396- How to Predict ACL Injuries

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week we are back with more research and if you are a sports interested chiropractor, this episode is gonna be for you. It is all around actually predicting non contact ACL injuries based upon hip strength. This study came out a few years ago. It flew under my radar until this past week and I am happy to present the information because it provides a ton of clinical context and insight with where if you're dealing with athletes, male, female, various different sports and you have people who are struggling or suffering with ACL injuries, this is gonna be a really interesting study because I don't think there's too many other providers out there that are analyzing it in the context of hip strength and especially with prognostication, so to speak, in terms of predicting ACL injuries due to lack of hip strength. We're gonna break this study down, highlight what's most important and much more on today's episode. And before we get started, I want to say a few words about the smart chiropractor. Send emails, get reactivations. That's what the smart chiropractor and specifically patient pilot by the smart chiropractor is all about. We have a 3x ROI guarantee because we have better data than anybody showing. If you give us your email list we're going to start to generate reactivations for your practice. These are people who already know, like and trust you. And it's probably the missing component is in more chiropractors than just about anything else. You have hundreds or thousands of people in your ehr right now that you're not consistently communicating with yet. You always are looking for more new patients. It is time to set up automated campaigns to drive more reactivations into your practice. We'll guarantee the results. Schedule a demo@thesmartchiropractor.com again that is at thesmartchiropractor.com but on today's episode we're talking all about ACLs, we're talking all about hip strength and much more. I'm gonna drop a link down to this study in the show notes so you can check it out if you so choose. And the official title is Hip muscle Strength predicts non Contact ACL injury in male and female Athletes. This was a prospective study and it was released in 2015. Now what do we know? We know that the ACL is the most frequently ruptured ligament of the knee, bar none. That's just the. We also know that in 2012 there was a review performed and it looked at the incidence of ACL injuries for competitive athletes and it stood at roughly 4%. So about 4% of competitive athletes on a yearly basis are going to have an ACL injury. That's a big deal. Because if you are a practice that has a couple hundred athletes in and out of your doors throughout the year, which many of you do, and many of you have more than that, you can anticipate that there could be whatever the math is on that 4, 8, 12, 16 ACL injuries coming through your door each and every year. Maybe not necessarily for you to treat, but you're going to see it as a byproduct of the activities they do outside of your office. Now, the secondary component of this, and we're going to drive to in this study, is what if you. Yeah, you and me. What if we could practically predict when an ACL injury is going to occur and then we could provide proactive steps for those people in our practice to minimize the likelihood of that injury. Do you think that that would be a unique selling point? Yes. Do you think that that would be exceptionally powerful? Yes. Do you think that'd be providing patient centered care for those people who are interested in sports activities? Absolutely. That's why I love this study and it was in the American Journal of Sports Medicine as well. So the highest number of ACL injuries are involved with people who play sports like basketball, soccer and football. So if you want to think of the trifecta of sports, and these sports are multi directional, which is some of why there's a high level of injury. There's a lot of shifting, there's a lot of dynamics and there's a lot of stress and strain. That is not unilateral. Basketball, soccer, football, that's your triad of most likely to be injured if somebody is playing those sports. Incidentally, female athletes also have a higher rate of ACL injury than male athletes. I did not know that coming into the study. So that was a tidbit to take away and it's gonna tie into the strength conversation we have as we unpack this topic. Now here is the shocking statistic that I was totally unaware of. 70% of ACL injuries are non contact injuries. 70% of ACL injuries are non contact. How do they happen if there's not contact. Jumping, decelerating, cutting, pivoting over a planted foot probably makes a lot of sense once I say that. But I can guarantee you probably didn't know that an overwhelming majority of ACL injuries were, were non contact. That's not the way that I think of it. But then I think back to watching even sports on tv. You see somebody, I just think about this, like in the lane, NBA basketball, you see somebody land and they're like, where's the contact? Where's the contact? Because the person just buckles when they land and there's no contact. And that is a classic non contact injury during landing. So that is a big, big deal. So why does this happen? Well, well, it's thought to be a result of movement patterns. So here is the big red flashing sign with that. If it's a result of movement patterns, then ACL injuries are, 70% of them are theoretically preventable. And identification of the risk factors can create