![\"single-leg-stick-finish\"](\"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2010\/12\/single-leg-stick-finish-300x168.jpg\" "\\"single-leg-stick-finish\\"")
<\/p>\nFor those who know me well, it is safe to say I am an “ACL geek” of sorts.\u00a0 I love studying, reading and searching for the best way to rehab and prevent these injuries.\u00a0 As I have grown in the profession, I have become increasingly concerned with articular cartilage damage and the long term effects it has on our young athletes.<\/p>\n
Perhaps I am getting more concerned as my knees aren’t getting any younger either (lol).\u00a0 Anyway, I truly believe we often underestimate how deleterious cartilage injuries can be long term.\u00a0 In addition, I feel we, as rehab and conditioning professionals, need to better understand how our training impacts the cartilage regardless of whether patients had a concomitant bone bruise with their ACL injury or not.<\/p>\n
One of my favorite prehab exercises is a single leg hop and stick (see below)<\/p>\n
<\/p>\n
I typically begin with an alternate leg approach (push off right and land on left) prior to initiating takeoff and landing on the same leg to teach proper landing mechanics.\u00a0 By now, we know increasing hip and knee flexion, as well as shifting center of mass forward reduces ACL strain and injury risk through a diminished extension moment.<\/p>\n
However, what we may not know as much about is how an ACL reconstruction alters tibiofemoral joint mechanics at such a landing.\u00a0\u00a0 I want to share some interesting information from a recent article in the September edition of The American Journal of Sports Medicine<\/em>.\u00a0 The article by Deneweth et al. looked at tibiofemoral joint kinematics of the ACL reconstructed knee during a single-legged hop landing.<\/p>\n <\/p>\n In the study, the authors used high speed biplane radiography to quantify 3D tibiofemoral joint kinematics in 9 subjects who underwent ACL reconstruction.\u00a0 Graft choices included single bundle (2) and double bundle (5) \u00a0hamstring autografts as well as double bundle allografts (2).\u00a0 All subjects completed a standard rehab protocol and then were tested between 4 and 5 months post-op.<\/p>\n The single leg hop testing consisted of three trials (on each leg) in which the subject was required to hop over a 4 cm barrier and land at a distance 30 cm forward\u00a0of the takeoff point.\u00a0 Upon landing, the subjects were coached to hold the position as long as possible.\u00a0 And now for the results:<\/p>\n So, what does it all mean?\u00a0 Well, in a nutshell the study indicates that significant kinematic differences exist for athletes who have been cleared to return to play by their physicians.\u00a0 Athletes will perform activities in sport like the single-legged hop to decelerate and change direction.\u00a0 It is known that landing in a more extended position at impact will subject the articular cartilage to much higher compressive loads than would normally be felt in the more flexed uninjured knee.<\/p>\n In medical circles, it has been suggested that ACL tears need to be fixed to prevent early arthritis in the knee.\u00a0 However, a recent study in the November American Journal of Sports Medicine <\/em>suggests in a 10 and 15 year follow-up after ACL reconstruction for isolated and combined injuries that both groups still develop arthritis radiographically (combined injuries more so than isolated tears).\u00a0 So, perhaps not all ACL tears need fixed?<\/p>\n So, I think we still have much to learn about how best to treat those with these injuries and how to carefully manage the rehab, return to play and surgical strategies to best preserve articular cartilage and sustain a high quality of life well beyond athletics.\u00a0 In addition, this article highlights the importance of repetitve neuromuscular training in prehab and rehab with emphasis on increasing knee and hip flexion angles with deceleration, as well as perhaps giving us pause at sending our athletes back to high impact loading too quickly.<\/p>\n As with all research, we must also be careful not to extrapolate the results of one study to all cases, but I myself think we need to keep learning and critically evaluating our loading progressions with respect to the cartilage\/joint\u00a0and strive to avoid creating harm too soon in the rehab process.\u00a0 I hope you will join me in seeking out the very best rehab and conditioning techniques for our athletes in this light moving forward.<\/p>\n","protected":false},"excerpt":{"rendered":" For those who know me well, it is safe to say I am an “ACL geek” of sorts.\u00a0 I love studying, reading and searching for the best way to rehab and prevent these injuries.\u00a0 As I have grown in the profession, I have become increasingly concerned with articular cartilage damage and the long term effects […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[32,7,31,8],"tags":[138,89,139,98,141,85,140,79],"class_list":["post-777","post","type-post","status-publish","format-standard","hentry","category-arthritis","category-injury-prevention","category-knee","category-rehab","tag-acl-injury-prevention","tag-acl-rehab","tag-acl-surgery","tag-acl-tear","tag-cartilage-damage","tag-knee-arthritis","tag-knee-cartilage","tag-knee-rehab"],"yoast_head":"\n\n