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Movement Skills, ACL Injuries and Coach Education.

by Brian McCormick, CSCS
Founder, The Cross Over Movement

On Full Court Press, Clay Kallam suggested the Women's Basketball Coaches Association invest in ACL research. I replied that the research is available; however, most coaches cannot be bothered to (1) find it and (2) apply it, as 10-15 minutes of practice spent doing a dynamic warm-up, lunges and so forth does little to help a team to win the next game.

The answer, in many ways, is coach's education. Unfortunately, most coaching clinics recycle zone defensive slides and tired set plays. Very little education occurs at a typical coaching clinic. Rarely does a clinic feature a speaker who is not a basketball coach but a strength and conditioning coach, training expert, sociologist, movement expert, professor, etc. However, by simply recycling the same information over and over, coaches stay the same; the game does not grow or expand. By incorporating knowledge from other disciplines, the game-the teaching and learning-expands from generation to generation, which, in turn, leads to progress, not stagnation.

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In the Sports Performance Journal from February 16, 2006, Peter Harmer, Ph.D., ATC, a professor of exercise science at Willamette University in Oregon, conducted a comprehensive survey of sports medicine literature to determine the characteristics and factors associated with injuries among young basketball players. His conclusions:

Girls are more likely to be injured than boys, especially with knee and ankle injuries. Among girls, knee injuries are more likely to be severe than in boys. Neuromuscular training can reduce the incidence of knee injuries among female players. Acute injuries are more common than chronic injuries.

In the same Journal, researchers from the University of Wisconsin are cited in regards to the impact of balance on ankle injuries:

The investigators, reporting in the Clinical Journal of Sports Medicine, found that subjects who demonstrated poor balance had nearly seven times as many ankle sprains as subjects who demonstrated good balance.

In a subsequent Sports Performance Journal, a response to a question about knee pain suggested that "the hips are the most important part of your body to strengthen with regard to knee pain." At the June Perform Better clinic in Long Beach, Al Vermeil, former Strength and Conditioning Coach for the San Francisco 49ers and Chicago Bulls, said the rash of knee injuries is in part due to the artificial stability at the ankle due to ankle taping, ankle braces and high tops. By limiting the range of motion at the ankles, the force moves to the next joint, which is the knee. In fact, another expert trainer reiterated that a client's problem is very rarely where they feel pain; a knee problem, for instance, is often a hip or ankle problem. Some research suggests one factor for girls' higher incident rate of ACL injuries is a lower ratio of hamstring to quad strength; put simply, girls tend to be more quad dominant and do not engage their hamstrings, their hips, when landing from a jump, and thus land in a more upright posture, creating more force at the knee joint.

In regards to movement skill education, especially in regards to ACL injury prevention, coaches can take several simple measures:

1) Evaluate. Most ACL injuries occur during eccentric deceleration, either from a jump or when stopping or cutting. So, first, evaluate each player's squat and jumping technique. When the player performs a squat, they should sit their hips back; their knees should stay over their toes, not in front. And, their knees should not come together. If their knees come in front of the toes, they need to re-learn how to squat properly; start with them sitting down into a chair and build to a squat, emphasizing the pushing back at the hips, not the bending of the knees. If the knees move inward, it is likely a strength issue. Girls tend to be stronger in adduction (bring the knees together) than abduction (moving them away). One way to strengthen their abductors is to use a mini-band. Place the band around the knees and step laterally with the lead leg and then the trail leg. I have used this as a warm-up routine using a basketball and executing a protect dribble across the court and back. Use the bands as a teaching tool; while athletes squat, the bands illustrate the knee collapsing inward and players learn the feel of keeping the knees in-line with the toes.

Brian Grasso, the founder of the International Youth Conditioning Association, offers a simple evaluation process for the squat in one of his newsletters, available through his Developing Athletics web site:

A simple way of doing this is to create and utilize a tracking plan that illustrates an athletes 'Rate of Technical Ability' (RTA). Develop a 1 - 5 scale that has technical performance markers evident at each ascending score. In a squat for instance, an RTA scale may look like this -

1 = Knees are valgus (inward)/lumbar spine is either rounded or arched/head is down/weight is on toes or ball of foot
2 = knees are valgus/lumbar spine is either rounded or arched/head is down
3 = lumbar spine is either rounded or arched/head is down
4 = lumbar spine is either rounded or arched
5 = Perfect form

Start with bodyweight squats and teach proper form and execution. Grade your young athletes on a piece of paper as to where they are on your '5'-point scale. Progress in volume or load only when they have reached a '5'.

