Brian Schiff’s Blog

I hope you are enjoying this series on the ACL.  I have been passionate about preventing and rehabbing these injuries since I began working in PT in 1996.  In today’s post, I am going to briefly discuss one of the critical areas of weakness in athletes that substantially raises injury risk for knees.  Simply put, it is hip abduction weakness.

While I see this in nearly all females, males often have gluteus medius weakness as well.  Why is this an issue?  The gluteus medius is not only responsible for pulling the thigh outward, but more importantly it helps reduce and control rotation/deceleration of the femur with cutting maneuvers.  If you have been reading my blogs or articles, you may see a persistent theme emerging – deceleration matters.

To protect the body from injury, we MUST understand how to train deceleration of the body.  This is often where forces are greatest and present the biggest injury risks.  The hip is a major player in knee prevention programming.  There are lots ofdifferent exercises to strengthen the gluteus medius, but today I will share one of my staples I use in all my knee prevention and rehab programs.  It is called the single leg lateral reach.

Master this move and your knee injury risk will be greatly diminished.  It is an effective way to teach athletes to turn on the gluteus medius and learn how to control the valgus and rotational load with all the weight on one leg.  In the upcoming final ACL post, I will reveal yet another way to improve landing mechanics and body control through a simple lateral plyo maneuver.

In my last post, I spoke about the key components of a successful ACL prevention program.  I also demonstrated a simple drill for teaching proper landing mechanics.  This is just a start.  Most athletes exhibit diminished body awareness/control.  On top of that, female athletes may be up to eight times more likely to suffer a knee injury.

Research has pin pointed many reasons for higher ACL injury risk in females such as:

• Wider pelvis
• Higher Q angle
• Increased ligamentous laxity
• Single leg dominance
• Quad dominance (weak hamstring to quad ratio)
• Potential hormonal implications
• Faulty muscle activation patterns

The list could go on further.  However, the take home message is proper training has been noted to reduce in some cases close to 70% of injuries.  Better yet, these programs can even be coach directed.  The key is doing the right stuff.  Spending as little as 20-30 minutes 2 days a week can make a big impact.  I implemented such a program at an area high school in the pre-season for 30 minutes 2x/week and then once per week in-season.

The team responded well, made it to the district final and did not suffer one ACL injury all season.  I say that not to brag, but rather to tell you that out of 50 plus girls (grade 9-12) not one was injured.  Now, I am also not saying there would have been an injury without me.  But statistically speaking, odds are that 1-2 players per year on each school team will suffer such an injury.  My assumption is the training offered an extra layer of protection.

In addition, the training methods are designed (in my mind) to improve athletic performance too.  Improving body awareness inherently increases athletic movement capacity/skill.  I included a sample session for you to check out below:

Sample Program

Please keep in mind this is one day and not intended to serve as the whole of the program.  Each session should be progressive and sequential, building upon the motor learning that takes place as well as what the performance of the team tells you.

You may be well aware that ACL injuries have reached epidemic proportions in our country.  They affect females more often than males (up to 8 times more often in some studies).  The good news is that research reviews have generally been positive in regard to prevention programs reducing injury rates.

So, what exactly is a prevention program?  It must be holistic in nature yet very precise as athletes and coaches have little extra time each week to add more exercise.  It begins in the off-season and pre-season, but should definitely continue in-season as well.  Ideally, it should consist of:

• Pre-season screening to assess bio mechanical flaws, as well as strength, power and balance deficits
• Proper dynamic mobility and warm-up exercises
• Essential strength exercises
• Balance training
• Plyometrics with emphasis on jump landing technique
• Agility drills

It is essential to train the neuromuscular pathways to ensure critical development of motor learning and feedback loops that are in the best interests of our kids.  To that end, I believe there are fundamental drills that should be implemented.  Today, I included one of these drills.  It is simple but very effective in teaching athletes to reduce valgus moments at the knee.

I begin with 3-5 reps on each leg emphasizing low intensity hops and strict form.  Once the athlete demonstrates good form with ease, you may increase the intensity of the hops, eventually advancing from alternate leg landing to takeoff and landing on the same leg for max difficulty.

One of the most common things I see when training athletes is the inability to control their body in space as they transition from deceleration to acceleration and move in a different direction.  They often stand too upright, add extra steps, use bad angles and fail to apply force to the ground efficiently to propel them forward.

Early on, I implement a 2 cone shuffle drill to teach proper body awareness, how to plant correctly and most importantly how to move as fast as possible.  It is best to follow a set predictable sequance at first to ensure proper motor learning.  Here is an example:

1. Slow speed with verbal cues throughout (to maintain athletic posture, foot position, body angle, etc)
2. Half speed with no verbal cues (correct with demonstration and verbal feedback afterward)
3. Full speed with no verbal cues and shorter cones (still correct after the drill as needed)

These sequences are all predicatble in nature.  Once the athlete masters form and body control, you can begin to ask them to react to both auditory and visual cues in a more random nature.  This will force them to improve reaction time and more colsely mimic sport situations.  In the video clip, I shuffle with quick steps at first and then increase my stride toward the end.  You will need to decide whether you want to work on precise footwork (for small space work) or more powerful strides for open space explosion.  I think both are relevant and worthy to be trained.

Next week, I will turn my attention to ACL injury prevention as Spring soccer is upon us and share some tips and strategies to prevent these injuries.

Many parents call me and inquire about training their son or daughter with the primary goal of improved speed.  Most of the time, I turn the conversation to body control (acceleration & deceleration) as well as agility.  Most sports are not won or lost with pure linear speed.

Most sports I watch are won by superior athletic movement skill.  In other words, superior footwork and body control.  Over the years, I have been both awed and left wanting while watching some of my clients move for the first time.  The truly great ones make movement seem so fluid and effortless.

Those who struggle most on the court or field simply need to work to improve their footwork.  In particular, I like to focus on lateral quickness (agility).   Today’s short video clip reveals one of my favorite drills to heighten the ability to move side to side quickly and effortlessly. 

If your athlete has difficulty maintaining the proper form and rhythm initially, slow the drill down.  Emphasize that both feet touch down (minimal pressure on inside foot) but that the power comes from the outside foot pushing off.  I typically have my athletes work for 20-30 seconds and repeat 2-3 times.  Once they master the form, you may elect to use a higher hurdle to increase the emphasis on power as well.