NFL & knee injuries

How can Chargers, other NFL teams reduce ‘alarming’ rate of ACL injuries?

JACK WANG |

link: http://www.ocregister.com/2017/08/03/chargers-search-for-clues-to-alarming-number-of-acl-injuries/

Inside the knee is a diagonal band of fibrous tissue, roughly the size of pinky finger. When it snaps, the course of an NFL season changes.

On football injury reports, few words are as dreaded as “anterior cruciate ligament.” ACL tears once ended careers. Even today, they often signal lost seasons.

Chargers offensive guard Forrest Lamp is one of the latest victims. On Wednesday, the second-round pick tore his right ACL, ending what would have been his rookie season four days into training camp.

He is hardly alone. Just this week, a number of players have gone down with similar injuries, sparking winces and groans across the league. On Tuesday, it was Rams defensive lineman Dominique Easley, suffering the third torn ACL of his athletic career. On Thursday, it was Dolphins quarterback Ryan Tannehill and his injured left knee — one followed by a forebodingly inconclusive MRI.

But the Chargers have been uniquely unlucky in this regard. Since the start of the 2016 season, they have lost six players to torn ACLs. In addition to Lamp, the list includes: receiver Keenan Allen, running back Danny Woodhead, cornerback Jason Verrett, linebacker Nick Dzubnar, and defensive lineman Caraun Reid.

“It’s certainly a big cluster,” said Dr. Bert Mandelbaum, a Santa Monica-based orthopedic surgeon and ACL injury prevention researcher at the Kerlan-Jobe Institute. “There’s no question about it being a big cluster when you have that many ACL injuries on any one professional team. It’s alarming.”

An important caveat: Although Mandelbaum has worked closely with high-level athletes, including the Galaxy and the U.S. Men’s National soccer team, he has not directly examined any of the injured Chargers. Barring closer analysis on his part, he could not say whether or not the Chargers’ rate of ACL tears indicated simple bad luck or an underlying systemic problem.

But Mandelbaum also has spent nearly two decades studying how to prevent and reduce ACL injuries, a quest that began when he and other doctors saw a spike in knee injuries among female teenage athletes in Southern California. They realized that when the athletes were jumping, landing or decelerating, deficiencies in their hip caused the upper legs to turn in, excessive strain on the ACL.

In response, he developed the PEP program, which consists of warm-up and strengthening exercises, plyometrics and stretches in order to promote better posture and control.

This approach, Mandelbaum believes, could also benefit professional football players. Over the past three seasons, he worked with team doctors, including the 49ers’ Timothy McAdams and the Giants’ Scott Rodeo, to examine film of ACL injuries. In doing so, they found 68 instances of non-contact ACL injuries.

The study did not focus on ACL injuries that occurred as the result of a hit.

In March, the NFL Physicians Society awarded McAdams the Arthur C. Rettig Award for Academic Excellence for presenting the study, titled “Video Analysis of ACL Injuries in the National Football League.”

But why would professional athletes, who have access to some of the best training and rehabilitation resources, lack sufficient control in their lower body?

Mandelbaum said he thinks it’s a matter of emphasis. NFL players often work out on their own during the offseason, and may enter training camp in different physical shape. Once they report for training camp, teams are focused on moving into preseason preparation and fully-padded practices, leaving little time to correct deficiencies on an individual basis.

“They’re extremely fast, extremely powerful, and extremely strong,” Mandelbaum said. “But the problem is, the steering isn’t so good. We call that steering neuromuscular control.”

Mandelbaum said that he has helped some high school and college teams reduce the frequency of non-contact ACL injuries by upwards of 70 percent.

He believes his PEP program can translate to the pros, but it is unclear how widely these principles have already been adopted across the NFL.

“I never had the interaction with a team that said, ‘OK, come on guys, let’s go do this program,’” he said. “That said, I know for a fact that there are a number of teams who have sports medicine programs who are on top of these things and are getting their athletes and their teams to do portions of this program.

“So it’s not to say that no one does it. I think that as a league, the league doesn’t work like that. Every team for themselves.”