and drive a prevention program. Think about how powerful that is for you and your practice. Think about how powerful that is for the the conversations you're having with people in your practice each and every day. And I'm gonna go one step farther. Think about how powerful that is for the conversations you are having with the parents of your teenage pediatric college age population who are looking forward to taking their career to the next level. There is potentially no more powerful conversation than you can have. And if you add in on top of this, this study does not go the direction I'm gonna highlight right now. But when you add in movement assessments and strength assessments, whether you're using jtech medical tools for assessments, whether you're using DNS, SFMA for the movement pattern assessment, whatever that might be, this starts to become something where it makes a lot of sense for you to monitor patients over a period of time that is good for them. The side effect is also good for your business, but primarily it's really good for them. So treat and release that, that makes sense in many contexts. However, if you have athletes coming into your practice, especially growing athletes, looking to take things to the next level, identifying movement patterns and periodically testing strength, we're going to discover is a really, really good idea. It is a massive value add that basically nobody else is doing, and it's a complete hole in the marketplace when you look at nearly a 4% injury rate and 70% of those being non contact. This is powerful stuff. This is why this study got me so excited and pumped to talk about on today's episode. So previous studies had reported that Valgus motion and val. Valgus and valgus movements and motion, excuse me, during landing, you know, is a big deal. And valgus movements predicted ACL injury with nearly 80% sensitivity and nearly 75% specificity. So that's a big deal. In abnormal movement patterns, when we talk about that that can extend to the trunk, the hip or the knee may in part be caused or correlated or however you want to say that, by diminished hip strength. So hip strength really is key when we talk about movement patterns of the trunk, the hip and the knee. And obviously this ties back into where we started this conversation. So deficits in hip muscle performance can negatively affect movement patterns and in the hip, the knee. So it stands to reason that that also predicts the potential for an injury. And yes, there's a variety of factors that can contribute to a non contact injury, but hip strength is a modifiable risk factor. That's what's important. It's easily assessed by you, by me in a clinical setting. That's why it's so important for us. And the present aim of this study was to determine whether reduced hip strength, hip external rotation and abduction predisposes athletes to non contact injuries. So they looked at over 600 athletes from competitive clubs in football, soccer, volleyball, basketball and handball and they found a couple really, really interesting things. So how do they measure this? Bilateral isometric hip strength, abduction and external rotation was assessed using a jtech Medical Industries, excuse me, dynamometer. So that's how they. I'll say it one more time, bilateral hip streng abduction and external rotation. Those were the key findings. They use jtech devices, J Tech devices are awesome, highly recommend. Now over. And they tracked these athletes throughout a season. And what did they find? Well, they found a total of 23 ACL injuries over the course of the season. 14 of those were in males, nine of them were in females. So 64% for male athletes, 64% were non contact. So pretty close to the same 70% that was estimated at the beginning. And the remaining 35% were contact. For female, 67% were non contact. So man, that 70% number really held true even with a relatively small injury sample size. Powerful stuff to remember. 70% are non contact injuries. Now the annual incidence rate they found was 2.5 and 4.3% for male and female athletes respectively, which again is pretty darn close to that 4% number. So even with a small sample size, that data held really, really true, which is really, really interesting in my mind. So there were no significant associations in their study between sport and injury status and no differences between sex and injury status. Everything was about the same when it was kind of normalized and put through statistics. Grinder there so important to keep in mind, the numbers held true. This study did provide evidence that a significant relationship, as they say, and anytime they use the word significant in a study, it is significant that a significant relationship does exist between baseline hip strength and future injury status. Specifically, increased hip strength had a protective effect against future injury, and it applied equally to both males and females in this study. So athletes classified as high risk on their preseason strength test had an increase in the probability of injury from 3% to 7%. That's over double the risk of injury. If they were high risk due to low strength numbers, that is a big deal. This study, furthermore provided evidence that greater hip strength may protect against those future injuries. And that, again, is a big deal. Is this something you can look at and analyze in your practice? Yes. Is this something that is a pretty straightforward conversation to have with people? Yes. Increase hip strength, decreased likelihood of ACL injury. That's about as simple as it gets. So