WEBVTT
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Factor spelled FA k t R stands
for Functional and Kinetic Treatment with Rehabilitation.
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Over the past decade, this unique
approach to treating pain and dysfunction has been
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utilized by healthcare providers on six continents, serving as a framework that guides clinical
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decision making and patient visits around the
globe on a daily basis. With this
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podcast, our goal is simple to
bring the best and brightest in clinical education
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to the forefront and empower practitioners with
cutting edge, evidence based content that improves
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patient outcomes and inspires healthcare providers to
continually evolve their approach to treatment. In
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each episode, we will feature a
training or interview with some of the top
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minds and healthcare in a short format
that is easy to digest, with actionable
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information that you can implement into practice
right away. Let's get started. Welcome
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to a new episode of The Factor
podcast. I'm your host, Jessica Riddle.
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If this is your first time tuning
in, welcome and thank you for
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listening. In today's episode, we're
going to explore a fascinating topic that has
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gained significant attention in recent years.
Today's training is titled creating a Prehabilitation program
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with doctor Davis McAllister. Whether you're
an athlete, a fitness enthusiast, or
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someone preparing to go under the knife, prehabilitation is a proactive approach that can
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help optimize your physical and mental well
being before an event or a sport.
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This subject is one that really hits
home for me as I sit here today
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prepping to leave for a World Series
Baseball tournament with my nine year old and
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his baseball team. Even at such
a young age, we are constantly monitoring
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our kids to make sure they're getting
proper rest, nutrition, hydration so that
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they can perform at their best and
of course, reach their full potential as
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an athlete at every stage as they
grow. Now, I am fortunate enough
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to have a husband that's very well
versed in athletic performance and recovery, and
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I consider myself a little bit smarter
than most when it comes to that subject.
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But for most parents that's simply not
the case. So what do they
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do? Who do they look to
to help guide them on making sure their
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athlete is well taken care of and
not leaving themselves open for injury. In
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the world of sports medicine, we
talk so much about how to treat injuries
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after they occur, but you don't
hear a lot about how to prevent them
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in the first place. And of
course we can't prevent every injury all of
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the time. With athletes, there's
never going to be a one hundred percent
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prevention rate. But what we can
do is better prepare our athletic patients for
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competition by implement menting a prehabilitation program
that is customized to the unique needs of
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their sport and current level of fitness. And this isn't only for athletes.
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This can also be for your weekend
warriors or those that enjoy running regularly,
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cycling regularly. This doesn't necessarily have
to be only when there's a major competition
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or a sporting event a game of
some sort. This could be for your
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patients at all levels. So you
might be asking, well, what does
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the research say about this topic.
Lucky for you, I have a few
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quick excerpts I'm going to share here
before we get into today's training because I
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think these are relevant and they were
certainly eye opening for me. So a
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study published in the American Journal of
Sports Medicine found that athletes who participated in
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prehabilitation programs experienced a forty percent decrease
in the incidence of sports related injuries compared
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to those who didn't. There was
also another study by the University of Wisconsin
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School of medic in Public Health where
they implemented a prehabilitation program with the study
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participants. This program resulted in a
fifty percent reduction in the risk of lower
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extremity injuries among collegiate athletes, and
doctor McAllister will hit on that sum when
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it comes to acl tayers. This
is a very important study. There's also
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one from the National Athletic Trainers Association
that reported that athletes who engage in prehabilitation
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activities specific to their sport had a
twenty nine percent decrease in non contact lower
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limb injuries, emphasizing the profinitive benefits
of both of these programs. And then,
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of course, finally, a systematic
review published in the British Journal of
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Sports Medicine analyzed various studies and concluded
that prehab programs reduced the overall risk of
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sports injuries by approximately thirty percent.
So if you aren't currently doing any prehabilitation
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programs with your patients, listen closely
and take notes. I can guarantee this
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training will teach you strategies you can
implement in practice right away. Our instructor
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today for this two episode series is
doctor Davis McAllister. He's a clinic faculty
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doctor for the Parker University Dallas Wellness
Clinic. Doctor McAllister earned his doctorate of
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Chiropractic from Parker University in two thousand
and three and has been a team doctor
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for various high school sports teams and
both pro and semi pro sports teams.
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Prior to his career in chiropractic,
doctor McAllister served in military intelligence for the
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US Army from nineteen ninety one to
nineteen ninety nine and as a human intelligence
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specialist and linguist. After his military
service, he attended Mississippi State University,
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where he earned his bachelor's degree in
science. Doctor McAllister also has a bachelor's
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degree in anatomy from Parker University,
a master's degree in Educational Leadership from soeul
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Ross State University, and he has
sifications and Adaptive Rehabilitation, occupunctions and cushion
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and kettaball. He specializes in chiropractic
treatments for sports related injuries, rehabilitation,
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taping, and soft tissue. Let's
cue the intro music and dive in.
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Just a little bit of background where
kind of where I'm coming from. I've
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been a chiropractor for eighteen years,
prior that of eight years in the military.
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During that time while I've been in
practice, have also been a strength
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and conditioning coach and a high school
coach here in the state of Texas for
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the past fifteen years. I'm a
powerlifting coach both for USA Powerlifting and for
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a Texas high school team, and
I'm also the team chiropractor for the w
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NBA Dallas Wings currently, but I
have also worked with the XFL Dallas Renegades
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before COVID shut everything down last year. I've also done work the PBR,
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several semipro baseball teams and so forth. So give you a little bit of
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background as to where this presentation came
from. One of the high schools that
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I worked with had a problem in
their basketball program, the girls basketball program,
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where they had three ACL tears in
the same school year. Basically it
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devastated the whole Three of them are
varsity players, starters, and it just
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basically decimated their program. And so
they asked me to come in evaluate assess
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what was going on. Functionally with
their players and then be able to offer
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some advice and out of that,
I felt that there was a need to
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be able to put together a program
to be able to share some information some
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of the evidence and research that's out
there on ACO prehabilitation. Of course,
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the angle that we're going with this
is non contact a CEO. Obviously,
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there's not a whole lot you can
do. Somebody comes crashing through somebody's knee
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and you get your triad there.
But this we're trying to minimize the possibility
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of risk for an ACO terror just
by poor mechanics and some of the other
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factors. And we'll get into a
little bit of that. So just a
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little bit of a refresher on the
acel ligaments. The anterior cruciate ligament extends
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from the lateral from oral condyle to
the anti medial aspect of the tibial crest.
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It assists with need stability by providing
passive biomechanical restraint for rotation and limiting
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anterior translation of the tibia in relation
to the femur. And as we get
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into some of the mechanisms and mechanics
of it, I want you to bear
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that in mind as far as the
function, we're going to get into different
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aspects of function, as far as
passive restraint versus active restraint, when we
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talk about structure of the need,
and then to achieve need stability while running,
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jumping, or cutting, there has
to be a combination of active muscle
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contractions in conjunction with precise neuromuscular timing. So those are some of the things
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that we're going to talk about.
So you can see we have the acel
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that's right here, a PCL is
behind it, alternating in the other way.
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Here's the PCL on the backside as
well. And then just a quick
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review of the muscular chure. You
have a lot of musculature that goes around
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and crosses the knee. I mean, if you think about most of your
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dynamic joints, I mean, obviously
with the knee being a hinge type joint,
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you're looking at primarily flection extension with
very very minimal internal external rotation.
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It's possibility at the knee. So
you have to pay attention to the muscular
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balance and especially when you're doing your
functional assessments, and we'll talk about some
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of the different things that you should
look for during your functional assessment that may
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relate to muscular imbalances, especially when
you're dealing with lateral stability versus medial stability
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with the adductors, quad dominance versus
hamstring weakness, and those types of things.
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So some of the contributing factors that
you're going to deal with, let's
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talk about some of the incidents of
injury. So you have fifteen to twenty
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five year old competitive or recreational athletes
are at the greatest risk of injury.
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You start to see, especially if
you're dealing with high school, you'll start
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to see a little bit of issues
that can creep up for evolving knees.
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When kids are in middle school to
early high school, you'll start to see
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things like teller tendonitis show up because
they're getting into that stage where the muscular
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development will start to increase, and
it typically will increase rapidly and the tendons
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don't necessarily have time to adjust,
and so we've got to allow those the
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muscular truth to properly develop, with
the tendons around the need to properly develop
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so that we can get that active
restraint around the knee. So that's you
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think about. Most of your people
are most active up until they hit about
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twenty five, and then all of
a sudden life kicks in and then you
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have kids and job and everything else, and activity level typically will go down.
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For most people, eighty percent of
your ACO injuries are non contact and
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then overall, female athletes are at
risk four to six times greater than male
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athletes, And there's a lot of
speculation and that most people attribute it to
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jo one thing, but there's some
other factors that we're going to go into.
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Female high school athletes are nine times
greater and risk of injury female college
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athletes or five times greater. Professional
female athletes have five times greater risk,
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and sports that have reported the highest
incidents of injury due to high dynamic loading.
