Risk factors for ACL tears have been studied for many years. The following risk factors were identified in a 2000 article from the Journal of the American Academy of Orthopedic Surgery from the year 2000.

How ACL tears occur.

Research shows that only 30% of ACL tears are from a direct blow or contact.  The other 70% occur without contact – when athletes pivot or cut or “land wrong” on a jump.  A question that we will tackle in the future is, “What can we do to reduce the risk of this 70% of tears?”

Anatomic Risk Factors

The way our bodies are structured – or individual anatomy – can be identified as risk factors for ACL tears. Here’s what we do know:

• ACL tears are more common in females than males. 

• Differences in structures of the female body include a large “Q angle”. In simple terms this means the hips are wider than the knees and thus the angle from the hip to knee is greater.  This puts increased stress on the knee joint. 

• Women are more “lax” than men. Meaning females tend to have more mobility throughout their bodies.

• Another factor is called the “notch”.  This is part of the big thigh bone (the femur), right where it joins to make the knee.  The ACL connects in the notch.  In general, the smaller the width of the notch, the more likely people are to tear their ACLs.

These factors continue to be researched and we continue to attempt to understand WHY they change the stress on the ACL.

Hormonal Risk Factors

This continues to be an area that medical professionals continue to research.  There have been studies to look at the interaction between female hormones and how these may affect the ACL.  Some people speculate that during some phases of the menstrual cycle the ACL may be weakened.  Much more research is needed in this area.

Biomechanical Factors

Terms such as “proprioception” and “neuromuscular control” are often deemed risk factors for ACL tears.  Neuromuscular control essentially means the ability of your nerves to control your muscles.  This is an unconscious process that happens in the body, although there is some research to support it can be trained.  Proprioception is a term that refers to the ability of our bodies to provide information from the body to the brain to assist with a good response to provide proper neuromuscular control.

Hip and Trunk Contributions

In simple terms – the ability to generate proper forces at both the hip and trunk – including from the hamstrings and gluteus medius (a hip muscle) – is being studied more and more as risk factor for non-contact ACL tears.  When people are unable to stabilize their trunk and hips they are found to have increased forces on the knee and altered muscle activation in the leg.  The changed mechanics tend to put more force on the ACL and thus risk of tearing is increased.

There are many other factors being studied and there is more current research than that provided.  The article reviewed in this blog does show that the risk of ACL tears has been a large area of research and the continued attempted to find risk factors in order to better reduce the risk of ACLs is at the forefront of the orthopedic world! 

Our next blogs will cover: Ways to reduce the risk of ACL tears, Advances in PT follow ACL injuries, and Returning to Sport after an ACL tear.

REFERENCE (this entire blog is a review of the follow article)

1. Griffin LY et al.  Noncontact Anterior Cruciate Ligament Injuries: Risk Factors and Prevention Strategies.  Journal of the American Academy of Orthopaedic Surgeons. 2000, 8(3). 141-150.

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Young athletes who begin to complain of pain on the inside of the elbow, have decreased movement of their elbows and/or even have locking of the elbow joint should immediately stop throwing and be evaluated by a health care professional (Physical Therapist, Orthopedic Physician). This condition can typically be treated without surgery. However, it is important for the younger athlete to rest and then to rebuild their muscles and restore their proper mechanics with throwing to reduce the risk of re-injury, or more serious injuries. ¹

Many athletes, I have seen in our clinic, that have Little Leaguer’s Elbow also have many other deficits.  Our philosophy at Sports PT is: if a patient is overusing their elbow, we want to find out what they are NOT using in order to reduce tension on the elbow when throwing.  When I evaluate a baseball player I will look not only at their elbow, but their shoulder, their shoulder blade, core strength, hip strength and range of motion, and more importantly look at how their body is working together as whole unit.  If we can help to correct these imbalances prior to returning to sport, the chances of re-injuring themselves will most likely be decreased.  Also it is important to note that the risk of suffering these “overuse injuries” can be significantly reduced with a proper post-season, off-season, and pre-season program to assist with improving mechanics, strength, and coordination throughout the body.

