Last weekend Wellpepper attended two conferences, the Washington Physical Therapy Association Conference in Spokane, Washington and the Physical Therapy Association of British Columbia Annual General Meeting in Vancouver, BC. It was amazing to introduce Wellpepper to so many new faces and to hear feedback. We were too busy at both conferences to take advantage of the information and other activities however, we did manage to attend one talk “Recreational and Elite Athletes: Can we really prevent injuries?” by Rick Celebrini. Dr Celebrini is the head of sports medicine and science for the Vancouver Whitecaps MLS team, and former physiotherapist for the Canadian Olympic Ski Team. He became interested in physiotherapy after breaking his food during his teen years as a high-level soccer player.
Dr Celebrini started his talk with some statistics about injuries. Injuries cost the MLS $7M in 2012. Considering that MLS players are not the highest paid professional athletes, you can only imagine what this might be in other sports. He also shared that sport and recreational injuries can cause osteoarthritis later in life. Then he focused on one of the most common sport injuries: ACL tear. The ACL tear will take an athlete out of commission for 8-12 months and is estimated to cost the US healthcare system $2B a year. Women are 4-6 times more likely to have an ACL tear and have a greater risk of osteoarthritis. The major cause of ACL tear is changing direction. 70% of injuries are non-contact, that is they are incurred by the athlete him or her self by changing direction or landing incorrectly: if the knee is close to extension, and the foot moves outside the center mass, this becomes a perfect situation for an ACL tear. This situation of imbalance can result from extrinsic or intrinsic factors. Extrinsic factors are things like weather, footwear, equipment. Intrinsic factors are related to things about the person: How does the person move? Is the person tired? What is their mood? When Dr. Celebrini had his injuries, he remembers that he was tired and felt he shouldn’t have been playing. These types of factors change on a daily basis.
It turns out however, that a study in 1986 proved how to prevent ACL tears. In particular changing how deceleration happens and making rounded turns instead of sharp changes of direction are two key factors. However, in all this time, there has been no change in the number of ACL injuries. The reason for this: human nature. He cited a study where physical therapists were brought in to help professional athletes with preventative techniques and exercises for ACL. As soon as the PTs left, and the coaches and players were on their own, only 50% had compliance with the program.
Dr. Celebrini believes that we don’t need to do any more research into how to prevent ACL tears. What he’d like to see is the translation of the research into a practical application for people. That is, focusing on how to motivate them to change their behaviors for the better. He thinks there’s a gap between academic research and practical application. Even the Whitecaps, who rely on their bodies being healthy and functional for their careers, don’t do their preventative exercises.
Dr. Celebrini had some suggestions for this:
- How do you fit preventative exercises into the schedule? He gave the example that the Whitecaps players would not want to spend 30 minutes pre-game doing preventative exercises, they would want to be warming up for key skills they’d need in the game. Can you include exercises in the warm-up without detracting from other exercises they need to do?
- What is the player’s motivation? Can you tap into their desire to have a long career?
- How do you make it sport specific? Can the exercises be adapted to have relevance to the specific sports?
- Make sure that the decision makers are bought off. In the study he mentioned, the coaches weren’t on board and didn’t continue the program after the physical therapists left.
Finally he stressed the need for the research to include implementation. Researchers should collaborate with athletes, sports psychologists, and coaches, to translate the research into practice. At Wellpepper we’re working with physical therapists, behavior researchers, and patients to try to solve these challenges in getting people to do what’s good for them, so we were really happy to hear this message!