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Thought these were pretty interesting. Most
of them made sense to me because
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there were the ones that I've seen
with high school students pretty consistently. Except
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for the handball. I didn't even
know if people still played handball anymore,
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but that was still listed on fairly
recent research. And so females in the
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military are found to not be more
susceptible to ACO injury compared to males.
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Now that's based on statistical information of
incidents within the military. Part of the
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reason for that, though, is
because traditionally the role of females in the
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military have been more support oriented.
They tend to be kind of what we've
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referred to as in the rear with
the gear. As women start to progress
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more and become more active participants in
combat roles, I would be confident in
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saying that that dynamic will change and
that number will change. So some of
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the consequences that you deal with with
ACL injury, and so we have a
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lot of athletic trainers on here so
that you guys are going to be able
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to speak to this pretty effectively.
So for athletes, time on the disabled
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list increase risk of further injuries and
development of osteoarthritis in the knee. For
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military personnel, that's loss of duty
time, same consequences as athletes. Knee
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injuries contribute to further knee injury,
and prior hip injuries will increase the risk
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of specifically ACL injury. So when
we see people that have been injured that
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got to go through a proper neurological
rehab, not just rehab the muscle,
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not just provide some passive stability to
the joint. We actually have to go
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through neurological rehab to make sure that
we're having proper weight distribution and symmetry from
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one side to the other, because
if you think about it, if somebody's
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constantly loading to one side because of
a dynamic shift that occurs when they're doing
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through movement patterns, you're constantly loading
one side more than the other. And
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so if you're asking somebody to load
up on a squat, you're asking them
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to put two hundred and fifty pounds
up on the squat. Well, if
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three quarters of the weight is being
shifted over to the right hand side,
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that's going to have a greater capacity
for injury to that side as well in
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the long run. So those are
things that you need to also thick into
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consideration when you're looking at this aco
re injury occurs in one out of every
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four use. There was no distinction
of age on that study. Male athletes
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are more likely to rupture an aco
graft after repair than a female is just
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because they tend to be you're dealing
with greater forces, greater dynamics, And
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then it also depends on if they're
using the proteller versus the candaver tending the
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candaver tendant tends to be a lot
tighter. I have not been able to
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go back and really get some good
information on if there's a greater incidence if
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anybody's actually done any studies on the
greater incidents of the patellar tending graph versus
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the cadaver graph, but that would
be some interesting information to be able to
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find out. There's a twelve year
study of two hundred and twenty one post
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acl found that sixty four percent head
condural defects. You'll get that plaque that
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starts to developing the joint, and
then twenty six percent head from all osteoarthritis.
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So once you do damage to that
knee, the symptoms and the progression
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continues on from there. So those
are things that you need to be able
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to advise your athletes on as they
continue to progress and go through their rehab.
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If you're listening to this podcast and
you've yet to attend a Factor Rehab
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live course, I have a special
offer just for you. See, I
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realize that sometimes you need to kick
the tires a bit to learn more about
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a course before you register, especially
one that offers a certification track. So
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I've developed a special offer just for
those of you who are interested in learning
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what this Factor thing is all about. See, We've put together a free
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one hour webinar to introduce the concept
of having a systematic approach to rehab.
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In this one hour online course,
our director of Education, doctor Todd Riddle,
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will show you how implementing a system
for patient treatment can improve patient outcomes,
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streamline your operations, grow your profitability, and help you to build a
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practice that you absolutely love. You'll
also hear from doctor Riddle's personal experience in
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using the Factor Rehab system, both
with elite athletes as well as the everyday
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patient just looking to move and feel
their best. It's a great first step
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to learn more about FACTOR certification and
how Factor could impact your patient care.
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And to sweeten the deal, we're
offering CE credit for completing this online training
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absolutely free. Yeah so you heard
that correctly. Free ce so CE credit
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is available in a number of US
states for chiropractors, as well as for
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massage therapists, athletic trainers, and
physical therapists. To learn more and get
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your free CE while learning more about
how Factor can impact your patient care,
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visit the free Factor webinar link in
our show notes. Now back to the
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show. All right, so some
features that contribute to ACL injury. So
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you have structural features enter condular not
size. All right. If the notch
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is too narrow, especially in females
due to a predisposition a smaller bone structure,
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the space may become compromised during rotation. The shortened distance as well as
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shorter fibers of ACO may result in
decreased elastic stretched distance. One of the
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studies that I read showed that if
you have somebody that suffers an ACO injury,
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they recover, they go through the
surgery, they repair, and then
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shortly thereafter they end up tearing the
other ACO injury, the other ACO on
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their knee. More than likely it
was contributed to the smaller interconto their knock
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size. That was one of the
high school that our referenced that we worked
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with the next year, after we
came in and did our changes with them,
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and after our assessment, we went
through, we redid their warm up
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protocol. We actually went through and
looked how they were training and working out
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with their athletes and wrote a whole
new program for them. The next year,
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they went from being last in district
to district champs the next year and
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made a pretty good run in the
playoffs. They only had one ACL injury
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during that next year, and the
one a CL injury that they had was
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a female that had torn her ACO
the previous year, and this terror,
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the second tear was on the opposite
knee. That was interesting enough. Not
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too long ago, that same coach
called me and asked me, is there
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possibility of a familiar relationship with ACL
tears? And I said, well,
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I said, given the athlete that
we were talking about, that is very
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well possible. I said, because
anatomic development genetics do play a part.
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And I asked him, I said, why do you ask? And apparently
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this same athlete has two younger siblings
that are all going through the exact same
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thing, and I told him,
I said, the best thing that those
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athletes can do is they need to
go get an X ray, get the
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distance measure between the intercondular notch.
And there is research and that some statistics
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out there that will tell you what
the greater disposition is for somebody to be
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at risk for an ACL tear based
on the size of that notch. So
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I thought that was interesting. Are
the things structurally that we need to look
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at integrity of the meniscus. So
during loaded motions such as flexion and rotation,
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female remains in contact with the tibio
plateau. While the meniscus functions to
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assist condular motion. The death and
integrity of the meniscus affects the efficiency of
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that motion, so you have to
pay attention. The meniscus is meant to
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add as a pad and as a
gliding mechanism within and so that can be
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disrupted if there's damage to the meniscus. That tear the meniscus will alter the
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translational motion of the condyles, resulting
in addage stress to the acl During cutting
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and jumping motions, the joint capsule
and ligament the structures those have to be
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stable as well. So you have
the joint capsule and the collateral ligaments provide
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passive restraints. So we talked about
the difference between active and passive restraint around
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the knee. So your joint capsule
and collateral ligaments that provide passive restraint for
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the knee by controlling dynamic motion,
assisting with the stability damaged to any passive
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restraint to the ning will have a
compromising effect of the biomechanical function and increase
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the risk for ACL injury. And
the increase tibual slope can have a potential
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risk for ACL injury as well.
So if somebody's already had an MCL injury
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and they don't have it properly rehabbed
and properly healed up, and they continue
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to go out and continue to try
to cut, then they are now at
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greater risk of ACL non contact injury
noamic a modifiable mechanical biomechanical features. You
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have movements that contribute to ACL stress. Hyper extension, excessive valgus, and
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abduction are the most common. Great
stress on the ACL is during internal tibial
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torsion at or near full extension.
So the ACL has the greatest resistance to
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rotational forces between ten to thirty degrees
of then flection. So you think about
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your athletic stance, athletic stance and
needs should be been about ten to thirty
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degrees and as it goes down goes
beyond that thirty degree mark. Now you've
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increased the possibility of over extending and
putting tension on that ACL. That if
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they were to take a cut,
step over extend, do anything like that
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and it goes into an internal rotation. With that, then you're looking at
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the possibility of tearing that actl quad
dominance. So during sustained flection action,
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the quadricep contraction unbalanced by sufficient hamstring
contraction results and and t your translation of
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the femur on the tibia, creating
predisposed stress on ACL. Now, but
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I'll throw something out here that kind
of figure this out. After working with
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athletes for fifteen years and being in
a training room, pretty much everybody's got
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a quad dominance. I'd love for
somebody to tell me I'm hamstring dominant and
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I said, no, you're not, And so you have that quad dominant.
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So if you think about certain mechanisms, the quads come up, they
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attached to the asis on the front
and that can create a great amount of
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tention. A lot of people put
a lot of focus on the so ass
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because it is the primary hip flexer, but they tend to neglect the dominance
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of the quad as it comes up
and attaches to that point on the antier
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aspect of the hip. Well,
if that's tight, you can have bilateral
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where you get a bilateral anterior tilt, or you get one side that has
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always been a tend to be stronger
or tiger than the other. So now
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you've got that antier tilt with torsion
to that side. Well, if that
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anterior tilts to that side with torsion, that the issue two braises. So
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if the issue two braises, we
now have a stretched hamstring. There's a
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problem. Most of the time when
somebody complains about tight hamstrings. What's the
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first thing they do? They tell
them go stretch their hamstrings. So if
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they stretch the hamstring, what they've
actually done is compound and made the problem
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worse by allowing that quad more room
to be able to pull that si anterior
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on the ilium anterior on that side. And then the next approach that I've
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started to see that's becoming more prominent
as well, with strengthen the hamstring.
