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Sorry about the delay! As you know, the Facebook universe was down for the count Monday, and that took down Bulletin/Open Court too. But we are BAAAACK!
When we last left our ACL saga, sports medicine specialist Dr. Kristy Smith walked us through the process of healing from the dreaded injury. The bottom line is your life as an athlete and regular person is better if the ACL stays intact. But if you tear the ligament, there is clear hope and optimism for a return to play – if you pack patience.
After that edition of Open Court, the big question was asked by reader Pat K. – how can knee injuries, like ACLs, be avoided in the first place? Wouldn’t it be better to focus on prevention, rather than post-incident intervention?
In a word: YEP.
Which is why I reached out to one of the best knee gurus in sports, Athletic Trainer Laura Ramus. She has an unmatched depth of Physical Therapy, Athletic Training, and player development experience, working the Olympics and Paralympics for Team USA, many years in the WNBA (Detroit Shock, N.Y. Liberty), the WTA Tour, to now being the Medical Partner for the Las Vegas Aces and on staff as at the Detroit Medical Center.
She has seen her share of knee injuries at all levels and has been focused on prevention. She started an effort in the late 1990s, called “Girls Can Jump”, to serve as a comprehensive ACL prevention program. It has been used widely, and Ramus has traveled around the country to teach ATCs and others about best practices in ACL prevention. Ramus is a former college softball player, and thankfully, has not suffered an ACL injury herself.
Q: Can we truly stop ACL injuries? The dynamic nature of sports, from the cutting to the violent reactions/collisions, seems to leave all of us susceptible.
A: We cannot stop them, no, but we certainly can do a lot to make the knee stronger and more able to withstand the force of play and other stressors. When we look at how athletes get injured, it does come back to the why’s: why are you jumping that way and how are you landing? Do you have muscle imbalances? Why are you using that form of technique? We want to push the odds into the athlete’s favor, before they get hurt, by looking at what is happening.
Q: So what are the things you are looking at when you assess an athlete, especially more at-risk females?
A: You need to take their sport into consideration, what are they doing day in and day out? What are the risky moves/elements? Then, a lot is anatomy. Then core strength – how strong are you in the areas for your sport? How are your glutes working? What is your flexibility level? All of that tells me a story. I can’t change your anatomy. I can’t - yet - change the way your brain is hard-wired to do some things. But we can work on a lot to improve everything.
Q: After you have that assessment…
A: We go to work on technique and strength training. I can teach you how to land correctly, preventing the knock-kneed position that happens to female athletes. And we do plyometrics, work on your balance, how your muscles are firing in the situations you encounter on the court, field, wherever. This is functional training, what do you need for your sport? Reaction? Speed? Power? Then we go from there. And everything matters, you need to stay hydrated, have good nutrition, because we want to make your body be at its best. So we take it all into consideration and evaluation.
Q: I’ve heard females over-develop and/or over-rely on their quads for jumping and landing, whereas male athletes use their hamstrings for that action. How much is that a risk factor?
A: It is significant, because you need to be using your gluteal muscles, your hamstrings, and calves a lot more. You literally have to get your butt into it. Women can really have strong quads and get away with being good athletes, but at some point, that is going to lead into the problems. By strengthening those other muscles in a smart fashion, you can make yourself less prone to knee injuries, and honestly, make your game better too. It’s not all about the prevention, it also helps performance.
Q: What other areas are you looking at now, in terms of new science?
A: I really am into the neurological aspect of injury. We have athletes who are recovered, and then hurt themselves the same way again. Like a re-tear of the same ACL. We now thinking that there may be pathways in the brain that lead to certain actions, can we retrain those pathways into doing things differently? How can we use or change neurofeed back to lead to better outcomes? That really intrigues me.
Q: When should athletes, and girls especially, be thinking about knee injury prevention?
A: I start training in middle school. The information needs to go out sooner than later, especially with how kids are specializing and playing more intensely at a younger age these days.
Q: Let’s talk about that. Dr. Smith and I discussed the impact of kids choosing one sport and playing it year-around. Your thoughts on that?
A: It’s awful, and I am so against it for many reasons. I think parents are being coerced by coaches and teams, you must do this, or your kid won’t get a scholarship. You must play on a travel team now, or you will never make it to the pros. It’s terrible to see the pressure being put on that community because of the greed. And that’s what it is, greed, because these coaches and all the industries that have sprung up around youth sports need to make money. They make money if they are having kids play more. Meanwhile, the kids are getting injured from overuse, burned out from having too many games and practices, and the parents are running themselves ragged to make practices and games all over the place and spending a lot of money. I hear stories of kids being kicked off teams for missing a game or practice because their family went on a trip or had a special occasion. I played sports growing up, and we never had it be the priority over our family. These days, it has changed so much, and not for the better for the kids. You can’t tell I have an opinion on this, right? (laughs).
Q: But how do we get everybody to see the big picture on this? Playing one sport more, at a younger age, does not mean more success. Playing more causes injuries. Not having proper coaching or athletic training can lead to injuries. Seems like a nihilistic equation.
A: I love sports, from being an athlete all my life to making it my profession. I want all the best things to come from sports. Seeing the machinery of youth sports growing and getting more negative for the kids is awful. It doesn’t need to be this way. Kids don’t need to keep getting hurt this way.