Lower Extremity Injury Prevention Techniques

Richard B. Garini, LATCMaineGeneral Sports Medicine

Do YOU have and utilize an injury prevention program?

Chicago Cancer Prevention Program

Divided their program into three different levels of prevention.

Primary PreventionSecondary Prevention

Tertiary Prevention

Their model seems to fit with a SportsMedicine concept.

Primary Prevention

• Playing conditions• Equipment• Illegal or influential substances.• Abnormal anatomical structures.

– Bow legged– Flat feet– Tight musculature– Limited ROM– Abnormal joint laxity.

is the reduction or control of causative factors of potential health problems.

Causative Factors:

Secondary Prevention

• EVERY assessment is a chance to prevent injuries.• EVERY assessment is a chance to find a potential problem.

(Not just the problem the athlete came in with.)

is the early detection and treatment of health problems.

Injury assessment and rehabilitation

Tertiary Prevention

• morbidity = injuries• quality of life = performance

Am I really doing this?

How can I get started?

Providing appropriate supportive and rehabilitative services to minimize morbidity

and maximize the quality of life.

Developing a Program• Best to incorporate into the athlete’s daily routine.• Must be monitored for proper technique and form.• Should be individualized according to each athletes

abilities and adapt as needed. (Time based vs. Reps)• Should be sport specific• Should address basic injury prevention goals:

– Increase strength– Increase flexibility– Increase proprioception

So, what’s already out there?

Injury Prevention Programs• Sportsmetrics™: Jumping drills are used to teach the athlete to

preposition the entire body safely when accelerating (jumping) or decelerating (landing). The selection and progression of these exercises are designed for neuromuscular retraining proceeding from simple jumping drills (to instill correct form) to multi-directional, single-foot hops and plyometrics with an emphasis on quick turnover. (Cincinnati)

 • PEP: This prevention program consists of a warm-up, stretching,

strengthening, plyometrics, and sport specific agilities to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint. (Santa Monica)

• Weight Training: Widely utilized for decades as a proven method of increasing strength, increasing flexibility, enhancing performance, and reducing injuries.

How can I add this into what I am already doing?

• Group workouts• Individualized programs• Integrated into their daily practices.

– Dynamic Warm-ups PLUS– Sport specific drills

• ALL OF THE ABOVE

Prevention starts with Assessment

To fix a problem, first you have to know what the problem is.

You have to look at the whole picture.

It may be dressed like a race car…• Is it getting the right

fuel? • Does the engine fire

with the right timing?

• Are the wheels aligned and balanced?

• Are the tires the right size and type?

• Is the suspension too tight?

• What about the cooling system?

He may be dressed like an Athlete…

What about this guy?

• Is he eating right? • Is he in the right foot

wear for his sport and foot type?

• Do his muscles have good timing to maximize his power, efficiency, and safety?

• How is his flexibility?• Is he hydrated?

How do we find out?

Let’s go to the gym!

Flexibility

• Calves

• Big toe

• Hamstrings

• Quads

• Hip Flexors

Joint Integrity•Big toe

•Forefoot

•Subtalar

•Knee

•Patella

•Hips

&

Foot and Gait Analysis

• Arches• Calluses• Sub-talar

neutral• NWB vs. WB• Shoes• Walking

Balance

Two Leg Squat

Single Leg Squat Assessment

• Must rule out underlying factors first.

The “CORE” of success

• Is involved in all activities.

• Controls motions between the upper and lower extremities.

• Protects the spine from extraneous motion.

Lower ExtremityDynamic Stretching

Be Sport Specific

Shark Agility Test

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Home

•Single leg multi directional hopping test

•Count time and errors