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That's great, you can strengthen the
hamstring, but the hamstring is still exposed
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to injury because it's being pulled taught. Now you're asking a taught muscle to
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try to contract and shorten when you
haven't addressed the initial problem to begin with,
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which is the tight quad. You
loosen up the quad, release the
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ilium, get the ilium to retract
and then then you can start focusing on
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getting the hamstring tighter after that.
So another dynamic immdifiable biomechanical features, so
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great and greatest force of the aco
generated and the knee during a double limb
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or single limb landing with the knee
extended and abducted, just as the knee
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accelerates to a bogus position, stress
on the acel increases. So what they're
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basically it's referred to somebody jumps up, comes down lands you see the knees
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go in, or whether it's on
a single limb or double limb. My
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favorite thing of the seeds. You
watch NBA players, both in the w
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NBA and the men's NBA, and
you see them up there just doing free
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throbs and they drop down into their
stance. Instead of their knees pushing out,
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they push their knees in and allow
their knees to touch just to come
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up and do a free throw shot. That's already a predisposition to a bad
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mechanics as it is. And then
those guys get out there and have to
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get out and jump, and they're
going to do that just on something as
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simple as a free throw. You
really need to pay attention because they're probably
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going to do it on their landing
and then they're going to turn their acls
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and the process. So poe musk
of the control affects neil linement and can
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increase antier post tier translation, but
rotary sheer forces of the knee stressing the
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ACL that can cause an excessive roto
relaxity that results in a cl injury and
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tearing of the monescus. So as
far as risk of re injury post surgery,
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knee injuries contribute to the risk of
recurring knee injuries. Prior hip injuries
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will significantly increase the risk of a
co injury. ACO re injury occurs in
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one out of every four utes,
and then male athletes more likely to rupture
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an ACO graph. So we went
into a little bit of that already,
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but there was a twelve years study
that we talked about earlier, and I
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just wanted to add the reference in
here to that. All that two hundred
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and twenty one people that had the
sixty four percent condural defects in the twenty
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one the twenty six percent developed the
OA and the knee after that. So
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performance impacting movement and factors, So
you have frontal plane motion. In the
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frontal plane you have an increased risk
of a cl during an excessive adduction of
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the knee. Increased knee adduction or
correlated with drop, jump landing, single
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or double ag and cutting maneuvers.
So what you'll see is as they plant,
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you'll see that knee over extent.
They plant, they drop, and
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you'll see that knee kind of cave
in a little bit us all we had
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to two years ago one of the
players on another team. I was at
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the game and I was able to
go back and look at it, and
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she planted over extended and then when
she tried to cut and redirect, that
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knee dropped into a valgus or adducted
and snapped her ACL right there just on
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the push off. So those are
things that you have to work on.
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Comparatively, the single leg technique of
side step cutting with poor mechanics generate six
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times more adduction than the drop landing. All right, The single leg motion
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analysis should be assessed prior to training
program initiation to assess mechanics. So you
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need to go through and do a
proper functional assessment to see what the predisposition
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of the athlete is in order to
be able to determine their level of risk
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frontal plane motion. This is what
I was referring to. Now, there's
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a couple of different things that are
play here. So if you look at
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the knee, you can see everybody
pays attention to the Q angle. The
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other thing that needs to be paid
attention to is what's going on right here.
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If they've got fallen arches, flat
feet, those types of things without
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proper art support and proper support of
the angle, you've now increased the risk
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of this becoming a problem with that
angle. So we've got to make sure
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that these are properly supported down here
in order to be able to make sure
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that we can minimize this. Then
it's also a matter of focusing on lateral
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stability development on the quad to be
able to help push those knees out and
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get them focused and retrained on pushing
those knees out when they land. And
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again Q angle differences so another contributing
factor. So as an athlete goes out,
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they may be paying particular attention to
the techniques and things that you go
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over and that you coach them on. But then as time goes on during
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the game or even during the course
of practice, fatigue will start. To
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00:27:00.079 --> 00:27:03.440
that end. The more fatigue sets
in, the sloppy or they will get,
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the less focus they become they get
on technique. So it's something that
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has to be consistently reinforced both in
practice and throughout the course of the game.
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So during the onset of fatigue,
athletes will demonstrate increased motion and sagittal
349
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in frontal planes in conjunction with increased
ground reaction forces, so hip and the
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00:27:21.160 --> 00:27:26.519
internal rotation increases, resulting in increased
valgus. Increased ground reaction forces are going
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to increase. The single leg show
being increased on a single leg hop.
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So you think about your volleyball players, think butch your basketball players. Those
353
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that have to jump, and a
lot of the times they don't always come
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down on both feet like they should. They're coming down single legs. So
355
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now you've increased the possibility of exaggerating
that valgus and fitting them at risk of
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00:27:45.519 --> 00:27:51.279
an ACL tare. So they increased
valgus force and increase ground reaction force predisposed
357
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for an ACL entry sore and trunk
stability. This is one of the things
358
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that spend a lot of time focusing
on even within the clinic that I'm working
359
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in right now, we've developed a
program working with veterans that have TBI and
360
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I handle the physical portion of their
therapy in conjunction with a neurologist and trying
361
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to get them to regain their balance
and start being able to do proper weight
362
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distribution. And one of the first
things that I look at is their core
363
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stability, so knee control during single
limb and cutting motions that are directly influenced
364
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by the position of the trunk and
hip motion. Weak trunk and hip strength
365
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will result in a much greater center
of mass displacement. Strengthening these components will
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00:28:33.680 --> 00:28:37.680
cut down on your center mass displacement
and frontal plane motion of the kneed.
367
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So if you think about if you
watch somebody they're going into a loudal motion,
368
00:28:42.039 --> 00:28:45.400
or you ask them to they're in
a straight line motion, ask them
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to cut and redirect, you'll see
that upper body if they if their core
370
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is weak and they're not properly engaging
their core during active movement, you'll see
371
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that top other body shift. And
we'll talk about some of the other things
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that you can look for on a
core on a functional assessment, but that's
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a huge indicator. If somebody's trying
to redirect and you see the upper body
374
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still moving with the lower body not, that's a problem. So that's something
375
00:29:10.119 --> 00:29:14.559
that needs to be addressed and working
with that athlete on active core engagement when
376
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they're doing movement patterns. So specific
training of the trunk and hips will result
377
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in more control of the frontal plane
motion and the athletic performance overall. Again
378
00:29:22.480 --> 00:29:26.079
with the core and then glute engagement, you'll see a lot of athletes that
379
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because of the quad dominance and those
things, you'll see it inherent and blute
380
00:29:30.400 --> 00:29:33.920
weakness start to develop on that side
and they don't know how to engage their
381
00:29:33.920 --> 00:29:37.839
glutes anymore to be able to help
maintain control. So those are things that
382
00:29:37.839 --> 00:29:42.200
need to be looked at. So
hip displacement while in the squat position,
383
00:29:42.279 --> 00:29:47.680
so a weight variation of this motion
can impact ligament and joint loading, soft
384
00:29:47.720 --> 00:29:52.720
tissue strain and ligament sprain, and
the asymmetry of strength development. So the
385
00:29:52.799 --> 00:29:56.319
lateral displacement can alter force distribution of
the hips and lower extremity and joint forces.
386
00:29:56.359 --> 00:29:59.759
This is what I was talking about, is that when somebody's going up
387
00:29:59.799 --> 00:30:03.079
in in a squat motion. How
are they shifting as the weight distribution or
388
00:30:03.119 --> 00:30:07.200
they shifting to the left or they
shift to the right. You may see
389
00:30:07.240 --> 00:30:10.839
it breakdown because there are different stages
within the squad that if you see them
390
00:30:10.880 --> 00:30:12.720
shift to the right on the initial
they may go all the way to the
391
00:30:12.759 --> 00:30:17.960
left or back to midline half about
two thirds of the way down, and
392
00:30:18.000 --> 00:30:19.799
when they get down to the bottom
they may shift one way or the other
393
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again. And so there are different
muscles that are engaging through that. So
394
00:30:23.359 --> 00:30:26.319
you need to be able to make
sure that you're paying close attention through that
395
00:30:26.359 --> 00:30:30.880
process so that you can see that
you get proper muscle engagement throughout the course
396
00:30:30.920 --> 00:30:34.599
of the entire motion, because as
they go down and come back up,
397
00:30:34.880 --> 00:30:40.440
certain muscles are activating and deactivating as
they go through that process. So combining
398
00:30:40.519 --> 00:30:45.440
lateral displacement with increased ground reaction forces
which has been calculated to be three,
399
00:30:45.079 --> 00:30:48.160
three to six times their body weight, will all through the distribution of force
400
00:30:48.200 --> 00:30:52.279
flows throughout the lower extremity ligaments and
Lombar's mind increasing the risk of soft tissue
401
00:30:52.319 --> 00:30:56.799
of ligament injury. So you can
get also developed low back issues as well.
