February 2008
by Kym Burke
This article was published in the February 2008 edition of the American Chiropractic Association News
In Part I, we discussed ways to improve lumbopelvic stability to help young athletes prepare for sports participation. This article addresses other areas of sports readiness.
Minimizing ACL Injuries
Let’s look at how we can reduce the incidence of ACL injuries, especially in girls’ basketball. Research shows that it is not their hormones causing all these injuries, nor is it the exaggerated “Q” angle; it is their inability to decelerate the adduction and internal rotation of their femur in relation to their tibia. Preston Wolin, MD, director of the Sports Medicine Program at the Neurologic and Orthopedic Hospital of Chicago, believes a general naivete about good strengthening and conditioning practices is a major reason young women are injuring themselves far too frequently in competitive sports. Dr. Wolin remarks that females typically overwork their quadriceps muscles more than males and tend to land more flat-footed. In addition, excessive movement in either the frontal plane (adduction) or transverse plane (internal rotation) will result in knee caving and, ultimately, wear and tear on the ACL. The knee is stuck between the foot and the hip. “Smart feet” and buttocks will ensure that the tibia and femur are driven into good alignment.
“Smart feet” are proprioceptively rich feet. If the proprioceptors of the foot/ankle complex are ineffective at stabilizing the lower kinetic chain, we will see a “bottom up” driver problem, with the tibia driving the knee into the caved-in position. It is a good idea to examine the athlete’s feet. If the athlete presents an arch in the non-weight-bearing position, but not in the weight-bearing position, you’ve got work to do. Sometimes simply performing exercises barefoot will wake up the proprioceptors in the foot/ankle. Cue your athlete to maintain a neutral foot position: Do not let the arch collapse.
It is fairly easy for the athletes to show good alignment when they are standing on two feet as in their “ready” stance. But what happens when they maintain their “ready” stance, but transfer all their weight to one leg? Are they still able to maintain the alignment necessary to ensure good patella tracking? If a patellar tracking disorder is detected, rule out the cause, which can range from femoral anteversion (internal femoral torsion) and patella alta (high small patella) to increased Q-angle. In addition, soft-tissue tightness of the muscles (gastrocnemius, hamstrings, rectus femoris and iliotibial band) and lateral structures (lateral retiniculum, IT band and vastus lateralis) could be the cause of the patella tracking being too far laterally. Once abnormal biomechanics and soft-tissue tightness are ruled out as potential causes, look to muscular dysfunction as the root of the problem.
If the core/buttocks musculature is ineffective at stabilizing the trunk, we will see a “top down” driver problem with the knee. In addition to addressing lumbopelvic stability, focus on the gluteus medius. The gluteus medius decelerates adduction and internal rotation of the femur, especially when the hip is flexed at approximately 45 degrees. Single-leg stance work is crucial to training the gluteus medius because all athletes run, cut, leap and often jump from a one-legged stance to another one-legged stance.
Single Bent-Leg Balance
This activity is an extremely effective way to begin establishing good patella-femoral tracking. The athlete must “own” this position. It is very easy to challenge this exercise and keep it interesting. Balance is a function of the PVV system: proprioception, vestibular mechanism and vision. We can increase the stimulus to the proprioceptors by changing the surface the athletes are standing on, using, for example, an Airex mat or BOSU ball. Or we can have them dribble a basketball or perform a chest pass while maintaining their single bent-leg balance. Another “tweak” is to have them close one or both eyes.