT Knee, Logitech HD Pro WebcamC920, deg 0.33

RT Knee, Logitech HD Pro WebcamC920, deg 7.29

Report at 12.4 secLogitech HD Pro Webcam C920

Parameters

Report at 12.7 secLogitech HD Pro Webcam C920

Parameters

LT Knee, Logitech HD Pro WebcamC920, deg 9.41

RT Knee, Logitech HD Pro WebcamC920, deg -9.70

AI = 22.5% AI = 17.5%

Fz R Fz L Fz R Fz L INCREASE KNEE

ABDUCTION MOMENT (Kristianslund et al., 2014)

© Matt Jordan 2014

Countermovement Jump (CMJ) Squat Jump (SJ)

© Matt Jordan 2014

© Matt Jordan 2014

ASYMMETRY LEG MUSCLE MASS (%)

SJ M

ID T

O L

ATE

PHA

SE K

INET

IC IM

PULS

E A

SYM

MET

RY IN

DEX

(%)

−10

0

10

20

−4 −2 0 2 4 6 8 10

STATUSACL−RCONTROL

ASYMMETRY LEG MUSCLE MASS (%)

CM

J C

ON

CEN

TRIC

PH

ASE

KIN

ETIC

IMPU

LSE

ASY

MM

ETRY

IND

EX (%

)

−5

0

5

10

15

−4 −2 0 2 4 6 8 10

STATUSACL−RCONTROL

RELATIONSHIP B/W FUNCTIONAL ASYMMETRY AND MUSCLE ASYMMETRY

RE-INJURY CMJ CONCENTRIC PHASE SJ PHASE 2

STATUSCM

J EC

CEN

TRIC

DEC

EL P

HA

SE K

INET

IC IM

PULS

E A

SYM

MET

RY IN

DEX

(%)

0

5

10

ACL−R CONTROL

STATUSACL−RCONTROL

(Jordan et al., 2013)

Page 6: ACL INJURY PREVENTION - Jordan Strength · 2015-01-16 · PREVENTION ACL INJURY / RE-INJURY PREVENTION 2014-12-16 PhD Candidate, Faculty of Medical Science, University of Calgary

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SJ LATE PHASE KI ASYMMETRY INDEX (%)

CM

J C

ON

CEN

TRIC

PH

ASE

KI A

SYM

MET

RY IN

DEX

(%)

0

5

10

15

−5 0 5 10 15 20 25

BADEXA02468

10

STATUSCOPERNON COPER

MUSCLE MASS AI

IDENTIFYING AT RISK SKIERS:KINETIC IMPULSE ASYMMETRY INDEX IDENTIFYING AT RISK ATHLETES

§  N = 71 athletes §  Females: n=51, Age=20.6±2.3 years, Body Mass =

67.8±11.5 kg

§  Males: n=20, Age=20.1±1.7 years, Body Mass = 78.7±16.5 kg)

§  Alpine skiing, luge, soccer, rugby, wrestling

§  Assessed at the start of the off-season preparatory period and throughout training (1x/week)

ASY

MM

ETRY

IND

EX C

MJ

ECC

DEC

EL P

HA

SE (%

)

5

10

15

20

STATUSUNINJUREDINJURED

ASY

MM

ETRY

IND

EX C

MJ

ECC

DEC

EL P

HA

SE (%

)

5

10

15

20

STATUSUNINJUREDINJURED

IDENTIFYING PREVIOUSLY UNINJURED AT RISK ATHLETES

Odds of injury 1.2x (95% CI = 1.1-1.4x) (P<0.01)  

ACL INJURIES 2010 – 2014 = NONE

ACL RE-INJURIES = NONE

LOWER BODY RE-INJURIES = 2

STRATEGIES FOR ACL INJURY/RE-INJURY PREVENTION

TRAINING CONSIDERATIONS

Can the system find the right solution?

Can the motor system generate the right solution?

WHERE IS THE BREAKDOWN?