402
00:30:56.079 --> 00:31:00.359
You think about what we talk about
with the quad dominance and how that
403
00:31:00.400 --> 00:31:03.319
affects the pelvis, Well, that
stress has got to go somewhere, So
404
00:31:03.359 --> 00:31:07.599
then that stress is typically going to
go right into the low back. Now
405
00:31:07.640 --> 00:31:12.240
you've got overactivation of the erectors in
the back, and inherently what happens is
406
00:31:12.240 --> 00:31:15.680
is that they should have three sixty
core engagement. Well, if the erectors
407
00:31:15.680 --> 00:31:21.680
are constantly overactivated, then what's going
to eventually happen is is both your internal
408
00:31:21.720 --> 00:31:26.200
and your ant your external core going
to start to weakend over time. And
409
00:31:26.480 --> 00:31:29.920
one of the classic things that you'll
see there's people that they refer to as
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00:31:29.920 --> 00:31:33.000
sway backs, but if you watch
them run, you'll see their stomach start
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00:31:33.079 --> 00:31:37.119
to come forward and their hips start
to drift back while they're running. And
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00:31:37.279 --> 00:31:41.519
that's a lack of core engagement and
lack of glute activation that's going to put
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00:31:41.559 --> 00:31:45.119
greater stress on that low back as
well. So these are all just kind
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00:31:45.119 --> 00:31:48.319
of things to look for and watch
for. So studies have shown the correcting
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00:31:48.319 --> 00:32:02.440
and the lateral displacement will improve vertical
jump height and sprint speed. That's it
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00:32:02.559 --> 00:32:07.960
for today's episode. Be sure to
tune in for episode fifty eight, where
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00:32:07.960 --> 00:32:12.480
we wrap up part two of this
series. We'll discuss the evidence based components
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00:32:12.519 --> 00:32:16.599
that every prehab program should have.
Dive into the research surrounding ACL injury,
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00:32:16.960 --> 00:32:22.039
as well as the application of force
and movement as it relates to injury prevention.
420
00:32:22.559 --> 00:32:24.839
You won't want to miss it.
Episode fifty eight drops in two weeks
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00:32:25.440 --> 00:32:30.079
before we end today's episode, I
have a quick favor to ask. We're
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00:32:30.119 --> 00:32:34.000
working on some exciting new things at
Factor, and while I can't yet announce
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00:32:34.119 --> 00:32:37.240
everything, what I can say for
certain is that our team is continually seeking
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00:32:37.319 --> 00:32:43.839
new and innovative ways to serve you
our global network of healthcare providers and students.
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00:32:44.680 --> 00:32:47.680
After working with providers across the globe
for the past decade, I feel
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00:32:47.680 --> 00:32:51.480
like I have a pretty good pulse
on the biggest needs of our community.
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00:32:51.759 --> 00:32:54.960
But I never want to make assumptions
and miss the mark. So in the
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00:32:55.000 --> 00:32:59.279
spirit of making sure we're heading in
the right direction, head to the show
429
00:32:59.319 --> 00:33:04.279
notes and the link on the Factor
survey. It contains just five simple questions
430
00:33:04.319 --> 00:33:07.559
to help us zero in on exactly
what you need most from our team,
431
00:33:07.240 --> 00:33:10.319
and it'll take less than a minute
to complete, and I will be ever
432
00:33:10.480 --> 00:33:15.599
so grateful to have your feedback,
and as a thank you gift, we
433
00:33:15.680 --> 00:33:21.400
will send you a cultivated playlist of
our top ten Factor podcast episodes, the
434
00:33:21.440 --> 00:33:24.759
most popular ones from the past two
years. So go to the show notes,
435
00:33:24.920 --> 00:33:29.240
click the link on the Factor Survey, or you can visit the link
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00:33:29.240 --> 00:33:32.640
in our bio on Instagram. If
you're not following us on Instagram, definitely
437
00:33:32.680 --> 00:33:38.519
head over there and do so.
Our handle is Factor Education. That's Faktr
438
00:33:39.160 --> 00:33:43.799
Education all one word. I have
to tell you, guys, I've been
439
00:33:43.920 --> 00:33:46.519
getting these responses in for the past
couple of weeks. I read each and
440
00:33:46.599 --> 00:33:51.559
every one of them personally, and
I am so excited about what I'm hearing
441
00:33:51.559 --> 00:33:54.759
back from you guys and from our
global community. We're so excited to be
442
00:33:54.839 --> 00:33:59.720
working on some exciting new offerings for
you. So that's all for today.
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00:34:00.079 --> 00:34:04.599
See you next time. Hey,
guys. If you like what you heard
444
00:34:04.640 --> 00:34:08.519
today, I encourage you to visit
our website at Factor Hyphenstore dot com that's
445
00:34:08.559 --> 00:34:15.840
spelled fak Tr Hyphenstore dot com to
find out more information about all that we
446
00:34:15.920 --> 00:34:20.239
have to offer. We have a
variety of online offerings as well as our
447
00:34:20.239 --> 00:34:23.639
hands on Factor Rehab System course scheduled
in cities around the globe. Be sure
448
00:34:23.639 --> 00:34:29.039
to also check out our event calendar
and bookmark any of these upcoming live webinar
449
00:34:29.159 --> 00:34:31.199
dates coming up in the near future
so you can join us live. And
450
00:34:31.280 --> 00:34:35.360
of course, the biggest compliment we
can receive is for you to help us
451
00:34:35.360 --> 00:34:38.039
spread the word to your friends,
colleagues, and classmates. You'll find all
452
00:34:38.079 --> 00:34:42.440
the important links, as well as
info about our sponsors in the show notes,
453
00:34:42.480 --> 00:34:43.800
so be sure to check those out.
1
00:00:17.960 --> 00:00:24.519
Factor spelled FA k t R stands
for Functional and Kinetic Treatment with Rehabilitation.
2
00:00:24.960 --> 00:00:29.239
Over the past decade, this unique
approach to treating pain and dysfunction has been
3
00:00:29.320 --> 00:00:34.560
utilized by healthcare providers on six continents, serving as a framework that guides clinical
4
00:00:34.600 --> 00:00:39.439
decision making and patient visits around the
globe on a daily basis. With this
5
00:00:39.479 --> 00:00:44.600
podcast, our goal is simple to
bring the best and brightest in clinical education
6
00:00:44.679 --> 00:00:50.759
to the forefront and empower practitioners with
cutting edge, evidence based content that improves
7
00:00:50.799 --> 00:00:57.280
patient outcomes and inspires healthcare providers to
continually evolve their approach to treatment. In
8
00:00:57.359 --> 00:01:00.840
each episode, we will feature a
training or interview with some of the top
9
00:01:00.880 --> 00:01:04.799
minds and healthcare in a short format
that is easy to digest, with actionable
10
00:01:04.840 --> 00:01:14.519
information that you can implement into practice
right away. Let's get started. Welcome
11
00:01:14.560 --> 00:01:18.400
to a new episode of The Factor
podcast. I'm your host, Jessica Riddle.
12
00:01:18.680 --> 00:01:21.519
If this is your first time tuning
in, welcome and thank you for
13
00:01:21.599 --> 00:01:26.280
listening. In today's episode, we're
going to explore a fascinating topic that has
14
00:01:26.280 --> 00:01:33.159
gained significant attention in recent years.
Today's training is titled creating a Prehabilitation program
15
00:01:33.159 --> 00:01:38.079
with doctor Davis McAllister. Whether you're
an athlete, a fitness enthusiast, or
16
00:01:38.120 --> 00:01:42.640
someone preparing to go under the knife, prehabilitation is a proactive approach that can
17
00:01:42.680 --> 00:01:48.040
help optimize your physical and mental well
being before an event or a sport.
18
00:01:48.959 --> 00:01:52.959
This subject is one that really hits
home for me as I sit here today
19
00:01:53.040 --> 00:01:56.920
prepping to leave for a World Series
Baseball tournament with my nine year old and
20
00:01:57.040 --> 00:02:00.840
his baseball team. Even at such
a young age, we are constantly monitoring
21
00:02:00.840 --> 00:02:06.239
our kids to make sure they're getting
proper rest, nutrition, hydration so that
22
00:02:06.280 --> 00:02:09.240
they can perform at their best and
of course, reach their full potential as
23
00:02:09.280 --> 00:02:14.520
an athlete at every stage as they
grow. Now, I am fortunate enough
24
00:02:14.599 --> 00:02:19.000
to have a husband that's very well
versed in athletic performance and recovery, and
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I consider myself a little bit smarter
than most when it comes to that subject.
