Wake Up and Smell the Roses

Posted: May 2, 2012 in Uncategorized

You have to feel bad for Derrick Rose who was lost for the entirety of the playoffs this past weekend after tearing his ACL. You can watch it happen here.

This is your classic ‘non-traumatic ACL injury’ as Rose was simply building blocks of dysfunction the entire year until something this unfortunate happened. I have written about this concept in the past here. This was a downward spiral with an inevitable ending. Just look at his injuries this season (in order):

  1. Turf Toe
  2. Bad Back
  3. Groin Injury
  4. Sprained Ankle
  5. Torn ACL

Seemingly, the only thing they all have in common is the fact that they are from the waist down.

I just wanted to share some of my own thoughts on the injury:

  • Derrick Rose just signed a 5-year, $95 million dollar contract with the Bulls. Listen, I have no idea how the Chicago Bulls organization works, but it would be safe to say they wanted their star on the floor when it mattered most. Many of my fellow students (myself included) often talk about how one of our goals is to work for a pro team at some point. I think this is the part that we also need to consider. When this much money is at stake, medical decisions can become a bit more complicated.
  • Throughout Derrick’s rash of injuries (he played in only 39 of the 66 games this season), I wondered how he would score on a Functional Movement Screen. I have also talked about this in the past here. I then realized that the FMS stops once pain is present. Still, like many of us out there, I am curious as to what kind of treatment Derrick received from the onset.
  • Dr. Dave Altchek, a world-renowned surgeon in NYC had this to say about the injury,“There is no evidence that wear and tear, or that kind of issue, playing too much, really has any correlation with ACL injuries in any sport that we’ve ever studied.” Altchek argues that too much playing could actually make a player less susceptible to the injury that Rose sustained in the opening round of the playoffs, because he might lack the type of explosiveness it takes to blow out a knee ligament.

I know I’m just a lowly chiropractic student on the bottom of the food chain, but I have to respectfully disagree. For the life of me, I just can not understand how playing too much would make someone less susceptible because they “lack the type of explosiveness needed to blow out a knee ligament.” He also went on to say that ACL tears, far more common in female athletes, are scary injuries in that there’s little explanation for how to prevent them.

Well, courtesy of Researchreviewservice.com I did some  on my own searching. This is what I found (and I apologize to my readers because I usually try not to quote research, but this is a special case):

Brophy et al. ACL Injuries: Etiology and Prevention. Sports Medicine and Arthroscopy Reviews 2010. 18(1): 2-11. This paper found something a bit different from Dr. Altchek:

First, the article states the following, “Neuromuscular activation during pivoting, decelerating or landing from a jump may predispose an individual to ACL injury by increasing ACL strain values due to abnormal posture and alignment.”

Next, the article states that external rotation of the knee decreases ACL strain (neuromuscular control on the hip abductors anyone??). It also states that adding an impulse to a 15 degree flexed knee vs. 25 degree flexed knee caused a greater strain on the ACL in the less flexed knee. (I must mention that this specific information was ascertained from cadavers just for the sake of full disclosure. Have no fear, there is much more evidence on ‘live’ subjects later.)

In agreeing with Dr. Altchek, females are at a higher risk for ACL injury for the following reasons: (1) landing with the knee in more extension (2) more valgus through the stance phase (3) higher quad activation and lower hamstring activation.

This quote is directly from the review, “There is strong evidence that prevention programs can lower the rate of ACL injury (especially in the “at risk” athlete).”

Here are some general findings from Brophy et al. on ACL prevention programs:

-The use of ACL injury prevention programs focusing on basketball, skiing, soccer and handball showed an overall reduction of severe ACL injuries from 60 to 80%.

-An 89% reduction in the rate of ACL injuries was achieved in a prevention study in 2 Division I basketball programs (over an 8 year period of changing player technique) by stressing knee flexion upon landing, using accelerated rounded turns and deceleration with multistep stops.

-An 87% decrease in ACL injuries was found by implementing a proprioceptive balance training program in 600 semiprofessional and amateur soccer players which consisted of a 20-minute training program divided into 5 phases of increasing difficulty. This study occurred over 3 complete soccer seasons.

-A prospective analysis of 1263 athletes in various sports who completed a neuromuscular training program revealed the ability to reduce serious knee injuries – the incidence of injury in the untrained group was 2.4 to 3.6 times higher. It was also noted was that 5 untrained female athletes sustained ACL injuries and no trained females sustained an ACL injury.

-A reduction of 62% of serious knee injuries was achieved among trained individuals in a “guided discovery” technique in Vermont, aimed at recognizing potentially dangerous skiing situations and responding quickly to unfavorable conditions.

-The development of the Santa Monica PEP ACL Prevention program achieved an 88% overall reduction of ACL injuries in two groups of female soccer players (14-18 years old and 18-22 years old). The program consisted of a 20 minute warm-up protocol to proceed the normal training session. As a result 2 ACL tears occurred in the trained group and 35 were reported in the control group (2).

The above studies were found by Brophy et al. and showed the strongest evidence for ACL prevention programs. It is also important to note what “effective” programs consist of: proper landing technique (landing softly with knee and hip flexion, avoiding genu valgum, strength training focused on increasing hamstring strength, hip abductor strength, and proper deceleration technique.  

Conclusion: To be fair, I realize that just about anyone can have an opinion and find “research” to back it up. It would not surprise me at all if Dr. Altchek has some of his own research proving exactly what he stated in the article. I obviously tend to side with the research based on my beliefs on injury prevention and rehabilitation.

Also, I think we should all take the quotes and news article with a grain of salt. I realize how certain things can often be taken out of context or that a reporter may only use the quotes that will create a stir. I would assume this reporter interviewed Dr. Altchek for a good amount of time yet only decided to use two or three ‘juicy’ quotes. If that was the case, mission accomplished.

All that being said, I will continue to advocate ACL prevention programs for the general population and athletes alike. Better yet, if it were my child, I certainly would not leave it to chance and just assume that  non-traumatic ACL injuries happen totally by accident.

Proper Assessment. Proper Training. Proper Treatment.

This is what I believe in, no matter what the top surgeon in NYC might say.

Thank you for reading!

  1. Todd says:

    Great stuff, Justin. I’ll agree that non-traumatic ACL tears can be prevented. But what is an ACL prevention program? A good coach is going to write programs that put an athlete’s body in balance while making it stronger. ACL tear prevention is just good programming and training with good form.

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