ACL prevention in young athletes: An interview with Lindsay DiStefano

Can doing an ACL prevention exercise program really decrease the risk for tearing your ACL? If so, which athletes should do them, and how long should they continue doing them?

As I was researching and writing my book That’s Gotta Hurt: The Injuries That Changed Sports Forever, I had the opportunity to speak to Lindsay J. DiStefano, Ph.D., ATC, Associate Professor in the Department of Kinesiology at the University of Connecticut. She has studied ACL injuries and injury prevention for over a decade. Here is a short excerpt from that interview.

Dr. David Geier:     I wanted to talk to you about some of the research into the neuromuscular programs to try to prevent ACL injuries. Your thoughts on who might benefit from those programs, how they’re implemented, that kind of thing. Just in an overall sense, what do you think the pros and cons of these programs are for young athletes?

Lindsay DiStefano:     I definitely think the pros completely outweigh the cons. I believe if you look closely at the evidence that when these types of programs are performed will, with high fidelity, that they truly can lead to a reduction in injury rates. And not just ACL injuries but other lower extremity injuries that are non-contact in nature like ankle sprains. I think they have a lot of positive benefits on health.

No research has shown any harm from an injury standpoint which further lends support for doing the program. A lot of times they are used as warm up activities prior to sport, and there are well documented benefits to that technique and preparation for an athlete. So if you can get good preparation, there’s good evidence that these programs do not impair performance immediately after or in the course of a season and in fact, may actually improve performance by improving movement efficiency.

Dr. David Geier:     Would we be better off, we were talking about implementing these programs, would we as team doctors and sports medicine professionals be best recommending that they’re implemented across the board for entire teams, entire leagues or should we try to screen athletes, find the ones with the biggest problems and gear them individually toward those athletes?

Lindsay DiStefano:     We’ve been working with intervention with these athletes, trying to implement these programs for the past 7 or 8 years. The screening, the ability to first screen and target high-risk athletes, that can happen, more likely in more elite-type training environments. But when you’re talking about a normal youth athlete, these programs are much better implemented on a widespread standpoint.

Because there doesn’t appear to be any harm involved with exposing programs to individuals who are deemed lower risk. It doesn’t make sense to isolate out those high-risk individuals. What we can do is we can educate coaches and other healthcare professionals or captains of the team. I’ve had success teaching 8 and 10 year-olds on a team how to identify in their teammates and encourage them to move better. So there’s no reason why we can’t work on education to facilitate good control, so that way the coach or the captain or whoever is the one implementing, can try to give more feedback and instruction to those higher risk individuals.

But usually, especially with kids, they don’t want to be called out and have to do something extra versus if you just from a healthy behavior standpoint, this is what everybody does. This is what every athlete should do prior to school participation, it’s just a normal routine. I think we’re going to get much better benefits.

Young soccer player suffers ACL injury

Dr. David Geier:     That makes sense. What I talked to Holly Silver she said one of the challenges has been getting coaches to buy into this. Getting the word out and getting people to do it. But what are the challenges with convincing coaches that this is necessary?

Lindsay DiStefano:     Absolutely. That’s the biggest barrier that we’re facing and what I hope all of us in this field of research are turning to is, I think there’s good evidence that these programs can be effective at reducing injuries but the problem is nobody’s doing them.

Coaches really seem, if you asked them to do a 15 or 20 minute extra activity with their practice, that’s way to much. But as soon as you say 5 or 10 minutes, then they perceive that as a lot more feasible.

Then they also had concerns, “If I have my athletes do this program before a game or before a hard practice, they’re not going to be able to do the practice that I want or the training that I want.” And we’re trying to prove that they’re actually going to probably perform better because they’re going to be better warmed up and have better control, so it’s definitely not going to impair their performance.

Dr. David Geier:     Is this something that you can just do for a season and it has long-lasting benefits, or is this something that basically needs to become part of an athlete’s training throughout his or her career?

Lindsay DiStefano:     We’ve done some preliminary research looking for the retention of changes with these programs. Everything keeps pointing to dosage matters, and it appears, especially in a youth athlete that’s rapidly changing, that these need to be done on a constant standpoint. For athletes to choose to adopt these programs as a normal part of the process, they have to do them all the time.

From an implementation standpoint, I think continued training with these programs is the way to go. What I usually tell athletes is, like a basketball player, you don’t stop practicing foul shots the minute you make the foul shot. Even professional basketball players continue to shoot foul shot after foul shot after foul shot. Movement, neuromuscular control is the exact same thing. We need to be continuing to keep our brains controlling our movements in a safe manner.

In my new book, That’s Gotta Hurt: The Injuries That Changed Sports Forever, I discuss ACL injuries and surgeries and how we can decrease these injuries. If you have kids who play sports, especially girls, you should read it and take steps to keep them healthy. Order your copy now from AmazonBarnes and NobleBooks-A-MillionApple iBookstoreTargetIndieBound or Powell’s Books.