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00:02:23.520 --> 00:02:27.879
But for most parents that's simply not
the case. So what do they
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00:02:27.919 --> 00:02:31.319
do? Who do they look to
to help guide them on making sure their
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00:02:31.360 --> 00:02:38.439
athlete is well taken care of and
not leaving themselves open for injury. In
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00:02:38.479 --> 00:02:42.159
the world of sports medicine, we
talk so much about how to treat injuries
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00:02:42.240 --> 00:02:45.599
after they occur, but you don't
hear a lot about how to prevent them
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00:02:45.599 --> 00:02:50.520
in the first place. And of
course we can't prevent every injury all of
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the time. With athletes, there's
never going to be a one hundred percent
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00:02:53.919 --> 00:02:58.280
prevention rate. But what we can
do is better prepare our athletic patients for
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00:02:58.319 --> 00:03:04.879
competition by implement menting a prehabilitation program
that is customized to the unique needs of
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00:03:04.919 --> 00:03:08.719
their sport and current level of fitness. And this isn't only for athletes.
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00:03:09.080 --> 00:03:15.840
This can also be for your weekend
warriors or those that enjoy running regularly,
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00:03:15.039 --> 00:03:21.479
cycling regularly. This doesn't necessarily have
to be only when there's a major competition
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00:03:21.719 --> 00:03:24.599
or a sporting event a game of
some sort. This could be for your
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00:03:24.639 --> 00:03:29.719
patients at all levels. So you
might be asking, well, what does
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the research say about this topic.
Lucky for you, I have a few
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quick excerpts I'm going to share here
before we get into today's training because I
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think these are relevant and they were
certainly eye opening for me. So a
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study published in the American Journal of
Sports Medicine found that athletes who participated in
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prehabilitation programs experienced a forty percent decrease
in the incidence of sports related injuries compared
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00:03:54.039 --> 00:03:59.240
to those who didn't. There was
also another study by the University of Wisconsin
46
00:03:59.319 --> 00:04:04.280
School of medic in Public Health where
they implemented a prehabilitation program with the study
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00:04:04.319 --> 00:04:11.159
participants. This program resulted in a
fifty percent reduction in the risk of lower
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00:04:11.199 --> 00:04:15.639
extremity injuries among collegiate athletes, and
doctor McAllister will hit on that sum when
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00:04:15.639 --> 00:04:20.120
it comes to acl tayers. This
is a very important study. There's also
50
00:04:20.199 --> 00:04:27.240
one from the National Athletic Trainers Association
that reported that athletes who engage in prehabilitation
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00:04:27.319 --> 00:04:33.120
activities specific to their sport had a
twenty nine percent decrease in non contact lower
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00:04:33.199 --> 00:04:40.319
limb injuries, emphasizing the profinitive benefits
of both of these programs. And then,
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00:04:40.360 --> 00:04:45.160
of course, finally, a systematic
review published in the British Journal of
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00:04:45.199 --> 00:04:50.680
Sports Medicine analyzed various studies and concluded
that prehab programs reduced the overall risk of
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00:04:50.720 --> 00:04:58.959
sports injuries by approximately thirty percent.
So if you aren't currently doing any prehabilitation
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00:04:59.040 --> 00:05:03.000
programs with your patients, listen closely
and take notes. I can guarantee this
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00:05:03.040 --> 00:05:09.279
training will teach you strategies you can
implement in practice right away. Our instructor
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00:05:09.319 --> 00:05:14.639
today for this two episode series is
doctor Davis McAllister. He's a clinic faculty
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00:05:14.680 --> 00:05:19.160
doctor for the Parker University Dallas Wellness
Clinic. Doctor McAllister earned his doctorate of
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00:05:19.240 --> 00:05:24.720
Chiropractic from Parker University in two thousand
and three and has been a team doctor
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00:05:24.759 --> 00:05:29.759
for various high school sports teams and
both pro and semi pro sports teams.
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Prior to his career in chiropractic,
doctor McAllister served in military intelligence for the
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00:05:34.399 --> 00:05:40.800
US Army from nineteen ninety one to
nineteen ninety nine and as a human intelligence
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00:05:40.920 --> 00:05:46.319
specialist and linguist. After his military
service, he attended Mississippi State University,
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00:05:46.600 --> 00:05:50.480
where he earned his bachelor's degree in
science. Doctor McAllister also has a bachelor's
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00:05:50.480 --> 00:05:57.240
degree in anatomy from Parker University,
a master's degree in Educational Leadership from soeul
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00:05:57.360 --> 00:06:02.720
Ross State University, and he has
sifications and Adaptive Rehabilitation, occupunctions and cushion
68
00:06:02.759 --> 00:06:09.800
and kettaball. He specializes in chiropractic
treatments for sports related injuries, rehabilitation,
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00:06:10.000 --> 00:06:14.839
taping, and soft tissue. Let's
cue the intro music and dive in.
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Just a little bit of background where
kind of where I'm coming from. I've
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been a chiropractor for eighteen years,
prior that of eight years in the military.
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During that time while I've been in
practice, have also been a strength
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00:06:35.600 --> 00:06:40.720
and conditioning coach and a high school
coach here in the state of Texas for
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00:06:40.839 --> 00:06:45.120
the past fifteen years. I'm a
powerlifting coach both for USA Powerlifting and for
75
00:06:45.160 --> 00:06:48.399
a Texas high school team, and
I'm also the team chiropractor for the w
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00:06:48.720 --> 00:06:56.000
NBA Dallas Wings currently, but I
have also worked with the XFL Dallas Renegades
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00:06:56.079 --> 00:07:00.600
before COVID shut everything down last year. I've also done work the PBR,
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00:07:00.759 --> 00:07:03.680
several semipro baseball teams and so forth. So give you a little bit of
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background as to where this presentation came
from. One of the high schools that
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I worked with had a problem in
their basketball program, the girls basketball program,
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00:07:14.480 --> 00:07:17.439
where they had three ACL tears in
the same school year. Basically it
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00:07:17.800 --> 00:07:21.839
devastated the whole Three of them are
varsity players, starters, and it just
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00:07:21.959 --> 00:07:29.240
basically decimated their program. And so
they asked me to come in evaluate assess
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00:07:29.279 --> 00:07:32.040
what was going on. Functionally with
their players and then be able to offer
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00:07:32.120 --> 00:07:35.399
some advice and out of that,
I felt that there was a need to
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00:07:35.439 --> 00:07:40.079
be able to put together a program
to be able to share some information some
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of the evidence and research that's out
there on ACO prehabilitation. Of course,
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the angle that we're going with this
is non contact a CEO. Obviously,
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00:07:47.839 --> 00:07:51.800
there's not a whole lot you can
do. Somebody comes crashing through somebody's knee
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00:07:51.800 --> 00:07:58.040
and you get your triad there.
But this we're trying to minimize the possibility
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of risk for an ACO terror just
by poor mechanics and some of the other
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00:08:01.879 --> 00:08:05.519
factors. And we'll get into a
little bit of that. So just a
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00:08:05.519 --> 00:08:09.920
little bit of a refresher on the
acel ligaments. The anterior cruciate ligament extends
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00:08:09.920 --> 00:08:13.600
from the lateral from oral condyle to
the anti medial aspect of the tibial crest.
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00:08:13.720 --> 00:08:20.839
It assists with need stability by providing
passive biomechanical restraint for rotation and limiting
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00:08:20.120 --> 00:08:24.319
anterior translation of the tibia in relation
to the femur. And as we get
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00:08:24.360 --> 00:08:28.000
into some of the mechanisms and mechanics
of it, I want you to bear
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00:08:28.079 --> 00:08:31.159
that in mind as far as the
function, we're going to get into different
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00:08:31.200 --> 00:08:37.799
aspects of function, as far as
passive restraint versus active restraint, when we
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00:08:37.840 --> 00:08:41.039
talk about structure of the need,
and then to achieve need stability while running,
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00:08:41.120 --> 00:08:45.240
jumping, or cutting, there has
to be a combination of active muscle
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00:08:45.279 --> 00:08:50.799
contractions in conjunction with precise neuromuscular timing. So those are some of the things
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00:08:50.799 --> 00:08:54.720
that we're going to talk about.
So you can see we have the acel
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00:08:56.159 --> 00:09:00.720
that's right here, a PCL is
behind it, alternating in the other way.
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00:09:01.279 --> 00:09:05.120
Here's the PCL on the backside as
well. And then just a quick
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00:09:05.200 --> 00:09:09.399
review of the muscular chure. You
have a lot of musculature that goes around
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00:09:09.639 --> 00:09:11.799
and crosses the knee. I mean, if you think about most of your
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00:09:11.879 --> 00:09:16.320
dynamic joints, I mean, obviously
with the knee being a hinge type joint,
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00:09:16.759 --> 00:09:22.840
you're looking at primarily flection extension with
very very minimal internal external rotation.
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00:09:22.879 --> 00:09:26.200
It's possibility at the knee. So
you have to pay attention to the muscular
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00:09:26.240 --> 00:09:30.720
balance and especially when you're doing your
functional assessments, and we'll talk about some
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00:09:30.759 --> 00:09:35.279
of the different things that you should
look for during your functional assessment that may
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00:09:35.399 --> 00:09:39.960
relate to muscular imbalances, especially when
you're dealing with lateral stability versus medial stability
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00:09:39.960 --> 00:09:46.519
with the adductors, quad dominance versus
hamstring weakness, and those types of things.
