UK snowsports ACL injury

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Strength and Conditioning for Skiing

ACL injuries and their prevention

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Session overview

• A bit about me• Common injuries• Mechanisms of ACL injury• How to screen for these injuries• Practical - injury prevention strategies

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Neil Welch MSc ASCC• BSc Sports science and physiology

• MSc Strength and conditioning

• Worked with snowboard-X and ski coaches in Canada

• Experience with premiership rugby team Leeds Carnegie

• S&C coach for the the England alpine ski team

• Work with athletes from multiple sports including rugby, cricket, rowing and triathlon

• Founder of nw conditioning strength and conditioning consultancy

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Common Injuries

• In terms of injury type, biggest is acute trauma• Not much we can do about impacts, nature of the sport, although

better strength and conditioning will mean better ability to concentrate

• Pulled muscles are definitely preventable, need; – Appropriate strength through full range of motion– No bilateral imbalances– Limit agonist antagonist imbalances

• Traumatic injuries such as tendon/ligament ruptures we can have some say in reduction

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Common Injuries

• In terms of area, knee is the biggest concern, depending on where you look, between 30-40% of injuries occur in the knee

• Due to limited motion at the ankle, more force has to be ‘handled’ through the joint

• Lots of uneven surfaces and rapid accelerations and decelerations around the joint

• Fatigue plays an important role and as such so does nutrition around training

• Cruciate ligament injuries are particularly common

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The knee - ligaments

• 4 ligaments in the knee• Collateral ligaments prevent lateral movement• Cruciate ligaments prevent anterior posterior movement

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The knee - musculature

• Significant musculature surrounding the joint

• Imbalance can put altered load on the ligaments

• Lack of strength can increase load on the ligaments

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Causes of ACL injury

• Can be due to weakness in musculature about the hips and core

• Particularly vulnerable in a position of knee valgus• Knee valgus can lead to medial collateral ligament strain

and increase risk of anterior cruciate ligament (ACL) injury• ACL injury also due to shearing forces, often related to ski

boot stiffness• More susceptibility with females due to q-angle at the hip

and more reliance on ligaments• Usually involves a rapid deceleration of the joint, therefore

increased strength is a requirement

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Female athletes and ACL injury

• More occurrence of ACL injury than males• Due to hormonal, anatomical and neuromuscular

differences• Neuromuscular control deficits: strength, power or activation

patterns• Ligament dominance: imbalance between ligament and

neuromuscular control of knee stability• Quadriceps dominance: imbalance between quads and

hamstrings• Leg dominance: imbalance from leg to leg• Trunk dominance: inability to activate core correctly

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Screening

• Allows progression to be monitored• Can show the athlete why they need to be doing

the exercises/training they’ve been set• It can highlight those most at risk and allow the

coach to target specific work to those athletes

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Methods of screening: Hop and stop

• Measures differences in force production and stability relative to height

• Gives quantitative information to compare on an ongoing basis

• Is quick and easy to administer• For details and reminder of protocol see link:

http://www.athletebydesign.com/Research/HopStop/tabid/217/Default.aspx

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Methods of screening: Tuck jumps

• Again, quick and easy to administer• Feet 35cm apart, slight knee bend and jump using an arm

swing bringing the knees up to parallel with the floor• On landing immediately go straight into the next jump

continuing for 10 seconds• The athlete should be encouraged to land softly using a toe

to midfoot rocker and keep the same footprint on landing• The athlete should be instructed to stop if they show a sharp

decline in technique

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QuickTime™ and a decompressor

are needed to see this picture.

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Methods of prevention

• Now we have an idea of the mechanisms of injury, we can target those areas to help prevent them

• You don’t have to train individual muscles unless to address a specific imbalance or rehab program

• By training the correct movement it makes prevention functional and also aids performance

• Some of these movements will also cross over to future physical preparation

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Get stronger!

• The stronger your athletes, the greater the ability to cope with and produce force, the faster they can ski.

• Reduction in potential for injury, prevention is better than cure.

• Focus on whole body strength, upper body is essential for the start and is often neglected.

• First strength gains are neuromuscular, you get better at the movements.

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Addressing ligament dominance: Jumping and landing• Focus on technique

– Maintain correct knee alignment– Landing on forefoot rocking back to mid-foot– Keep the noise down– Brace core

• Progressions:– Increase height– Change direction– Introduce rotation– Single leg

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Activating hip abductors

• To help maintain proper alignment at the knee

• Exercises working against a lateral resistance during uni or bi-lateral exercises– Band squats– Split squats– Step ups– Monster walks– Side lying leg raises

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Addressing quad dominance: Hamstrings

• Looking to load the Hamstrings eccentrically• Number of possible exercises to use

– Nordic hamstrings– Split stance Zerchers– Good mornings– Stiff leg deadlift– Stiff leg deadlift variations

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Addressing leg dominance

• Even out through correct bilateral technique• Use of single leg exercises

– Single leg squats– Split squats– Lunges

• Increase the load on the non-dominant leg

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Core

• Important to use and train core musculature in the correct way

• Hip tilt awareness• Use of the abdominal Brace• The big 4!

– Curl ups– Bird dogs– Glute bridges– Side bridges

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Athlete education

• Education plays an important role, create the all round athlete

• Help the athlete to understand why they’re doing what they’re doing

• Get the athletes to coach each other, will embed the technique

• Will give greater adherence• Encourage self awareness, the athlete should be able to

feel where they are going right and wrong

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Recap

• You don’t have to devote particular time to it, your time with the athletes is valuable.

• Don’t waste the warm up, it is a substantial percentage of training and contact time

• Be creative

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Any Questions?

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Thank you for your time

neil@nwconditioning.com

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