Habilitation Over Re-Habilitation: A PEP Talk

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The number of anterior cruciate ligament (ACL) tears athletes at all levels and in all types of sports are experiencing continues to represent a dynamic challenge for sports medicine. Not only are ACL injuries severe in nature, they also bring with them the looming prospect of re-injury. As research has shown, any athlete who has suffered a tear to the ACL is automatically 10 times more likely to tear the ligament on the opposite knee, or re-injure the same knee. We as orthopedic specialists strive to find a way to avoid these daunting statistics all together, and I am confident that it all begins BEFORE the ACL injury with preventative strategies.

Studies have shown us that the population at highest risk for tearing the ACL is teenage girls ages 14-18. Typically participating in high school sports, it may be easy to conclude that these young athletes simply lack access to proper athletic training and/or resources. BUT even pro athletes in peak physical condition and with unlimited access to the very best trainers, coaches, and sports medicine doctors, still often find themselves the unsuspecting victims ACL tears. This begs the question, WHY are these injuries happening, what can we do to treat them effectively and how can we ultimately prevent them from happening altogether? In order to answer these questions, it’s vital to identify and understand all of the contributing factors leading up to the injury so we can implement a prevention program that has the right focus.

This is where the PEP (Prevent injury and Enhance Performance) program comes into play. We know that rehabilitation is KEY to healing, regaining stability of the knee joint, and returning to play after ACL surgery, so why not design an injury prevention program that encompasses this type of training and practices to prevent ACL injuries in the first place, not just a program that is put into action after an injury. Yes, it is possible to undergo a successful surgery, complete a great rehabilitation program and regain previous function of the knee joint, but even so, the risk for re-injury remains.

The goal of the PEP program is to avoid these risks by preventing injury and enhancing performance. So how is this done? The program consists of a warm up, stretching, strengthening, plyometrics, and sport-specific agilities – a 15-minute training routine that is performed just three times a week. These exercises are designed to address the potential deficits in the strength and coordination of the muscles that surround and support the knee joint, as well as the hip joint. We designed the program NOT to solely focus on the knee itself, but to take into consideration and offer solutions for other possible precursors for ACL tear, and this is why the program has become so successful. In a study of 60 men’s college soccer teams, players who performed the preventative PEP program were 66% less likely to tear an ACL during the season and this is great news.

Paying particular attention to prevention strategies and the PEP program is a strong framework for decreasing the amount of ACL tears among all sports and athletic levels. We want our athletes and coaches to understand the need for and direct their focus into habilitation and not just RE-habilitation. In doing so, I have no doubt that athletes will perform at their utmost fitness level and significantly reduce their risk for injury – all while staying in the game!

Sources:

http://mmqb.si.com/2013/09/20/bert-mandelbaum-acl-prevention

http://smsmf.org/smsf-programs/pep-program

https://www.facebook.com/DrBertMandelbaum/videos/vb.1432706326991641/1742484732680464/?type=2&theater

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