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00:09:46.039 --> 00:09:50.480
So some of the contributing factors that
you're going to deal with, let's
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00:09:50.480 --> 00:09:54.600
talk about some of the incidents of
injury. So you have fifteen to twenty
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00:09:54.600 --> 00:09:58.120
five year old competitive or recreational athletes
are at the greatest risk of injury.
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00:09:58.399 --> 00:10:01.600
You start to see, especially if
you're dealing with high school, you'll start
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00:10:01.679 --> 00:10:05.759
to see a little bit of issues
that can creep up for evolving knees.
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00:10:05.840 --> 00:10:11.519
When kids are in middle school to
early high school, you'll start to see
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00:10:11.639 --> 00:10:16.600
things like teller tendonitis show up because
they're getting into that stage where the muscular
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00:10:16.679 --> 00:10:24.279
development will start to increase, and
it typically will increase rapidly and the tendons
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00:10:24.320 --> 00:10:28.679
don't necessarily have time to adjust,
and so we've got to allow those the
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00:10:28.759 --> 00:10:33.440
muscular truth to properly develop, with
the tendons around the need to properly develop
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00:10:33.480 --> 00:10:37.519
so that we can get that active
restraint around the knee. So that's you
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00:10:37.559 --> 00:10:39.519
think about. Most of your people
are most active up until they hit about
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00:10:39.559 --> 00:10:41.840
twenty five, and then all of
a sudden life kicks in and then you
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00:10:41.840 --> 00:10:48.559
have kids and job and everything else, and activity level typically will go down.
129
00:10:48.600 --> 00:10:52.600
For most people, eighty percent of
your ACO injuries are non contact and
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00:10:52.639 --> 00:10:58.679
then overall, female athletes are at
risk four to six times greater than male
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00:10:58.799 --> 00:11:01.480
athletes, And there's a lot of
speculation and that most people attribute it to
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00:11:01.679 --> 00:11:05.120
jo one thing, but there's some
other factors that we're going to go into.
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00:11:05.440 --> 00:11:11.519
Female high school athletes are nine times
greater and risk of injury female college
134
00:11:11.559 --> 00:11:16.240
athletes or five times greater. Professional
female athletes have five times greater risk,
135
00:11:16.720 --> 00:11:20.639
and sports that have reported the highest
incidents of injury due to high dynamic loading.
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00:11:22.000 --> 00:11:24.720
Thought these were pretty interesting. Most
of them made sense to me because
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00:11:24.720 --> 00:11:28.519
there were the ones that I've seen
with high school students pretty consistently. Except
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00:11:28.600 --> 00:11:31.879
for the handball. I didn't even
know if people still played handball anymore,
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00:11:31.200 --> 00:11:37.600
but that was still listed on fairly
recent research. And so females in the
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00:11:37.600 --> 00:11:41.320
military are found to not be more
susceptible to ACO injury compared to males.
141
00:11:41.399 --> 00:11:48.360
Now that's based on statistical information of
incidents within the military. Part of the
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00:11:48.399 --> 00:11:52.080
reason for that, though, is
because traditionally the role of females in the
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00:11:52.159 --> 00:11:56.360
military have been more support oriented.
They tend to be kind of what we've
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00:11:56.440 --> 00:12:01.840
referred to as in the rear with
the gear. As women start to progress
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00:12:01.919 --> 00:12:07.600
more and become more active participants in
combat roles, I would be confident in
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00:12:07.679 --> 00:12:11.039
saying that that dynamic will change and
that number will change. So some of
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00:12:11.080 --> 00:12:16.720
the consequences that you deal with with
ACL injury, and so we have a
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00:12:16.720 --> 00:12:20.639
lot of athletic trainers on here so
that you guys are going to be able
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00:12:20.639 --> 00:12:24.360
to speak to this pretty effectively.
So for athletes, time on the disabled
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00:12:24.399 --> 00:12:28.440
list increase risk of further injuries and
development of osteoarthritis in the knee. For
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00:12:28.559 --> 00:12:35.159
military personnel, that's loss of duty
time, same consequences as athletes. Knee
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00:12:35.159 --> 00:12:39.440
injuries contribute to further knee injury,
and prior hip injuries will increase the risk
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00:12:39.519 --> 00:12:46.759
of specifically ACL injury. So when
we see people that have been injured that
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got to go through a proper neurological
rehab, not just rehab the muscle,
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not just provide some passive stability to
the joint. We actually have to go
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through neurological rehab to make sure that
we're having proper weight distribution and symmetry from
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one side to the other, because
if you think about it, if somebody's
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constantly loading to one side because of
a dynamic shift that occurs when they're doing
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through movement patterns, you're constantly loading
one side more than the other. And
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so if you're asking somebody to load
up on a squat, you're asking them
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to put two hundred and fifty pounds
up on the squat. Well, if
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three quarters of the weight is being
shifted over to the right hand side,
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that's going to have a greater capacity
for injury to that side as well in
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the long run. So those are
things that you need to also thick into
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consideration when you're looking at this aco
re injury occurs in one out of every
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four use. There was no distinction
of age on that study. Male athletes
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are more likely to rupture an aco
graft after repair than a female is just
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because they tend to be you're dealing
with greater forces, greater dynamics, And
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then it also depends on if they're
using the proteller versus the candaver tending the
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candaver tendant tends to be a lot
tighter. I have not been able to
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go back and really get some good
information on if there's a greater incidence if
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anybody's actually done any studies on the
greater incidents of the patellar tending graph versus
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the cadaver graph, but that would
be some interesting information to be able to
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find out. There's a twelve year
study of two hundred and twenty one post
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acl found that sixty four percent head
condural defects. You'll get that plaque that
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starts to developing the joint, and
then twenty six percent head from all osteoarthritis.
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So once you do damage to that
knee, the symptoms and the progression
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continues on from there. So those
are things that you need to be able
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to advise your athletes on as they
continue to progress and go through their rehab.
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If you're listening to this podcast and
you've yet to attend a Factor Rehab
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00:14:50.279 --> 00:14:54.080
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00:15:37.200 --> 00:15:43.200
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00:16:18.600 --> 00:16:22.080
visit the free Factor webinar link in
our show notes. Now back to the
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show. All right, so some
features that contribute to ACL injury. So
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you have structural features enter condular not
size. All right. If the notch
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is too narrow, especially in females
due to a predisposition a smaller bone structure,
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the space may become compromised during rotation. The shortened distance as well as
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shorter fibers of ACO may result in
decreased elastic stretched distance. One of the
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studies that I read showed that if
you have somebody that suffers an ACO injury,
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they recover, they go through the
surgery, they repair, and then
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shortly thereafter they end up tearing the
other ACO injury, the other ACO on
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their knee. More than likely it
was contributed to the smaller interconto their knock
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size. That was one of the
high school that our referenced that we worked
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with the next year, after we
came in and did our changes with them,
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and after our assessment, we went
through, we redid their warm up
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protocol. We actually went through and
looked how they were training and working out
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with their athletes and wrote a whole
new program for them. The next year,
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they went from being last in district
to district champs the next year and
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made a pretty good run in the
playoffs. They only had one ACL injury
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during that next year, and the
one a CL injury that they had was
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a female that had torn her ACO
the previous year, and this terror,
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the second tear was on the opposite
knee. That was interesting enough. Not
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too long ago, that same coach
called me and asked me, is there
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possibility of a familiar relationship with ACL
tears? And I said, well,
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I said, given the athlete that
we were talking about, that is very
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well possible. I said, because
anatomic development genetics do play a part.
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And I asked him, I said, why do you ask? And apparently
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this same athlete has two younger siblings
that are all going through the exact same
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thing, and I told him,
I said, the best thing that those
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athletes can do is they need to
go get an X ray, get the
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distance measure between the intercondular notch.
And there is research and that some statistics
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out there that will tell you what
the greater disposition is for somebody to be
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at risk for an ACL tear based
on the size of that notch. So
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I thought that was interesting. Are
the things structurally that we need to look
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at integrity of the meniscus. So
during loaded motions such as flexion and rotation,
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female remains in contact with the tibio
plateau. While the meniscus functions to
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assist condular motion. The death and
integrity of the meniscus affects the efficiency of
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that motion, so you have to
pay attention. The meniscus is meant to
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add as a pad and as a
gliding mechanism within and so that can be
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disrupted if there's damage to the meniscus. That tear the meniscus will alter the
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translational motion of the condyles, resulting
in addage stress to the acl During cutting
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and jumping motions, the joint capsule
and ligament the structures those have to be
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stable as well. So you have
the joint capsule and the collateral ligaments provide
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passive restraints. So we talked about
the difference between active and passive restraint around
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the knee. So your joint capsule
and collateral ligaments that provide passive restraint for
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the knee by controlling dynamic motion,
assisting with the stability damaged to any passive
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restraint to the ning will have a
compromising effect of the biomechanical function and increase
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the risk for ACL injury. And
the increase tibual slope can have a potential
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risk for ACL injury as well.
