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ACL Injury Prevention: The Importance of Neuromuscular Training

By Joseph Janosky on April 16, 2019 hst Print

High school sports are more popular today than ever with nearly eight million participants during the 2017-18 school year. Unfortunately, this record number of athletes suffered more than one million sports-related injuries. The knee is one of the most frequently injured joints among high school athletes, accounting for one out of every seven injuries.

The Anterior Cruciate Ligament (ACL) is one of the most common knee injuries and is among the most devastating in all of sports. ACL injuries often require a complex surgery and up to a year of rehabilitation before athletes can safely return to play. Costs associated with surgery and recovery can soar as high as $50,000.

Researchers have found that the long-term consequences of an ACL injury are even more worrisome than the short-term impact. Athletes with ACL injuries are four times more likely to develop painful knee arthritis within 10 years of the injury than non-injured athletes. They are seven times more likely to eventually need knee replacement surgery – and at a much younger age – than those who haven’t been injured. These statistics detail the devastating effects of ACL injuries that play out for tens of thousands of adolescent athletes each year.

A recent survey of more than 2,000 parents throughout the United States found that joint injuries were second only to concussions as the most concerning sports-related injury. Parents and sports medicine professionals agree that the ACL injury epidemic is a significant public-health issue that needs immediate attention from the sports medicine community.

Programs designed to reduce the risk of ACL injury have been studied by researchers across the world for more than a decade. Screening tests to identify athletes who are at high risk of ACL injury have been developed, but these assessments are expensive and require significant investments of time and resources. Research studies demonstrated that screening programs were cost-prohibitive and that other preventive strategies could provide better outcomes at a fraction of the price.

Further research on injury prevention led to the development of Neuromuscular Training. These exercise programs are designed to improve the strength, flexibility, balance and agility needed to participate in sports and can be done as a component of an athlete’s pre-season or in-season training. Many studies have shown that these exercise programs can dramatically reduce the number of ACL injuries for young athletes when incorporated into daily training.

One key to successful Neuromuscular Training is performing specific types of exercises throughout a sports season with an emphasis on proper technique. Researchers at Hospital for Special Surgery (HSS) in New York City studied school-aged children as they performed some of the most common Neuromuscular Training exercises and determined that less than one-third of high schoolers could perform the exercises correctly. Interestingly, this number increased to over two-thirds when sports medicine professionals provided the students with cues to correct their exercise technique.

Additionally, high school athletes who performed Neuromuscular Training throughout their sports seasons were found to have greater improvements in performance tests that measured jumping, landing and deceleration technique than athletes who did not perform the Neuromuscular Training. These specialized programs typically rely on the expertise of highly trained professionals like physical therapists or athletic trainers – a resource not always available to high school athletes.

The above findings tell us that strategies to prevent ACL injury for high school athletes must include both the regular performance of Neuromuscular Training exercises, AND athletes must receive frequent feedback about their exercise technique. However, there just aren’t enough sports medicine professionals available to work with millions of high school athletes. So how do we meet this challenge? HSS started by asking for help from the people who lead each sports team – THE COACHES!

In the survey mentioned earlier, the vast majority of parents reported that a coach’s knowledge of injury prevention and sport safety was ‘absolutely essential’ to reducing the risk of sports-related injury, while one-third of parents wanted coaches to receive more injury prevention training. In a survey of more than 1,000 high school coaches conducted by the HSS Sports Safety Program, nearly half reported coaching at least one athlete with an ACL injury, but more than 90 percent had never received ACL injury prevention education or training.

To help keep athletes injury-free, the Sports Safety Program at HSS partnered with the NFHS to provide coaches with a free educational course: ACL Injury Prevention: How to Lead a Neurodynamic Warm-Up. This 30-minute online course, which can be accessed through the NFHS Learning Center, was made available in December 2018 and is designed to teach coaches how to identify and correct movements that increase the risk of ACL injury and to use that knowledge when leading a warm-up proven to reduce the risk of ACL injury.

Nearly 4,000 coaches have currently enrolled in the course, with most demonstrating dramatic increases in knowledge. More than 90 percent of the course participants report that they would recommend the course to other coaches.

ACL injuries have reached epidemic levels in high school sports and the devastating short- and long-term effects are a serious concern for parents, athletics administrators, coaches, sports medicine professionals, and most importantly – high school athletes. But 30 minutes of training can help prevent this life-changing injury for thousands of young athletes. To get started, go to NFHSLearn.com/courses and enroll in the ACL Injury Prevention course today.