Often, our young athletes are asked to do “too much, too fast, too soon” and this can also lead to significant injuries.²

Little League Baseball has strict guidelines about pitch counts and rest periods that are imperative to follow in order to reduce the risk of injury. I am finding that many athletes in our area play in multiple leagues and these guidelines are not being followed. This is causing us to put our athletes at significant risk of injury.²

Here are Little League Baseball’s Guidelines²

MAXIMUM PITCH COUNT²

What I seem to be hearing and finding the most is that parents and coaches are pushing our young athletes too much. It is important to understand the dangers of pushing our children too hard and too fast. It is important that our children have time to rest – which can be a time they cross train and strengthen other areas of their body to support their ability to throw. It is also essential that parents, coaches, athletic trainers and others that work with young athletes identify the early signs of elbow pain (or pain in general) and DO NOT push through the pain and seek medical advice quickly.  Remember, if you have a physical therapist you have worked with in the past, by law you DO NOT need a PRESCRIPTION! If you are concerned of an injury, come and get evaluated!

1. OrthoInfo. American Academy of Orthopaedic Surgeons. Throwing Injuries in the Elbow in Children. http://orthoinfo.aaos.org/topic.cfm?topic=a00328 Accessed on 21 June 2012.

2. Stop Sports Injuries.  Baseball Injuries. http://www.stopsportsinjuries.org/files/pdf/AOSSM_Baseball.pdf Accessed on 21 June 2012.

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The majority of my session was spent working on the “basics”.  I spent most of the lesson on two well known pieces of Pilates equipment: the “Reformer” and the “Cadillac”. Both are frequently used in Pilates and help to assist with movement and provide resistance. The fact that these were basic exercises made me laugh a little when I realized that my core strength needs some improvement! The personal touch from Arielle and the one-on-one instruction showed to be a necessity for me. I did require constant cuing about my position and to be sure I was using the right muscles and keeping the correct form.  By no means was it easy, but the exercise focused on areas that I needed help with and improvements in my body!

As Arielle and I talked through the session it was clear that we share similar styles and concepts when it comes to approaching body correction and strengthening..  First, the “core” (defined as the muscles from your buttock to your shoulders, in both the front and back) is where we like to focus and get people to gain control first.  We both focus on form, and regardless of your knowledge or ability level, it is always better to have somebody watch you perform the task to ensure proper understanding.. With all the training and knowledge I have, I still needed her to constantly remind me to hold my belly tight, relax my shoulders, tighten my buttock – cues I give to my patients regularly. Also we felt that the more we understood each other’sprofession, the more we can help people over come injury or pain, get fit and live a healthy lifestyle.  Many times she sees clients that may have injuries and feels they could benefit from PT prior to or in conjunction with Pilates. Also many times as PTs we are asked about Pilates programs or suggestions of what to do once PT has been completed.  This is where we can greatly work together to better serve our community!

There have been multiple studies in a wide variety of journals regards the use of Pilates to assist with low back pain.  This continues to be a “hot topic” in research. One research article compared the use of Pilates compared to no treatment to assist with reducing low back pain.¹ The participants went through a six week program and improvements were seen in pain levels, general heath and sports functioning. ¹  There were some limitations in this study, but what I infer and believe is that a program such as Pilates that focuses on core stability is an essential part of recovery from low back pain.

Most recently, in May 2012 a study was published in the Journal of Orthopedic and Sports Physical Therapy, a well respected PT journal.  It attempted to help predict people with low back pain that would respond from a Pilates based treatment plan. ²  Another recent article cited in the first article (Lim et al) reviewed multiple articles and found that Pilates is not superior to other forms of exercise when treating low back pain. ¹ Therefore this most recent article tried to identify factors that may lean more towards a Pilates based program.  The results from this study found 5 factors that may predict good results in improving low back pain from a Pilates based intervention. They were: 1) no leg symptoms in the last week, 2) body mass index >25 kg/m2; 3) total trunk flexion <70 degrees, 4) left or right hip average rotation >25 degrees, 5) duration of symptoms less than 6 months.  The participants that had 3 or more of these findings increased their likelihood to respond to a Pilates based program by 10-20x.²

The interventions were performed by physical therapist that had at least 2 years of training in Pilates.²  This is the start of great research to help us understand who will benefit the best from Pilates and may help us guide patients as well to a more fitting program once their PT is complete.  Although some PTs do continuing education in Pilates, I think it is great in our community to get to know the professions and work together to best improve our patients and clients!

Thanks so much to Arielle for reaching out to me and inviting me to try Pilates! It was an enlightening experience! Check out Sports PTs Facebook page soon to see pictures of us in action!

Reference:

1. Gladwell V, Head S, Haggar M, Beneke.  Does a Program of Pilates Improve Chronic Non-Specific Low Back Pain?  J Sport Rehabilitation 2006. 15; 338-350.
2. Stolze LR, Allison SC, Childs JD.  Derivation of a Preliminary Clinical Prediction Rule for Indentifying a Subgroup of Patients with Low Back Pain Likely to Benefit from Pilates-Based Exercise.  Journal of Orthopaedic and Sports Physical Therapy. 2012: 42(5) 425-436.