This lays the foundation for future developed skill and allows for a safe progression.

2) Teach. Most believe movement skills develop naturally and only sport-specific skills need to be taught. However, one can teach proper movement skills and correct problems to prevent or reduce injuries. Since landing from a jump is a cause of many ACL tears, teach athletes to land properly. Athletes should land on the balls of their feet and sit their hips back so they land ball of the foot to the heel, rather than sticking the landing on their toes. Use a small (6-12 inches) box. Have athletes jump up and land on the box. Have the athletes step off the box. If boxes are unavailable, have athletes jump straight up and down in place, always sticking the landing before a second jump (not repetitive jumps).

Also, teach athletes to stop. In the forum section, Lee Taft explains a lunge stop:

The lunge stop is used when running forward and needing to stop quickly but stay in the split stance (lunge position). The key is to lower the hips and stop the lead leg knee somewhere over the foot- similar to a lunge. The shoulders should be more forward than a strength training lunge though. The back leg is bent close to 90 degree but that may depend on what the athlete needs to do to balance. Keep in mind- in live drills or competition the athlete will not hold the lunge position- they will reactively push off and being to back pedal.

The reverse lunge is done off the back pedal position with the rear leg or stopping leg much further back and the shoulders forward so they can accelerate forward quickly.

Taft also describes an angled or hockey stop, used when an athlete needs to stop and change directions in a sprint. A shuttle run (or a suicide) is an example of a drill which incorporates this skill; however, few coaches teach the skill, yet most make players run some sort of down and back sprint drill for conditioning or punishment. This time can also be used to teach an important skill:

The angled stop (hockey stop) is done by turning the hips, leg and feet so they are parallel with the end line. This is done when doing suicides. The outside leg is the final decelerator and is the most important leg to control momentum and to change direction. the inside leg will begin deceleration only because it is in a normal stride pattern (r,l,r,l,r)and it will touch down first as the body begins to turn. Always remember that deceleration in most cases is the first step in acceleration.

3) Develop a Dynamic Warm-up Routine. Most teams stretch or do some pre-practice routine to "warm-up." A dynamic warm-up incorporates needed elements to "warm-up" with some movement skill enhancement. After evaluating players and teaching important skills, use these in a dynamic pre-practice warm-up. In addition to injury prevention, research from the Sports Performance Journal shows "Sport-specific, dynamic stretching movements used as part of a warm-up/movement prep routine may enhance some areas of athletic performance."

Examples of an ACL injury prevention program: PEP (Prevent injury and Enhance Performance) and other exercises:

This prevention program consists of a warm-up, stretching, strengthening, plyometrics, and sport specific agilities to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint. It is important to use proper technique during all of the exercises. The coaches and trainers need to emphasize correct posture, straight up and down jumps without excessive side-to-side movement, and reinforce soft landings. This program should be completed 3 times a week. This program should take approximately 15 - 20 minutes to complete.

Three times a week for no more than twenty minutes and the The Santa Monica Orthopaedic and Sports Medicine Research Foundation concludes this program has reduced the ACL incident rate of soccer players in the Santa Monica, CA area. Unfortunately, too many coaches are unwilling to make this commitment.

Clay Kallam is right; the WBCA and the NBCA need to do more to educate coaches on pertinent issues relating to the sport beyond simple strategic moves. The strategy involved in coaching is probably the easiest part of a coaching job, especially at the youth level. It is the other aspects of coaching, from learning how kids learn to discovering different training theories to developing age-appropriate lessons and drills, which most coaches need most. And, movement skills education, and its emphasis, is one of these pertinent issues.

Brian McCormick is a player development coach and author who is currently the Head Coach of a professional club in Ireland. For more information, visit: TheCrossovermovement.com or to purchase Coach McCormick's newest book: Cross Over; the New Model of Youth Basketball Development.

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