The ACL (anterior cruciate ligament) in your knee helps to stabilize the knee during cutting and stopping maneuvers. Complete ruptures have a significant impact on an athlete's ability to continue in sports or physical activity. You may frequently hear about ACL injuries occurring in basketball, soccer, skiing and other sports that involve rapid acceleration and changes of direction.
According to Amy Leu, DO, some ACL ruptures or complete tears occur in contact settings. However, roughly 2/3 of ACL tears occur when an athlete is landing from a jump, cutting, pivoting, accelerating or decelerating.
According to the National Athletic Trainers Association, an ACL injury prevention program should include:
- Warm up
- Quality technique correction (particularly during cutting, landing and sport-specific agility movements)
The Journal of Arthroscopy identified 3 ACL prevention programs that successfully reduced injury when their programs were implemented.
PEPProgram (Prevent Injury, Enhance Performance), developed by the Santa Monica Orthopedic and Sports Medicine Research Foundation
Sportsmetrics, developed by Dr. Frank Noyes at the Cincinnati Sports Medicine Research and Education Foundation
KIPP (Knee Injury Prevention Program)
Other helpful programs:
PEAK Control Program
Preventing injuries is an important goal for all organizations that support sports. However, when you’re moving fast and playing hard, it’s inevitable that some sports injuries will occur. Since an ACL injury tends to be one of the more devastating injuries in sport, it makes sense to develop a training regimen that puts you in the strongest position possible to prevent one in the first place.
Current research tells us that one of the best ways to prevent ACL injury is to pay close attention to each athlete’s biomechanics.
“Of all the many biomechanical variables that can contribute to an ACL injury, landing technique has the most predictive value,” says athletic trainer Kevin Messey, ATC. “At UC San Diego Sports Medicine, I work with athletes of all ages to identify specific errors in landing and athletic movement that contribute to ACL injury. I then use evidence-based techniques to correct those errors and return my athletes to play in a safer condition that ultimately improves their performance.”
Attention to form and detail are crucial for successful implementation of injury prevention. This means an athlete must work on skills that put his/her body in the best possible alignment until the those positions and movements become second nature.
Weight-bearing exercise and strength-training exercise both provide bone-stimulating mechanical stress. Weight-bearing exercise is any activity where you are supporting your body weight through your feet/legs.
According to clinical exercise physiologist, Robyn Stuhr, certain characteristics of exercise are associated with a greater bone response.
- Higher loads or intensities
- Faster speed of force application
- Changes of direction/different loading angles
- Adequate rest intervals
There are many fun activities that contribute to bone strength:
- Jump rope
- Various forms of dance
While sports and dance are great for all of us, they're especially important for adolescents and kids. Research has shown that children and adolescents hold onto the extra bone mass they’ve acquired well beyond the actual intervention. It’s different for adults – if adults don’t use it, they lose it, just like many other aspects of fitness.
So encourage your kids to get off the couch and step away from the computer to play whatever sports or recreational activities they enjoy!
Exercise still has a positive role to play.
Bone-loading activities can help you protect the bone you have or slow the rate of loss.
You don’t have to run for 30-60 minutes to reap the benefits. Animal research has shown that high-intensity intervals done over a short time period are more beneficial to bone than a long period of constant-intensity loading. Bone becomes “de-sensitized” after a certain period and won’t achieve additional benefit.
While swimming and cycling are great for cardiovascular fitness, weight control and muscle endurance, they are NOT weight-bearing forms of exercise. Elite cyclists, like those who ride in the Tour de France, have been shown to actually have
lower bone density than other athletes, which makes them more susceptible to fracture. Their low bone density may be due to the fact that they spend many hours training on the bike (an unloaded environment) and don’t replace the calcium lost in sweat.
If you participate in swimming or cycling, make sure that you balance out your exercise schedule with some “land-based” options and strength-training.
Strength training is terrific for bones and muscles. It’s great for adults who have orthopedic conditions that limit their ability to perform high-intensity weight-bearing exercise.