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A review of current literature done in 2012 found that recognition of injury, proper rest and attention to mechanics are factors that may decrease not only the number of injuries, but also the severity of injuries in our school-aged population. 

Recognition of Injury

It is essential that all coaches, parents, athletic trainers, physical therapist, or anybody that works with young athletes to be on the look out for injury.  In my experience working with athletes it is important to watch for drops in performance, changes in mechanics, and any signs of pain.  The earlier you recognize an injury and get treated properly, the better. It is important to know that to seek out a PT evaluation you DO NOT need a prescription. Many times getting into see your doctor takes days or even weeks. The earlier you or your child gets evaluated, the earlier treatment can begin.  Many times when you sustain an injury it is a perfect opportunity to see PT directly rather than wait. Playing through pain can significantly make injuries worse. Also, many times when we see children in PT for an injury – their deficits run much deeper than the injury and if they are addressed early this will will help reduce the risk of injury.

Proper rest

Think about this, professional athletes take AT LEAST 3 months off of their sport each year.  Yes, 3 months.  For many high school athletes, especially those that are focused on one sport, 3 months can seem like an eternity.  I pose the question – if ELITE athletes take 3 months off to allow their bodies to rest and heal up, why do we not do the same with our young athletes, whose bodies are continuously changing and need to develop and build strength.  During this “rest” time it is completely appropriate to cross train and work on strengthening / training other muscle groups that support the child’s main sport.  Sufficient rest is a serious concern in our young population, continue to follow our blog as there will be one focused on this topic!

Attention to mechanics

Good mechanics allow for proper stresses and forces to be place throughout our bodies.  When children are forced to do activities or sports through poor mechanics, some part of their body is going to break down. Injuries such as little leaguer’s elbow can certainly be caused by poor core strength, poor strength of the muscles the support the shoulder blade region, and thus when throwing the child puts extra stress on their elbow.  When evaluating female athletes I tend to find that most have very poor hip control and core strength.  These findings are showing more and more to be linked with ACL tears.  This is a huge area of opportunity for trainers, coaches and parents to collaborate with physical therapist who study, read research, and are extremely particular about form and body mechanics.  Proper training of mechanics from sport specific mechanics to mechanics with off-season training programs (lifting, plyometrics, etc) is absolutely essential to teach our children’s bodies to work correctly.

Stay tuned to our blog as we continue to break down Little Leaguers elbow, ACL tears in high school females, proper rest, and ways to reduce injuries by training correctly.

Reference:

1. Franklin CC. Weiss JM.  Stopping sports injuries in kids: an overview of the last year in publications.  Curr Opin Pediatr. 2012 Feb;24(1) 64-67.

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Here are some examples on how our facility constantly strives to be the best it can!

We implement evidence based practice.  This means we incorporate 1. Current research, 2. Patient values and goals and 3. Clinical Experience.  The combination of these three areas is what makes up evidence based practice.  Patient values and goals are so important to implement into treatment programs and we value listening to each patient and finding out what makes them happy and what they want to get back to.  Clinical experience is something we have and we are gaining every day. Each patient that is in and out of out teaches us something new. Lastly with regards to current research, all of our PTs are encouraged and expected to take continuing education courses regularly and to share the information with the rest of the clinic when they return.

We value customer service. Our Saratoga team and our company have extremely high expectations for customer service. From the moment you call and talk to our PSCs, when you come in the door for your first appointment (and every appointment after), and as we progress you through your treatment you can expect friendly, compassionate and excellent service.  To hold true to this value, we are open night hours, Saturdays, and stay open on Memorial Day, the 4^th of July, and Labor Day to assist those people who may have scheduling conflict get their appropriate care.  We are also here to assist with insurance questions.

We give back to the community.  Our Saratoga office is very active in the community. You may have seen us this year at any of the following places: The No Boundaries running group (takes place at the State Park), the Senior Center in Saratoga (giving lectures or participating in their health fair), the Arthritis Expo (held in Clifton Park), the Air National Guard giving a lecture on running. We also held our first Open House with educational session this year and it was a great success!

These are just a few examples of how we continually strive to be the best PT practice in the area.  We truly have an excellent and committed team and do our best to improve your movement and strength, reduce your pain, and get you back to all the fun things you love to do!

