JOHN DOHERTY: Are injury prevention priorities misplaced?

2014-01-06T18:15:00Z 2014-01-06T20:02:19Z JOHN DOHERTY: Are injury prevention priorities misplaced?John Doherty Times Columnist nwitimes.com
January 06, 2014 6:15 pm  • 

For all the ongoing angst involving concussion, the injury is almost always far less debilitating than a torn ACL in the knee.

In fact, in its haste to reduce head injuries, the NFL seems to have put alternate bull’s eyes on its players’ knees. League-wide, ACL injuries have increased dramatically in each of the last two seasons.

Has the apparent trade-off been worth it? Has there been a trade-off at all?

First, consider whether rule changes have reduced the frequency of concussion. Encouraging more touchbacks and thus fewer kickoff returns seems to have helped. Those that specifically provide for penalties for contact to the head seem to have had little or no effect. Decreasing the frequency of contact, not rules that attempt to change the manner in which contact occurs, is what works. Concussions in the NFL are down slightly from last year, but the numbers are no different than two years ago and higher than three years ago.

The bottom line is that the rule changes seem to have been more harmful to knees than beneficial to brains.

As long as there are contact/collision sports, there will be concussions. Reducing their frequency isn’t likely unless the sports in question fundamentally change. What has changed is the way concussion is managed. According to a study released by Edgeworth Economics in August, a player with a concussion in the NFL was sidelined an average of four days 10 years ago. Now? The typical time span is 16 days.

Meanwhile, the issues involving ACL tears are entirely the opposite. There are proven strategies for significantly reducing their frequency. They go largely ignored. However, the management of the injury hasn’t changed and isn’t likely to.

How to reduce ACL injuries?

Banning hits to the knee may help. However, 70 percent of ACL tears involve no contact, self-inflicted by a sudden stop, twist and/or loss of balance. Furthermore, the injury discriminates against females, with basketball players eight times more likely and soccer players six times more likely to be stricken than their male counterparts.

Train female athletes to strengthen their hamstrings, land from a jump properly and improve their balance and – depending on the study – their injury rate is at least cut in half.

The key, according to a recent Swedish study, is the coach. If the coach of a women’s team commits to starting and staying with an ACL prevention program, then the numbers drop.

The consequences for the individual and society as a whole can’t be ignored. There are 200,000 ACL tears per year nationwide. At least half of those undergo reconstruction, each of which costs upwards of $25,000. Recovery takes about a year. That financial estimate includes neither the loss of income involved nor the cost of future complications and disability.

Concussion, managed properly, typically requires a visit or two to the doctor with return to sport within a month. If the injury isn’t repeated within a year, long-term consequences are rare.

High school and youth coaches in most states are now required to complete a course regarding the dangers and management of concussion. That’s great. Still, female athletes in particular would be better served if their coaches resolved in 2014 to implement and maintain an ACL prevention program.

John Doherty is a certified athletic trainer and licensed physical therapist. This column reflects solely his opinion. Reach him at ptatcsport@sbcglobal.net. Follow him on Twitter @JDohertyATCPT.

Copyright 2014 nwitimes.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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