Since bone’s adaptation to mechanical stress is site-specific, put together a program that involves the entire body. The use of free weights can be a great choice as it requires more balancing and stabilizing around the spine.
Whatever bone-loading activities you choose, remember that something is better than nothing. And if you love it, you’ll do it!
The National Collegiate Athletic Association (NCAA), the College Athletic Trainers Society, and the American College of Sports Medicine (ACSM) have collaborated to develop new athlete safety guidelines in three areas:
- Football practice
- Independent medical care
See complete guidelines on the NCAA website Division I area
Concussions can occur in a variety of athletic situations. To get on top of early identification, monitoring and treatment of sports head injuries, UC San Diego Health Sports Medicine has assembled a multidisciplinary team of experts to provide comprehensive concussion evaluations and treatment.
See our Concussion Clinic.
There is no scientific proof that stretching
before exercise prevents injury during that specific workout. However, stretching in general can increase range of motion, promote smooth and efficient movement and may reduce the risk of injury during exercise, particularly in sports that require extreme flexibility or explosive movements.
There is some evidence that static stretching (long, slow stretching)
immediately before exercise may temporarily decrease the muscle’s ability to generate force or power.
“Dynamic stretching” is appropriate for sports that involve ballistic (bouncing) movements. For example, if you play tennis, jog for 5 to 10 minutes. Then do some hurdle walks, trunk rotations and swing your racquet easily to simulate all your strokes (forehand, backhand, overhead/serve), gradually increasing the arc of movement. Move onto the court and perform your strokes at half speed. Build up to hitting the ball with full speed and intensity. After your match or practice, stretch the muscles you use in tennis (e.g., calves, hamstrings, groin, trunk).
If you experience muscle soreness after a hard workout or competition, stretching doesn’t help get rid of the discomfort any sooner. But it won’t hurt either.
Since sunscreen can wear off, it’s important to reapply every three hours. If you’re an athlete, this might mean reapplying at halftime or between matches. If you’re out surfing or swimming, have sunscreen on hand when you get out of the water. Choose a cream, lotion or gel with at least SPF 30 to receive adequate protection.
You may have heard concerns that using sunscreen will compromise your Vitamin D status, but studies haven’t shown this to be true.
Since the new FDA guidelines were released in 2012, a different labeling system is required for sunscreens. However, most consumers don’t understand that SPF (Sun Protection Factor) ratings only apply to ultraviolet B (UVB) rays which cause sunburn. Ultraviolet A (UVA) rays penetrate the skin more deeply and are associated with skin cancer and aging/wrinkling. To provide protection from UVA rays, a sunscreen must also state that it is “broad spectrum.” There is currently no rating system for the amount of protection from UVA rays other than the overall term “broad spectrum.”
New technology using nanoparticles prevents active sunscreen ingredients from leaving a white residue on your skin, providing more even coverage and better UV protection. Oxybenzone is one of the few ingredients in sunscreens that provides both UVA and UVB protection. It was approved by the FDA in 1978 and there is no evidence showing negative health effects.
In a recent consumer reports review of sunscreens, SPF and broad spectrum product claims weren’t always accurate, and this was particularly true for sunscreens labeled “natural.” To ensure that you’re protected, remember to re-apply every two hours when you’re out in the sun. In addition, a rashguard or even a long sleeve t-shirt provides a physical sun barrier. (However, if the t-shirt gets wet, sun protection is lowered significantly). Specialized clothing manufactured with a certain weave, thread count and/or anti-UV protectants is sold with a UPF rating (Ultraviolet Protection Factor). The UPF number represents a certain level of protection. For example, UPF 40 blocks about 97% of UV rays.
It takes about 15 minutes for the skin to absorb sunscreen and provide protection. So apply at least 15 minutes before you head out into the sun. Most people put on less than half the amount needed for adequate sun protection, so be generous. It’s important to apply sunscreen regularly, even on cloudy days, since we’re still exposed to harmful UV rays.