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Modifications are provided and encourage

Not everybody in an exercise group is at the same fitness level.  Some people need higher or advanced level exercises, some need more basic or beginner level.  The importance here is that you are finding an exercise that is challenging, but that you can complete without loss of form.  To gain muscle strength it is essential to work at an appropriate intensity. More importantly, you should chose the level that is best for you and not worry about what everyone else is doing.  Working at a higher level than what your body is able to do can lead to serious injury.

Form is stressed, over and over. . .and over

In my opinion, form is everything. If you are doing an exercise with improper form you are essentially wasting your time and can actually injure yourself. The professional you are working with -instructor, a trainer, a “drill sergeant” or even a physical therapist – should be extremely conscious about your form.

You are expected to be accountable and to keep appointments

I truly feel that people who are successful in the fitness or health field realize that you have to be accountable, take responsibility for your own life and actions, and regularly attend your program in order to succeed. If you are allowed to reschedule, cancel, or miss appointments regularly you may need somebody else motivating you and being sure you are accountable for your own success!

As I have mentioned in previous blogs, I am no different than everybody reading this! I need to be motivated. I need to be held accountable at times.  This year I made it a goal to make fitness apart of my own life; to practice what I preach all day long!  I joined the Boot Camp Challenge in Malta, NY with “The Rock” as my “drill sergeant”.  I can say with confidence that I enjoy waking up 3 days a week and going to class at 5:15AM to ensure I am taking care of my body.  I feel comfortable with my options and my ability to modify my exercises. She questions me and expects me to let her know if and why I have missed a class and I am constantly corrected with my form!  This class was what was right for me, but you might need something different!  Keep these tips in mind when you are finding what is right for you.

***If you are a local trainer, group instructor, or fitness instructor, please feel free to reach out to me! I would love to take a look at your facility or take a class and discuss my experience!  In June I will be traveling to Pilates with Arielle Bernard as well as to CoreFitness in Saratoga and am looking forward to these experiences!

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At the end of the day, however, these are all excuses.  With the overwhelming amount of illness, diseases and concern for healthy living in our society, I find it more important  than ever to be sure you are taking care of your body. 

The following are some recommendations that have helped myself and others overcome some of the obstacles mentioned above:

1. Plan your day to allow for time spent exercising. I know from personal experience that unless I plan something out as part of my daily schedule, I’m far less likely to complete the task, whatever it may be.  I’m sure I am not alone in falling into this trap. The best approach to making sure you find time to work out is to proactively plan that time into your day.

2. Leave the guilt behind.  There is only one person that can take care of your health and that is YOU! Nobody else is going to do it.  If you don’t take an active approach to improve your life or your health then those you are closest with will eventually feel the burden. And the burden on friends and family of coping with your failing health would be far greater than the burden they may face when forced to accommodate your work out schedule. Let go of the guilt.

3. Join a group or find a workout buddy.  In a future blog I’ll be discussing my own experience with group exercise at the Boot Camp Challenge held in Malta, NY. It was a wonderful experience promoting health and fitness in a supportive group atmosphere. I know for me, even though I fully understand the importance of exercise and a healthy lifestyle, I can struggle with keeping consistent in my workouts if nobody is holding me accountable.  Consequently, when I have a class to attend, very rarely do I miss that class, as I will have to answer to others for  my absence. Working out in a group setting can be a great motivator. If you have at least one person to work out with, they depend on you just as much as you depend on them. Hold each other accountable and get moving!

You are the only person that can control where life takes you and if you are able to do the things you want to do. Sure, prioritizing your health takes planning, hard work, and plenty of motivation. Like all challenges, getting fit or staying in shape can be easier with the support of others.  Ultimately, though, it’s important to take a deep look into yourself. Plan better. Stop feeling guilty.  It is your body and you only get one. Take care of yourself!

Created by:

Alison Synakowski, PT, DPT, OCS, ATC, CSCS

Facility Manager

Certified Sportsmetrics Instructor

Sports Physical Therapy of NY, PC

1 West Ave, Suite 150

Saratoga Springs, NY 12866

(518)-583-7537 x2805

(518)-583-7606 (fax)

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Nearly 60,000 people in the US are diagnosed with Parkinson’s each year and nearly 1,000,000 people have the disease.¹ Parkinson’s disease (PD) is a disorder of the brain and central nervous system that leads to movement deficits. The substantia nigra, a specific area of the brain that produces a chemical called dopamine is primarily affected. Dopamine is thought to be the chemical that controls movement and the initiation of movement.