(Aagaard, 2003; Sale, 2003)

282 mechanism for adaptation

For example, it has been estimated that in tricepsbrachii, only about 5% of the motor units areType IIb (IIx), but this small number of units contains about 20% of the total number of musclefibres in the muscle (Enoka & Fuglevand 2001).The second way increased activation could occuris through increased motor unit firing rates (Fig.15.3, middle panel). By increasing or decreasingfiring rate (also referred to as discharge rate orrate coding), a motor unit can vary its force out-put over an approximately 10-fold range, knownas the force–frequency relationship. The motorunit firing rates observed in maximal voluntarycontractions appear to be lower than needed formaximum force output (Enoka & Fuglevand2001; cf. Bellemare et al. 1983). Training mayallow for firing rates consistently high enough tobe on the plateau of the force–frequency relation-ship, where force is maximal. The third wayincreased activation could occur is also throughincreased motor unit firing rates (Fig. 15.3, bot-tom panel). When the intent is to contract themuscle as fast as possible with maximum rate offorce development (so-called ‘ballistic’ contrac-tions), motor units begin firing at a very high fre-quency, followed by a rapid decline in frequency(Zehr & Sale 1994). The peak firing rates attained

Fig. 15.1 Control of muscle by the nervous system.Voluntary strength performance is determined notonly by the quantity and quality of the involvedmuscle mass, the ‘engine’, but also by the ability of thenervous system, the engine controller, to effectivelyactivate the muscles. Nervous system adaptations tostrength training may improve the control of musclesto increase maximum force (strength). These ‘neural’adaptations may occur in higher brain centres orwithin the spinal cord.

Strength training

Neural adaptation

Appropriatesynergist activation

HAntagonistactivation

Agonistactivation

HForce and/or rate of force development

HStrength performance

Fig. 15.2 Neural adaptations to strength training may take the form of increased activation of agonistmuscles, more appropriate activation of synergistmuscles (‘coordination’), and decreased (relative)activation of antagonist muscles. These adaptationswould act to increase maximum force (strength)and/or rate of force development.

© Matt Jordan 2014

Page 7: ACL INJURY PREVENTION - Jordan Strength · 2015-01-16 · PREVENTION ACL INJURY / RE-INJURY PREVENTION 2014-12-16 PhD Candidate, Faculty of Medical Science, University of Calgary

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TRAINING FOR INJURY PREVENTION MOTOR CONTROL NEUROMUSCULAR FACTORS

Unilateral Deceleration Motor Control

Core Control

Rested and Fatigued

Positional Strength

Bilateral Force Symmetry

Rate of Force Development (Explosive Strength)

Inter-Muscular Synergy and Muscle Balance

Thigh Muscle Strength Curve

Deceleration Strength

Bilateral Deceleration Motor Control

Muscle Pre-Activation / Anticipation

Expected / Unexpected Events

© Matt Jordan 2014

WARM UP

ACTIVATION

MOTOR CONTROL

PRIMARY LIFTS

SECONDARY LIFTS

ASSISTANT CIRCUIT

MOTOR CONTROL → Use a variety of loads and velocities but ensure

some specificity → Identify compensation strategies - ‘we are designed

to compensate’ → Groove motor patterns under expected conditions

→ Challenge system with fatigue conditions or unexpected conditions

→ Performed daily as a part of warm up and in combination with activation exercises

© Matt Jordan 2014

WARM UP Quotidian movement assessment

Dynamic warm up

Mobility

1. Omni Prone Plank

ACTIVATION

2. Omni Side Plank

3. Mini Band Mummy Walks

4. Mini Band Full Squats

© Matt Jordan 2014

MOTOR CONTROL

1. Jump Rudiment

2. Double Leg Freeze Drops

3. Single Leg Drops

4. Single Leg Drops Eyes Closed

© Matt Jordan 2014

LOWER BODY STRENGTH

Page 8: ACL INJURY PREVENTION - Jordan Strength · 2015-01-16 · PREVENTION ACL INJURY / RE-INJURY PREVENTION 2014-12-16 PhD Candidate, Faculty of Medical Science, University of Calgary

