Anterior cruciate ligament (ACL) injury experts are increasingly thinking outside the biomechanics box in an effort to better understand the factors that contribute to injury risk, which I think is admirable. But there’s one factor in particular that I wish were receiving more attention.
At the 7th ACL Research Retreat, held in March in Greensboro, NC, the overriding theme of the event was the need to look beyond biomechanics for variables that contribute to injury risk. Some of the variables discussed at the retreat included joint laxity, fatigue, neurocognitive factors, and even genetics—each of which appears to represent a piece of the injury prevention puzzle (see “Conference coverage: 7th ACL Research Retreat,” page 31).
But none of the studies presented at the retreat focused on what may be the most significant risk factor of all: The unwillingness of coaches to buy into the benefits of training programs for injury prevention.
Team-based interventions don’t work if coaches don’t implement them, and there is a growing body of evidence that coaches’ skepticism is a major barrier to success. Efforts to educate coaches about the benefits of injury prevention haven’t been convincing enough.
The latest study to document poor implementation of injury prevention programs was epublished in early April by the Journal of Science and Medicine in Sport. In that study, 66 head soccer and basketball coaches from 15 Oregon high schools responded to a survey about prevention programs. Although 52% were aware of the programs, just 21% reported using them, and only 9% had implemented a program exactly as it was designed.
Coaches who decided not to adopt an injury prevention program did so because they didn’t perceive a relative advantage over their existing practices, the programs did not align with their needs, or the programs were too difficult to implement.
This isn’t just a problem in Oregon. It’s a problem nationwide, even worldwide.
Just last fall in the British Journal of Sports Medicine, Swedish researchers published the results of a similar coaches’ survey. This survey was conducted three years after completion of a high-profile study documenting the benefits of neuromuscular training for reducing ACL injury incidence in female adolescent soccer players—so one would think the coaches would have at least been aware of it.
And, yes, 91% of the survey respondents who were currently coaching said they were aware of the training program, and 74% were using it. But only 35% said they were using it every week, and only 25% said they were using it exactly as designed. So clearly improving coaches’ awareness of training programs doesn’t necessarily lead to effective implementation.
I have no doubt that, as ACL injury prevention experts delve further into topics like fatigue and neurocognitive factors, and training programs are revised accordingly, the potential benefit of those programs for reducing ACL injury incidence will continue to improve. But I also hope that a discussion of implementation is
on the agenda at the next ACL Research Retreat. Because, until someone comes up with a program that coaches will implement as designed, the real-world impact of these interventions will be limited.