Exercise has been shown to be an effective treatment for people with PD. Known benefits of regular exercise include improved control of regular daily movements, improved flexibility, improvements in balance and overall increase in energy levels, amongst main other.¹

Many of us struggle to make exercise a regular part of our lives; people living with Parkinson’s are no different. ² I recently read an article titled “Factors Associated with Exercise in Parkinson Disease”. The article aimed to identify factors that are associated with why people with Parkinson’s Disease exercise regularly or not. After reflecting on the article, I came up with a few take-a-ways that can help you or someone you know with Parkinson’s. 

This article concluded that disease severity is NOT a primary factor that influences people with PD to exercise. More so, it found self-efficacy to be strongly associated with whether or not people with Parkinson’s disease exercise regularly. Self-efficacy is defined as “people’s beliefs about their capabilities to produce designated levels of performance, which determine how they feel, think, motivate themselves and behave”.²  In other words, how do you picture yourself and how do you feel you are able perform your desired activities. With regards to exercise, the authors defined self-efficacy as “a person’s belief in capabilities to overcome personal, social, and environmental barriers to exercising”.² Another way to think of this is do you feel strong enough and confident in yourself enough to be motivated to perform exercise regularly.

When you or someone you love with Parkinson’s disease is trying to make the commitment to exercise, it is extremely important that not only their health care providers, but also the people around them are supportive and empower them to be committed to exercise and a healthier lifestyle. Some recommendations are:

1) Find a group of other people that exercise regularly.

2) Start slow and be safe – if you set yourself up for success, you will improve your self-efficacy and may be more willing to exercise regularly.

3) Be sure your health care providers are positive influences in your life. A positive attitude of those who surround you can really make you feel better!

If you have Parkinson’s, be conscious of the people you come in contact with, as their attitude can greatly impact your well-being. If you are a friend of a family member of somebody with Parkinson’s be supportive, help your friend get motivated, offer to assist them when they are trying to become active. Little changes can go a long way!

Happy Parkinson’s Awareness Month! At Sports PT, we have been having a Penny War all month to donate towards research in Parkinson’s disease! Stayed tuned for the update on the game and how much money we were able to raise!

1. Parkinson’s Health. http://www.parkinsonshealth.com/About-Parkinson-s-Disease.aspx  Accessed on 29 April 2012.

2.  Ellis T. et al.  Factors Associated with Exercise Behavior in People with Parkinson   Disease. Physical Therapy. 2011: 91:1838-1848.

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Walk or bike instead of driving to work, school or even to the store. The American Heart Association recommends 30 minutes of exercise a day[1].  By simply adding one of these activities into your routine you can ensure you get the recommend amount each day! Walking 1 mile at a pace of 15 minutes per mile burns about 370 calories. Biking 1 hour burns about 650 calories.

Plant a garden. One hour of gardening burns about 272 calories per hour. Gardening consists of a lot of squatting. Squatting, if done correctly, is one of the best ways to strengthen your gluteus muscles (buttock) and legs. A good squat consists of bending your knees, keeping your back fairly straight, having your buttock reach out behind you, heels stay on the ground and knees stay behind your toes! Also, often times you are on your hands and knees when gardening. Believe it or not, this developmental position (a position that is used by babies as they grow to help develop their muscles) is very good at improving your core, arm, and leg strength. This position is used a lot in physical therapy to assist with strengthening when people have back pain, shoulder pain and many other ailments.

Plant a tree. Planting trees burns about 300 calories per hour. Check out www.sustainablesaratoga.com for information on the”Urban Forestry Project”. It will take place this Saturday 4/21 from 10-12:30. Volunteers will “assess and catalog the tress throughout the city”

Run for the environment. There are various races that raise money to support environmental causes (e.g. 5k Run for Clean Air) and there are even people who perform cross country runs to raise money for the same cause (e.g. “Run for One Planet”). I did do a quick search and did not find one yet in the Capital District however it is a good option to keep your eyes open.

Assist with community clean up. Raking burns nearly 300 calories per hour. It is a great activity to assist with strengthening the muscles in the middle of your back if done correctly! Check out the Events section at Saratoga.com for more Earth Day celebrations, activities, and events.

We encourage you all to get active to assist not only with your health but the health of the earth!

Websites used for Estimating Calories Burned:
1. http://www.healthdiscovery.net/links/calculators/calorie_calculator.htm Accessed on 28 April 2012
2. http://caloriecount.about.com/activities-lawn-garden-ac8 Accessed on 28 April 2012

1. American Heart Association.  American Heart Association Guidelines. http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/StartWalking/American-Heart-Association-Guidelines_UCM_307976_Article.jsp.  Accessed on 19 April 2012.

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