November 2014

Out on a limb: In defense of prevention

1Limb-JordanaBy Jordana Bieze Foster, Editor

If athletes knew that decreasing the risk of anterior cruciate ligament (ACL) injury would be accompanied by a slight decrease in athletic performance, how many of them would find that to be a reasonable tradeoff? The findings of a recent study may have lower extremity practitioners asking themselves this question.

In a study epublished in early November by the American Journal of Sports Medicine, researchers from the University of North Carolina at Chapel Hill found that two landing techniques intended to reduce ACL injury risk—landing “softly” and landing with increased knee flexion—were associated with significantly reduced jump height and movement speed during stop-jump and cutting tasks compared with the study participants’ preferred landing techniques.

On the face of it, it’s a rather ominous finding, appearing to suggest that athletes will have to choose between protecting their knees and competing at the highest level. But the real implications of this study may be somewhat different.

It’s important to note that the study participants did not undergo long-term training in either of the preventive landing techniques. They were simply given instructions. Doesn’t it make sense that they would perform better when landing the way they had done for years than when landing in a strange new way?

Here’s my take: The study findings do not suggest that athletes who undergo neuromuscular training for ACL injury prevention are doomed to lower levels of athletic performance than they otherwise would have achieved.

The findings do suggest that short-sighted efforts to correct landing mechanics in the interest of ACL injury prevention may compromise athletic performance if not implemented properly. If, instead of training that makes correct landing technique second nature, athletes are simply given instructions about correct landing technique and are consciously thinking about those instructions while moving, then, yes, their athletic performance may not be quite up to normal levels.

The findings do suggest that training is actually an essential component of ACL injury prevention, not just to decrease injury risk, but to do so in a way that keeps athletes performing at the highest levels. And they also appear to be consistent with the philosophy of implementing that training at an early age, so the corrected biomechanics become habitual at the same time the athlete is developing sports-specific skills.

The true test, of course, would be to take a group of athletes with similar performance test scores at baseline, have half of them undergo training so their corrected landing mechanics become habitual, and then compare their test scores with the preferred and corrected landing scores in the untrained group. But, even if such a study is undertaken, it will be quite a while before any meaningful results are available. And there’s no good reason to give up on ACL injury prevention in the meantime.

There are plenty of other scenarios in which athletes may be forced to choose between injury risk and athletic performance. But the prospect of using neuromuscular training to decrease
ACL injury risk isn’t one of them.

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