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Inside Physio
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05 November 2010
this issue The sporting knee: Prevention of OA P.1&2 Pro fe ssi o n a l De ve l o p me n t Physio Professionals prides itself in its continuing staff education initiatives.
The sporting knee
Sta ff Michelle Peauril Senior Physiotherapist Level III Sports Physio AIS Andrew Crew Remedial/Sports Massage Performance Bike Fit Analysis
Osteoarthritis (OA) is generally thought of a disease that affects the elderly; however sporting people that have suffered from a severe injury to the knee greatly increase the risk of developing OA in the knee. Statistics show that 30% of the general population will develop OA by 65 years, in the sporting population that have had a notable injury, mild OA can occur in the 30s and 40s. The number of sportspeople requiring knee replacements has increased five times in the last 10 years (W-Dahl et al. 2010) due to the increase in traumatic injuries. Anterior cruciate ligament (ACL) surgery appears to have the most bearing on developing OA in the knee. In a recent study (Keays et al. 2007) 48% of sportspeople were found to have mild OA six years post (ACL) surgery. Meniscal and medial ligament injuries also commonly lead to (OA). Recent study by (Gilcrist et al. 2008) found meniscal injuries or ligament injuries alone increases the likelihood of OA from 2% to 20% and meniscectomy increases the likelihood to 40% whereas ACL and meniscal injuries to 70%. OA occurs more frequently in the medial that the tibiofemoral (TF) compartment, but also occurs in the patellofemoral (PF) joint, especially following patella dislocation or injury. Primary prevention of injury. Reducing risks: The most effective way to reduce the occurrence of OA is to reduce primary injuries. Playing surfaces, footwear, protective equipment weather conditions and the athletes current conditioning should all be taken into consideration.
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Addressing poor neuromuscular control, muscular weakness, landing techniques and postural alignment issues and athletes fitness levels can be targeted with appropriate education and exercise programs to help decrease the likelihood of injury. Contact versus non-contact sports. Whilst most people may think the majority of ACL injuries are from contact sports the facts remain that 80% of injuries are non contact related. These injuries occur due forceful landing or cutting and are associated with knee valgus, poor trunk control, core strength, increased hip adduction and internal rotation with increased tibial external rotation. Physiotherapy preventative programs. Strategies in preventative programs include: 1. Recognition of at risk athletes. 2. Strengthen muscles around the knee, hip and trunk to reduce dynamic loading of the knee. 3. Learn proper landing techniques. 4. Training of posture alignment Recognising the at-risk athlete. Three common features exist in the athlete at risk group. 1. Generalised joint laxity (GJL) 2. Narrow intercondylar notches ( Specific to ACL injuries) 3. Poor neuromotor control Female athletes generally have a higher frequency of these features and they also have to be mindful of hormonal factors that have been shown in research to increase the risk of injury around the time of a female monthly cycle.
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Muscle strength around the knee has the greatest capacity to reduce injury and safeguard against OA as muscle has the capacity to absorb loads. The muscle groups targeted should be core, gluteals, calf, quadriceps and hamstrings.
Kn e e Fa c ts Pro mp t p h ysi o th e ra p y a s se s s me n t a n d tre a tme n t i n cre a se s th e ch a n ce s o f fu l l kn e e i n j u ry re co ve r y.
Ho w ma n y i n j u ri e s? 2 2 .1 % o f h o sp i ta l e p i so d e s fo r kn e e i n j u ri e s i n th e p u b l i c h o sp i ta l s o c cu rre d i n ma l e s a g e d 3 5 -4 4 ye a r s i n Au st ra l i a 2 0 0 1 -2 0 0 2 .
ACL injuries occur 2 to 8 times higher in women compared to men in sporting populations.
Training techniques. After addressing general strength and flexibility deficiencies, a plyometric program should be implemented, research has shown if taught correctly specific plyometric exercises over an 8 week period of 2 sessions per week can decrease vertical impact force and force development by approximately 27%. Plyometric training will improve neuromuscular adaptations and the stretch-reflex properties of the muscle. Running economy can be increased by 4% from a structured plyometric program and also increase the athletes coordination and timing during contact and take off, this not only greatly improves athletic performance but decreases the chance of injury.
Post injury management. The two most important aspect of rehabilitation are: 1. Restore full muscle function and correct quadriceps/hamstring strength ratio. Progress rehabilitation systematically. Complete rehabilitation fully. Rehabilitate muscle to act as movers, stabilisers and shock absorbers. Educate patient about potential for injured knee to become osteoarthritic
2. Prevention of re-injury particularly to the menisci and chondral surfaces is critical in prevention of OA. This is important for graft and menisci protection following ACL repair. This should not be based on time after surgery but after assessing agility and sports specific tests and the athletes confidence.
The implementation of a neuromuscular and proprioception exercise program has shown to reduce ACL tears by as much as 74% in young female athletes if the program is sports specific.
ACL injuries occur mainly in the 14-29 year age bracket, as this corresponds to your most athletic active years
Plyometric training does not increase muscle bulk that can inhibit athletic performance in a variety of sports but does increase strength, speed and power that all have a positive bearing on peak performance. This type of training should be implemented in most teams and running based sports no matter what level of athletic ability.
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