So if somebody's already had an MCL injury
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and they don't have it properly rehabbed
and properly healed up, and they continue
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to go out and continue to try
to cut, then they are now at
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greater risk of ACL non contact injury
noamic a modifiable mechanical biomechanical features. You
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have movements that contribute to ACL stress. Hyper extension, excessive valgus, and
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abduction are the most common. Great
stress on the ACL is during internal tibial
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torsion at or near full extension.
So the ACL has the greatest resistance to
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rotational forces between ten to thirty degrees
of then flection. So you think about
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your athletic stance, athletic stance and
needs should be been about ten to thirty
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degrees and as it goes down goes
beyond that thirty degree mark. Now you've
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increased the possibility of over extending and
putting tension on that ACL. That if
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they were to take a cut,
step over extend, do anything like that
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and it goes into an internal rotation. With that, then you're looking at
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the possibility of tearing that actl quad
dominance. So during sustained flection action,
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the quadricep contraction unbalanced by sufficient hamstring
contraction results and and t your translation of
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the femur on the tibia, creating
predisposed stress on ACL. Now, but
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I'll throw something out here that kind
of figure this out. After working with
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athletes for fifteen years and being in
a training room, pretty much everybody's got
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a quad dominance. I'd love for
somebody to tell me I'm hamstring dominant and
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I said, no, you're not, And so you have that quad dominant.
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So if you think about certain mechanisms, the quads come up, they
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attached to the asis on the front
and that can create a great amount of
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tention. A lot of people put
a lot of focus on the so ass
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because it is the primary hip flexer, but they tend to neglect the dominance
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of the quad as it comes up
and attaches to that point on the antier
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aspect of the hip. Well,
if that's tight, you can have bilateral
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where you get a bilateral anterior tilt, or you get one side that has
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always been a tend to be stronger
or tiger than the other. So now
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you've got that antier tilt with torsion
to that side. Well, if that
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anterior tilts to that side with torsion, that the issue two braises. So
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if the issue two braises, we
now have a stretched hamstring. There's a
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problem. Most of the time when
somebody complains about tight hamstrings. What's the
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first thing they do? They tell
them go stretch their hamstrings. So if
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they stretch the hamstring, what they've
actually done is compound and made the problem
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worse by allowing that quad more room
to be able to pull that si anterior
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on the ilium anterior on that side. And then the next approach that I've
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started to see that's becoming more prominent
as well, with strengthen the hamstring.
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That's great, you can strengthen the
hamstring, but the hamstring is still exposed
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to injury because it's being pulled taught. Now you're asking a taught muscle to
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try to contract and shorten when you
haven't addressed the initial problem to begin with,
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which is the tight quad. You
loosen up the quad, release the
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ilium, get the ilium to retract
and then then you can start focusing on
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getting the hamstring tighter after that.
So another dynamic immdifiable biomechanical features, so
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great and greatest force of the aco
generated and the knee during a double limb
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or single limb landing with the knee
extended and abducted, just as the knee
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accelerates to a bogus position, stress
on the acel increases. So what they're
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basically it's referred to somebody jumps up, comes down lands you see the knees
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go in, or whether it's on
a single limb or double limb. My
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favorite thing of the seeds. You
watch NBA players, both in the w
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NBA and the men's NBA, and
you see them up there just doing free
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throbs and they drop down into their
stance. Instead of their knees pushing out,
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they push their knees in and allow
their knees to touch just to come
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up and do a free throw shot. That's already a predisposition to a bad
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mechanics as it is. And then
those guys get out there and have to
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get out and jump, and they're
going to do that just on something as
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simple as a free throw. You
really need to pay attention because they're probably
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going to do it on their landing
and then they're going to turn their acls
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and the process. So poe musk
of the control affects neil linement and can
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increase antier post tier translation, but
rotary sheer forces of the knee stressing the
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ACL that can cause an excessive roto
relaxity that results in a cl injury and
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tearing of the monescus. So as
far as risk of re injury post surgery,
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knee injuries contribute to the risk of
recurring knee injuries. Prior hip injuries
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will significantly increase the risk of a
co injury. ACO re injury occurs in
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one out of every four utes,
and then male athletes more likely to rupture
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an ACO graph. So we went
into a little bit of that already,
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but there was a twelve years study
that we talked about earlier, and I
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just wanted to add the reference in
here to that. All that two hundred
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and twenty one people that had the
sixty four percent condural defects in the twenty
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one the twenty six percent developed the
OA and the knee after that. So
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performance impacting movement and factors, So
you have frontal plane motion. In the
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frontal plane you have an increased risk
of a cl during an excessive adduction of
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the knee. Increased knee adduction or
correlated with drop, jump landing, single
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or double ag and cutting maneuvers.
So what you'll see is as they plant,
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you'll see that knee over extent.
They plant, they drop, and
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you'll see that knee kind of cave
in a little bit us all we had
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to two years ago one of the
players on another team. I was at
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the game and I was able to
go back and look at it, and
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she planted over extended and then when
she tried to cut and redirect, that
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knee dropped into a valgus or adducted
and snapped her ACL right there just on
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the push off. So those are
things that you have to work on.
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Comparatively, the single leg technique of
side step cutting with poor mechanics generate six
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times more adduction than the drop landing. All right, The single leg motion
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analysis should be assessed prior to training
program initiation to assess mechanics. So you
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need to go through and do a
proper functional assessment to see what the predisposition
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of the athlete is in order to
be able to determine their level of risk
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frontal plane motion. This is what
I was referring to. Now, there's
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a couple of different things that are
play here. So if you look at
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the knee, you can see everybody
pays attention to the Q angle. The
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other thing that needs to be paid
attention to is what's going on right here.
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If they've got fallen arches, flat
feet, those types of things without
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proper art support and proper support of
the angle, you've now increased the risk
336
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of this becoming a problem with that
angle. So we've got to make sure
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that these are properly supported down here
in order to be able to make sure
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that we can minimize this. Then
it's also a matter of focusing on lateral
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stability development on the quad to be
able to help push those knees out and
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get them focused and retrained on pushing
those knees out when they land. And
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again Q angle differences so another contributing
factor. So as an athlete goes out,
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they may be paying particular attention to
the techniques and things that you go
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over and that you coach them on. But then as time goes on during
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the game or even during the course
of practice, fatigue will start. To
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that end. The more fatigue sets
in, the sloppy or they will get,
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the less focus they become they get
on technique. So it's something that
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has to be consistently reinforced both in
practice and throughout the course of the game.
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So during the onset of fatigue,
athletes will demonstrate increased motion and sagittal
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in frontal planes in conjunction with increased
ground reaction forces, so hip and the
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internal rotation increases, resulting in increased
valgus. Increased ground reaction forces are going
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to increase. The single leg show
being increased on a single leg hop.
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So you think about your volleyball players, think butch your basketball players. Those
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that have to jump, and a
lot of the times they don't always come
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down on both feet like they should. They're coming down single legs. So
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now you've increased the possibility of exaggerating
that valgus and fitting them at risk of
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00:27:45.519 --> 00:27:51.279
an ACL tare. So they increased
valgus force and increase ground reaction force predisposed
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00:27:51.279 --> 00:27:55.839
for an ACL entry sore and trunk
stability. This is one of the things
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00:27:55.880 --> 00:28:00.880
that spend a lot of time focusing
on even within the clinic that I'm working
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00:28:00.880 --> 00:28:06.319
in right now, we've developed a
program working with veterans that have TBI and
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I handle the physical portion of their
therapy in conjunction with a neurologist and trying
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00:28:12.279 --> 00:28:17.440
to get them to regain their balance
and start being able to do proper weight
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distribution. And one of the first
things that I look at is their core
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00:28:19.480 --> 00:28:25.519
stability, so knee control during single
limb and cutting motions that are directly influenced
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00:28:25.559 --> 00:28:29.559
by the position of the trunk and
hip motion. Weak trunk and hip strength
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00:28:29.559 --> 00:28:33.640
will result in a much greater center
of mass displacement. Strengthening these components will
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00:28:33.680 --> 00:28:37.680
cut down on your center mass displacement
and frontal plane motion of the kneed.
