Published on Scout.com on September 2, 2014
By Phillip B. Wilson
Colts wide receiver Reggie Wayne's 2013 season-ending injury has become a common non-contact occurrence in the NFL. Doctor Bert Mandelbaum has studied the league's ACL tears and is convinced the injuries can be prevented.
As much as it pained him, Reggie Wayne has watched the video.
"A trillion times," the Indianapolis Colts wide receiver said of Oct. 20, 2013, at Lucas Oil Stadium. "I've seen it over and over and over again."
Andrew Luck's pass is low and behind the target. Wayne instinctively reaches back, against his body's motion to try to snag it. His right knee gives out. The anterior cruciate ligament tears. The six-time Pro Bowl star, a model for durability with 189 consecutive games played, is lost for the season.
"I'd do it again if it had to," he said recently. "It was a freak accident."
That injury, however, is quite common in today's NFL. Dr. Bert Mandelbaum, an orthopedic surgeon at the Institute for Sports Sciences in Los Angeles and author of The Win Within: Capturing Your Victorious Spirit, has studied ACL injuries for about two decades. His work can be found online at Win-Within.com.
He looked at 62 ACL tears in the NFL last season. The circumstances of Wayne's injury, without contact from another player, was observed in 18 of those 62 cases.
"Reggie Wayne, we looked at his very closely," said Mandelbaum, 60. "If you take one that's a prototypical non-contact injury, it's really Reggie Wayne's injury. No one is even near him when he tears his ACL. If you go back and look at that video, his mechanism is exactly what we were seeing with young girls back in the late 1990s. Why should a football player tear their ACL in a non-contact way in that capacity?"
The young girls the doctor is referring to were athletes who started suffering an alarming rate of ACL injuries. Before then, about 80 percent of these breakdowns were found in boys and men.
"It all of a sudden switched in the late 1990s to 20 percent boys and men and 80 percent girls and women," Mandelbaum said. "We began looking at this and saying, 'What's going on?' Other surgeons got together as a consensus group in Hunt Valley, Md., in 1999 and looked at 50 videotapes and looked at all the different possible explanations."
They analyzed hormones, the fields of play, shoes worn, the anatomy of the athletes.
"We ultimately concluded none of those were consensus variables," the doctor said. "We felt the major risk factor is what we call neuromuscular control, the way that the athlete would land, jump and decelerate was really aberrant to overloading the ACL and then tearing the ACL. As a consequence of that, we began developing a prevention program that was called a PEP Program, Prevent Injury Enhance Performance."
Developed initially for 200,000 Southern California athletes competing in soccer, this warm-up program and understanding of a body's energy and control produced an 88 percent reduction in ACL injuries the next year, then 74 percent reduction the year after that.
The Center for Disease Control and Prevention asked Mandelbaum and his associates to do a randomized control level 1 study. Athletes from 61 NCAA universities were examined with the PEP Program implemented. ACL tears were reduced by 72 percent. FIFA asked for a study and the resulting FIFA 11 Plus Program, implemented globally, has resulted in a similar significant reduction in ACL tears.
So why has football seen so many of these injuries in recent years?
"What I've seen first is the game of football has changed," Mandelbaum said. "Football back then was a different game. It was a game between hashmarks, it was a game of pushing people two or three yards one way or another, it was hitting the sled, hitting the player. Today, the game is West Coast Offense, Spread Offense, Pistol Offense, where these big, strong, fast guys have to be in the middle of the field making these cuts. For the first time, we're seeing the same kind of injuries we saw in these young girls, these non-contact ACL injuries. We looked at it in the NFL last year and we found there's an alarming grade of these non-contact ACLs.
"They're playing a game like soccer players. They're big, they're strong, they're fast and they're powerful, but the control isn't very good. It's kind of like a Ferrari with a big engine, you go to this track and you've got all this power, you've got great tires and great acceleration, but at the end of the day, your steering isn't very good. What happens is you can't control the car."
While Wayne concurs with Mandelbaum's assessment that his ACL tear was common, they disagree on the perception that it couldn't be prevented.
"When you look at the videos of all these athletes, what happens is the hip basically gets away from them, the foot gets away from them, they're reaching in such a way and then they're using their hip strength to bring their leg in," the doctor said. "What they do is internally rotate the femur of the upper leg, then the lower leg goes out in what we call dynamic valgus. It's a position where your upper leg is turning in and your lower leg is turning out, and when that happens that free tension on the ACL, it gives it a proclivity to want to tear.
"The control mechanisms are set up through the hip to provide a stable platform to keep you out of that position. You've got to control that and keep yourself out of that dynamic valgus."
Wayne acknowledges the circumstances of his injury, "He's right. It's common with ACL tears."
The 35-year-old star has mended and is ready to begin his 14th NFL season when the Colts visit the Denver Broncos Sunday night. Wayne, who has caught 1,006 passes for 13,566 yards and 80 TDs, dismisses what happened last year as something that couldn't be prevented.
"There's nothing we can do about that," he said of his instinctive reaction to try to catch that pass. "What can you do? Can you tell a 300-pounder to stay under control when another 300-pounder is pushing on him? You do what you can. You tell your body to do something. It's either you're going to do it or you're not. It's force. You can't control force."
Mandelbaum respectfully disagrees. He says controlling the body starts in the mind.
"Neuromuscular control actually emanates from the brain in the motor cortex," he said. "It's a trainable phenomenon."
He cites learning to play the piano. At first, the fingers are "all over the place." In a period of time, your mind trains the fingers how to play.
"After six weeks, your brain has this very fluid pattern of control," Mandelbaum said. "It's the same thing when you do this and you train the mind and the body to understand what it shouldn't do and what it should do."
Easier said than done, right?
The doctor continues to study the energy of injuries and is convinced it's about how the bodies of elite athletes adapt to activity. In the case of running back Vick Ballard, who tore his Achilles tendon in training camp after rehabilitating from an ACL tear for almost a year, mal-adaptive re-injuries are common. And it's probably the same with offensive left guard Donald Thomas, who tore his quad last season and then did it again during training camp.
"A lot of it has to do with the muscle, the tendon, it isn't adapted to that energy," Mandelbaum said. "Yeah, it healed beautifully, but still, the athlete is playing at a real high level and you have to be able to adapt that level of injury. Sometimes, we don't.
"And especially when you come off an offseason, I think they're at significant risk because everything ramps up so fast. You can be running, doing your gym workouts and you've got the best trainer in the world, but you're still not out there in that high level of intensity. That's certainly a factor that one needs to consider."