this study had a lot of clinical implications. Most notably, as we just highlighted, an athlete's risk of sustaining an injury was increased from 3% to 7% when hip strength was measured and it was less or equal to the established cutoff. So that is a big deal. And considering that hip strength contributes to the movement patterns in the knee, the hip and the trunk, and that abnormal biomechanical patterns are independent risk factors, it is important to screen for this. So if you are seeing athletes, it is probably a really good idea. And especially if you're in the sports performance realm. Hey, if somebody's coming into you for a shoulder issue, you're only taking care of that shoulder issue. You know, I can understand maybe why you're not routinely measuring hip strength in that case, but if you are in any way, shape or form the performance realm, you need to start testing abduction and external rotation of the hip immediately so you can start having these conversations with your patients and asap. Now, I did not see in this study some any hard values. I'm sure it was in here. I just had difficulty digging it out on exactly. Well, what are those hip strength numbers? So if you're interested in those hip strength numbers, what's the cutoff? Please click the link down below. Check out the study. But I wanted to highlight the overarching theme that does hip strength matter? Absolutely. As it relates to ACL injuries, that a majority of these injuries are potentially preventable. Or at least you can have a significant decrease. And I'll flip that to as they said in this study, abnormal or hip strength that is not good enough, doubles over doubles your likelihood of a non contact injury. And to me, for a young athlete building, growing, looking to do things, whether that's play high school sports, whether that's move on to college sports, whether that's move on to semi pro or pro, this is about as important of a conversation as you can possibly have. It also is a great opportunity for you to get out there your in your community. So think about some of the next sports related events that you're going to and bringing up this conversation because I can guarantee you it is going to open some eyes wide. Nobody else that I've ever heard is having this conversation. And that provides you with an exceptionally unique selling proposition from a business perspective, if you're the one and you are perfectly trained, perfectly capable and probably the best person to be analyzing movement patterns, analyzing strength and providing the opportunity for that patient to optimize the strength. And this is where I'll tie it in directly to what we do with the spinal adjustment, with the chiropractic adjustment. If there's altered biomechanics, good luck. If there's pain, good luck. So this is where it ties into what I'm going to call hands on chiropractic care. When you can marry optimum performance through better range of motion, through improved biomechanics with the care you're delivering through the adjustments and then you're now coaching, guiding and monitoring their strength increases that they're actually able to get gains with because of your adjustments. They're able to move appropriately, they're able to feel better, they're able to get back and recover faster. This starts to become a very potent way for you to really emphasize in a true impactful and meaningful way the sports performance gains that can be had through the care that you deliver. And that is the take home message that I hope you have. So I loved this study. I hope you loved it too. Lots of great ways to apply this to your practice, even beyond what I highlighted today. But as we wrap up, I want to say a few things about Power Step Orthotics, which also in my mind do tie into this the biomechanical chain. So powerstep Orthotics are what I use. They're what my father uses. They were developed by a podiatrist over 30 years ago. They support this podcast. Please support them. And they're willing to hook you up with a free sample pair, there's absolutely no reason not to do this. I'm gonna drop the link down below. It's pro.powerstep.com sample pro.powerstep.com sample use the code EBC for evidence based Chiropractor and they will hook you up with a free sample pair. Head over there and do it. They're a great company and they want to hook you up, so why wouldn't you take advantage of that secondarily if you are looking to build and grow your practice if you are looking for an associate dc if you are looking for a ca, Chiro Matchmakers can help you do that. And Chiro Matchmakers recently added on virtual CA services. 70% less cost and you can get rid of these repetitive tasks to free up your time. Increase your practice's revenue by using a virtual ca. If you want to know how a virtual CA can help your practice, head over to ChiroMatchmakers.com, schedule a call with the team. Certainly, if you're going to hire an Associate DC in the next year, hiring an Associate DC does not happen overnight. So if you are planning on having that happen during this year, schedule a call with the recruiter at Chiral Matchmakers. Have a conversation, start the process because that ensures that you'll be able to hire top talent, which is what it is all about. So thank you so much for tuning into this podcast. Thank you for being a chiropractor. If you have not left us a rating or review, please do so. That helps more and more docs. Find out about this podcast. Have an awesome week in practice and I will talk to you soon.

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