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00:28:37.720 --> 00:28:41.440
So if you think about if you
watch somebody they're going into a loudal motion,
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00:28:42.039 --> 00:28:45.400
or you ask them to they're in
a straight line motion, ask them
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00:28:45.440 --> 00:28:49.960
to cut and redirect, you'll see
that upper body if they if their core
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00:28:51.119 --> 00:28:53.839
is weak and they're not properly engaging
their core during active movement, you'll see
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00:28:53.880 --> 00:28:57.279
that top other body shift. And
we'll talk about some of the other things
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00:28:57.279 --> 00:29:02.440
that you can look for on a
core on a functional assessment, but that's
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00:29:02.480 --> 00:29:04.480
a huge indicator. If somebody's trying
to redirect and you see the upper body
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00:29:04.599 --> 00:29:10.119
still moving with the lower body not, that's a problem. So that's something
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00:29:10.119 --> 00:29:14.559
that needs to be addressed and working
with that athlete on active core engagement when
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00:29:14.599 --> 00:29:18.759
they're doing movement patterns. So specific
training of the trunk and hips will result
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00:29:18.920 --> 00:29:22.440
in more control of the frontal plane
motion and the athletic performance overall. Again
378
00:29:22.480 --> 00:29:26.079
with the core and then glute engagement, you'll see a lot of athletes that
379
00:29:26.359 --> 00:29:30.400
because of the quad dominance and those
things, you'll see it inherent and blute
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00:29:30.400 --> 00:29:33.920
weakness start to develop on that side
and they don't know how to engage their
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00:29:33.920 --> 00:29:37.839
glutes anymore to be able to help
maintain control. So those are things that
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00:29:37.839 --> 00:29:42.200
need to be looked at. So
hip displacement while in the squat position,
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00:29:42.279 --> 00:29:47.680
so a weight variation of this motion
can impact ligament and joint loading, soft
384
00:29:47.720 --> 00:29:52.720
tissue strain and ligament sprain, and
the asymmetry of strength development. So the
385
00:29:52.799 --> 00:29:56.319
lateral displacement can alter force distribution of
the hips and lower extremity and joint forces.
386
00:29:56.359 --> 00:29:59.759
This is what I was talking about, is that when somebody's going up
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00:29:59.799 --> 00:30:03.079
in in a squat motion. How
are they shifting as the weight distribution or
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00:30:03.119 --> 00:30:07.200
they shifting to the left or they
shift to the right. You may see
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00:30:07.240 --> 00:30:10.839
it breakdown because there are different stages
within the squad that if you see them
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00:30:10.880 --> 00:30:12.720
shift to the right on the initial
they may go all the way to the
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00:30:12.759 --> 00:30:17.960
left or back to midline half about
two thirds of the way down, and
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00:30:18.000 --> 00:30:19.799
when they get down to the bottom
they may shift one way or the other
393
00:30:19.839 --> 00:30:23.319
again. And so there are different
muscles that are engaging through that. So
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00:30:23.359 --> 00:30:26.319
you need to be able to make
sure that you're paying close attention through that
395
00:30:26.359 --> 00:30:30.880
process so that you can see that
you get proper muscle engagement throughout the course
396
00:30:30.920 --> 00:30:34.599
of the entire motion, because as
they go down and come back up,
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00:30:34.880 --> 00:30:40.440
certain muscles are activating and deactivating as
they go through that process. So combining
398
00:30:40.519 --> 00:30:45.440
lateral displacement with increased ground reaction forces
which has been calculated to be three,
399
00:30:45.079 --> 00:30:48.160
three to six times their body weight, will all through the distribution of force
400
00:30:48.200 --> 00:30:52.279
flows throughout the lower extremity ligaments and
Lombar's mind increasing the risk of soft tissue
401
00:30:52.319 --> 00:30:56.799
of ligament injury. So you can
get also developed low back issues as well.
402
00:30:56.079 --> 00:31:00.359
You think about what we talk about
with the quad dominance and how that
403
00:31:00.400 --> 00:31:03.319
affects the pelvis, Well, that
stress has got to go somewhere, So
404
00:31:03.359 --> 00:31:07.599
then that stress is typically going to
go right into the low back. Now
405
00:31:07.640 --> 00:31:12.240
you've got overactivation of the erectors in
the back, and inherently what happens is
406
00:31:12.240 --> 00:31:15.680
is that they should have three sixty
core engagement. Well, if the erectors
407
00:31:15.680 --> 00:31:21.680
are constantly overactivated, then what's going
to eventually happen is is both your internal
408
00:31:21.720 --> 00:31:26.200
and your ant your external core going
to start to weakend over time. And
409
00:31:26.480 --> 00:31:29.920
one of the classic things that you'll
see there's people that they refer to as
410
00:31:29.920 --> 00:31:33.000
sway backs, but if you watch
them run, you'll see their stomach start
411
00:31:33.079 --> 00:31:37.119
to come forward and their hips start
to drift back while they're running. And
412
00:31:37.279 --> 00:31:41.519
that's a lack of core engagement and
lack of glute activation that's going to put
413
00:31:41.559 --> 00:31:45.119
greater stress on that low back as
well. So these are all just kind
414
00:31:45.119 --> 00:31:48.319
of things to look for and watch
for. So studies have shown the correcting
415
00:31:48.319 --> 00:32:02.440
and the lateral displacement will improve vertical
jump height and sprint speed. That's it
416
00:32:02.559 --> 00:32:07.960
for today's episode. Be sure to
tune in for episode fifty eight, where
417
00:32:07.960 --> 00:32:12.480
we wrap up part two of this
series. We'll discuss the evidence based components
418
00:32:12.519 --> 00:32:16.599
that every prehab program should have.
Dive into the research surrounding ACL injury,
419
00:32:16.960 --> 00:32:22.039
as well as the application of force
and movement as it relates to injury prevention.
420
00:32:22.559 --> 00:32:24.839
You won't want to miss it.
Episode fifty eight drops in two weeks
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00:32:25.440 --> 00:32:30.079
before we end today's episode, I
have a quick favor to ask. We're
422
00:32:30.119 --> 00:32:34.000
working on some exciting new things at
Factor, and while I can't yet announce
423
00:32:34.119 --> 00:32:37.240
everything, what I can say for
certain is that our team is continually seeking
424
00:32:37.319 --> 00:32:43.839
new and innovative ways to serve you
our global network of healthcare providers and students.
425
00:32:44.680 --> 00:32:47.680
After working with providers across the globe
for the past decade, I feel
426
00:32:47.680 --> 00:32:51.480
like I have a pretty good pulse
on the biggest needs of our community.
427
00:32:51.759 --> 00:32:54.960
But I never want to make assumptions
and miss the mark. So in the
428
00:32:55.000 --> 00:32:59.279
spirit of making sure we're heading in
the right direction, head to the show
429
00:32:59.319 --> 00:33:04.279
notes and the link on the Factor
survey. It contains just five simple questions
430
00:33:04.319 --> 00:33:07.559
to help us zero in on exactly
what you need most from our team,
431
00:33:07.240 --> 00:33:10.319
and it'll take less than a minute
to complete, and I will be ever
432
00:33:10.480 --> 00:33:15.599
so grateful to have your feedback,
and as a thank you gift, we
433
00:33:15.680 --> 00:33:21.400
will send you a cultivated playlist of
our top ten Factor podcast episodes, the
434
00:33:21.440 --> 00:33:24.759
most popular ones from the past two
years. So go to the show notes,
435
00:33:24.920 --> 00:33:29.240
click the link on the Factor Survey, or you can visit the link
436
00:33:29.240 --> 00:33:32.640
in our bio on Instagram. If
you're not following us on Instagram, definitely
437
00:33:32.680 --> 00:33:38.519
head over there and do so.
Our handle is Factor Education. That's Faktr
438
00:33:39.160 --> 00:33:43.799
Education all one word. I have
to tell you, guys, I've been
439
00:33:43.920 --> 00:33:46.519
getting these responses in for the past
couple of weeks. I read each and
440
00:33:46.599 --> 00:33:51.559
every one of them personally, and
I am so excited about what I'm hearing
441
00:33:51.559 --> 00:33:54.759
back from you guys and from our
global community. We're so excited to be
442
00:33:54.839 --> 00:33:59.720
working on some exciting new offerings for
you. So that's all for today.
443
00:34:00.079 --> 00:34:04.599
See you next time. Hey,
guys. If you like what you heard
444
00:34:04.640 --> 00:34:08.519
today, I encourage you to visit
our website at Factor Hyphenstore dot com that's
445
00:34:08.559 --> 00:34:15.840
spelled fak Tr Hyphenstore dot com to
find out more information about all that we
446
00:34:15.920 --> 00:34:20.239
have to offer. We have a
variety of online offerings as well as our
447
00:34:20.239 --> 00:34:23.639
hands on Factor Rehab System course scheduled
in cities around the globe. Be sure
448
00:34:23.639 --> 00:34:29.039
to also check out our event calendar
and bookmark any of these upcoming live webinar
449
00:34:29.159 --> 00:34:31.199
dates coming up in the near future
so you can join us live. And
450
00:34:31.280 --> 00:34:35.360
of course, the biggest compliment we
can receive is for you to help us
451
00:34:35.360 --> 00:34:38.039
spread the word to your friends,
colleagues, and classmates. You'll find all
452
00:34:38.079 --> 00:34:42.440
the important links, as well as
info about our sponsors in the show notes,
453
00:34:42.480 --> 00:34:43.800
so be sure to check those out.