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STRENGTH DEVELOPMENT

→  Don’t train on top of poor technique

→  Develop range of motion appropriately

→  Use a combination of uni-lateral and bilateral lifts

→  Develop positional strength AND positional rapid force production

© Matt Jordan, 2013

NEUROMUSCULAR FACTORS

→ Lower body symmetry → Train to be ambidextrous

→ Strengthen ACL agonists → Identify periods of strength development and

strength maintenance

→ Performed 1-2x / week as a part of microcycle

© Matt Jordan 2014

ESSENTIAL MOVEMENTS

→  Full range of motion unilateral / bilateral exercises

→ Hamstring (closed chain / open chain)

→ Hip abductor strength

→ Quadriceps strength balance (VM vs. VL)

© Matt Jordan 2014

ZONE TYPE REPETITION RANGE

RELATIVE INTENSITY 1RM=100%

TRAINING EFFECT

1

SSC 6-10 BW – 20% REACTIVE STRENGTH

2

DYNAMIC EFFORT 3-8 30% - 80%

EXPLOSIVE STRENGTH /

MECHANICAL POWER

3

REPEATED EFFORT 6-15 60% - 85% MUSCLE

HYPERTROPHY / WORK CAPACITY

4

MAXIMAL EFFORT 1-6 85% - 100% MAXIMAL MUSCLE STRENGTH

© Matt Jordan 2014

PRIMARY LIFTS

1. Full Power Clean

2. Full Back Squat

STRONG AND EXPLOSIVE BELOW 90 DEGREES

© Matt Jordan 2014

SECONDARY LIFTS

3. Full Depth Single Leg Squat Off Box

4. Band Resisted Romanian Dead Lift

BILATERAL STRENGTH SYMMETRY / CORE STRENGTH

© Matt Jordan 2014

Page 9: ACL INJURY PREVENTION - Jordan Strength · 2015-01-16 · PREVENTION ACL INJURY / RE-INJURY PREVENTION 2014-12-16 PhD Candidate, Faculty of Medical Science, University of Calgary

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ASSISTANT CIRCUIT

5A. Heel Elevated Step Down

5B. Eccentric Leg Curl

HAMSTRING / QUADRICEPS STRENGTH BALANCE

5B. Band Hip Abduction

© Matt Jordan 2014

FATIGUE →  Ski related injuries occur in a fatigued state (Bere et al., 2013)

→  Fatigue leads to risky biomechanics in landing (Kernozek et

al., 2008)

→  Alterations in hamstrings/quadriceps co-contraction observed in an acutely fatigued state (Zebis et al., 2011)

→  Evaluating neuromuscular function in the ACLR athlete under fatigue (Myer et al., 2006)

© Matt Jordan 2014

© Matt Jordan 2014

BALANCE AND LOWER BODY MOTOR CONTROL

→  Does an exercise require balance or train balance

→  New and unpredictable movements train balance

→  The best movement = the new movement

© Matt Jordan 2014

© Matt Jordan 2014

SUMMARY →  ACL injury affects many athletes (ski racers,

recreational skiers, female athletes in field sports)

→  We can identify modifiable (trainable) risk factors

→  Programming for injury prevention is multi-faceted

→  Daily motor control component

→  Strengthening component

→  Strategies can be very effective for injury prevention

© Matt Jordan 2014

Page 10: ACL INJURY PREVENTION - Jordan Strength · 2015-01-16 · PREVENTION ACL INJURY / RE-INJURY PREVENTION 2014-12-16 PhD Candidate, Faculty of Medical Science, University of Calgary

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ACKNOWLEDGEMENTS Canadian Sport Institute-Calgary

Own the Podium

Dr. Walter Herzog

Dr. Per Aagaard

Dr. Steve Norris

The Herzog Group (Azim Jinha)

Scott Maw, Stu McMillan, Jer Barnert, Dan Pfaff

The CSI-Calgary S & C Team

CANADIAN SPORT INSTITUTE

INSTITUT DU SPORTCANADIEN

THANK YOU

www.jordanstrength.com

@JordanStrength

Generating athlete performance solutions for strength coaches, teams, sports organizations and sports medicine professionals