Knee Injuries Workshop. Ross Corbett Fionntan O Dowd Julie Mc Vey

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1 Knee Injuries Workshop Ross Corbett Fionntan O Dowd Julie Mc Vey

2 Learning Outcomes Be aware of factors contributing to knee injuries in female athletes Know how to detect a predisposition to a knee injury Be able to prescribe a general knee injury prevention routine to your athletes. Be able to implement a warm up which reduces chance of injury for your athletes

3 2 joints Anatomy Tibiofemoral (knee) Patellofemoral Ligaments and cartilage major role in stability and shock absorption Anterior & posterior cruciate Medial & lateral collateral Medial & lateral meniscus 3

4 Acute Knee Injuries Females at greater risk than males (up to 7x more likely) Rise in number of females playing sport & to a higher level 1,305 cases of knee injuries in GAA 2011 Account for 11.6% of all GAA injuries

5 Common Causes of Acute Knee Pain Meniscal tears Collateral ligament tears Articular cartilage injury Patellar dislocation **Cruciate ligament tear** Often combined injuries I.e. more than one structure damaged 5

6 Mechanism of Injury Meniscus - flexion/rotation/compression MCL/LCL - valgus/varus stress PCL - direct blow to tibia ACL - cutting/twisting; landing; deceleration; hyper extension 60-80% of ACL injuries occur through non contact mechanisms 6

7 Predisposing factors Anatomical Hormonal Leg dominance - asymmetries in strength, coordination & flexibility **Neuromuscular control** 7

8 Neuromuscular control Ratio of quads - hams recruitment/ strength/power Ability to control lower limb alignment and rotation under pelvis Poor lumbopelvic control Decreased hip and knee flexion on landing Fatigue 8

9 9

10 10

11 Squat Good v Bad Hip-Knee Angle Torso Angle Depth

12 Squat Good v Bad Shin Angle Knees over toes Torso Angle

13 13

14 Why intervene? Cost of MRI/surgery/physio/orthopaedic reviews /person Long term implications - 105x increased chance of OA on X- ray in future Time missed from sport - approx. 1yr Increased female participation in sport therefore increased likelihood of occurrences in future Improved functional movement patterns and thus performance Improved dynamic neuromuscular control has been shown to increase knee stability & decrease risk of knee injury 14

15 What Can We Do? Screening Identify causative factors Out of season Implement strategies into training sessions/warm ups Early intervention/young age 15

16 Screening ASSESS Control Alignment Technique Posture 16

17 3 Step Movement Tests Screen Grading 1.Single Leg Squat 2.Forward Jump & Land (2-1) 3.Lateral Jump & Land (2-1) L.E.S.S. Training University North Carolina 12 Steps 0-3 Scoring System Pass/Fail Must Pass Test 1 to Progress to Test 2 Lumbopelvic Control Hip Control Leg Alignment Depth

18 1.Single Leg Squat 1.Single Leg Squat Lumbopelvic Control Hip Control Leg Alignment Depth

19 1.Single Leg Squat Lumbopelvic Control (Flat Back) Hip Control (Square) Leg Alignment (Hip-Knee) Depth (Below Parralel)

20 2. Forward Jump & Land Lumbopelvic Control Hip Control Leg Alignment Depth

21 2. Forward Jump & Land Lumbopelvic Control (Flat Back) Hip Control (Square) Leg Alignment (Hip-Knee) Depth

22 3. Lateral Jump & Land Lumbopelvic Control Hip Control Leg Alignment Depth

23 3. Lateral Jump & Land Lumbopelvic Control Hip Control Leg Alignment Depth

24 GYM Injury Prevention Squats SL Squats Bridge Plank Band Walks Wobble board Jump and land-2 onto 2, 2 onto 1, 1 onto 1 Needs to be functional - include perturbations, ball work etc 24

25 Corrective/Preventive Prone Plank Work Clams Side Planks Glute Bridges Hamstring Curls Donkey Kicks Lateral Walks Single Leg Balances

26 Prone Plank Timed holds based on stability Cues Keep straight line from shoulders to ankles Flat Back Feet shoulder width apart Brace core muscles

27 Side Planks Timed Holds based on stability Cues Straight line from shoulders to ankles Stack ankles, knees, hips and shoulders Elbow directly under shoulder Brace core muscles

28 Bridges Timed holds based on stability Cues Straight line from knees to shoulders Toes to sky (Glutes) Feet Flat (Hamstrings) Keep hips high Brace glutes Brace core muscles

29 Hamstring Curls Sets: 3 Reps: 12 Cues Start with straight line bridge position from heels to shoulders Press heels into ball and curl in to glutes Return to start position and repeat

30 Clams Sets: 3 Reps:12 each side Cues Make a 45 angle with knees between hips and ankles Start knees together Open knees apart like opening a shell, while keeping feet together Return to start position and repeat

31 Donkey Kicks Sets: 3 Reps:12 each side Cues Lift one knee and bring into chest, then extend back to make a straight line from glute to heel Flat back, Hips square No swaying at hips Squeeze glute at top

32 Lateral Walking Sets 3: Reps: 6 over & back Cues Drop into a parallel squat position While staying in this position take wide steps to the side Stay low, hips square, torso facing forward

33 Single Leg Balances 30 second 1 minute holds Cues Stand on one leg, non standing leg bent behind Brace Glute of standing leg

34 Warm Up s Skills Based Dynamic Stretches Corrective Movements Change of Direction TECHNIQUE

35 Learning Outcomes Be aware of factors contributing to knee injuries in female athletes Know how to detect a predisposition to a knee injury Be able to prescribe a general knee injury prevention routine to your athletes. Be able to implement a warm up which reduces chance of injury for your athletes

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