To avoid eye stinging, try products made specifically for the face or sensitive skin. If you sweat a lot, a headband can absorb sweat and sunscreen instead of letting it roll into your eyes. And while you’re on the sidelines, a broad-brimmed hat will provide extra protection for your skin and neck.
Our active Southern California lifestyles mean lots of sun exposure. Unfortunately unprotected skin looks older faster - with more wrinkles, spots and sagging. Not to mention a greater risk of skin cancer. Sun protection is a MUST. The bottom line? When purchasing a sunscreen look for the following:
- SPF 30 or
higher (SPF 30 blocks 97% of UVB rays)
- Broad Spectrum
- Water resistant
To see how well you’re protecting your skin, take the Suntelligence Survey as part of the Play Sun Smart program developed by the American Academy of Dermatology with Major League Baseball. Go to
“Gone are the days when standing around in a circle and holding a stretch for 15 to 30 seconds (static stretching) is considered warm-up,” says
Alan Shahtaji, DO, team physician for the U.S. Soccer Federation.
“What’s most important is to get your muscles warm and ready for the explosive activity that will be needed in the match. There are a variety of ways to accomplish this and your coach may have a routine for the team to follow.”
This will likely include:
- Some cardiovascular warm-up (running around the field).
- Dynamic stretching and drills, starting at half-speed and working up to full-speed. Even if you’re
not starting the game, it’s important to do a similar warm-up on the sidelines prior to going into the match.
Dr. Shahtaji recommends a warm-up and conditioning program from FIFA (Federation of International Football Associations) that can be found on the following website:
The post-match or post-practice cool-down period is just as important as the warm-up.
"Our strength and conditioning coach has certain players sit in an ice bath for several minutes," says Dr. Shahtaji."This may not be possible, but applying an ice pack to sore or injured areas for 10 to 20 minutes is also helpful. The time to do static stretching is after you are done playing and
before icing. Sometimes the whole team will do this together if it’s practical; it’s a nice way to wind down after the competition.”
Stretch the muscles that you particularly use in soccer (calves, hamstrings, quads, buttocks) or muscles that you know are tight. An evaluation by an athletic trainer can help you assess personal deficits of flexibility and strength to design a personalized program.
Contrary to popular belief, crunches and sit-ups aren’t the best exercises for the core. The best way to train your core muscles is by activating them through a “bracing” maneuver. Bracing involves tightening the muscles in your stomach and low back as if you were preparing to absorb a punch to the abdomen and a shove in the back at the same time.
Here are some examples of core exercises, from basic to advanced:
Plank: Assume a push-up position, but with your forearms on the floor. Keep your body perfectly straight by performing abdominal bracing. Hold 30 secs. A side plank can be performed to improve hip stability.
Bridging with a stability ball: Lie on your back with your knees bent and both feet on the stability ball. Perform abdominal bracing, contract your glutes and lift your hips off the floor.
Cable diagonal pattern: Using a cable machine or resistance band, perform a diagonal motion across the body from high-to-low or low-to-high. As you move, keep your ab and back muscles contracted and strong.
Lunge twist: Perform abdominal bracing. Then step forward into a lunge position while turning your torso toward the side of your rear leg. Return to the start position. Hold a medicine ball in front of your chest for a greater challenge.
Remember that the most important part of these exercises is what you cannot see: contracting your core muscles to provide a stable axis for movement. Whenever you move your arms or legs away from the body, bear down to stay strong in your body’s center.
A physical therapist or trainer can teach you how to engage and strengthen these muscles through progressively challenging exercises.
For many beach-goers, summertime means shredding waves. More than 17 million Americans are active surfers, including 1 million in California alone. The benefits for the body and mind are unquestionable, yet there are inherent risks associated with the sport.
“The most common injuries are bruises and cuts often caused by contact with the surfer’s own board,” says
Ken Taylor, MD, medical director for the International Surfing Association. Surfers are also at increased risk for sunburns and developing skin cancer.
Dr. Taylor recommends the following safety precautions:
- Protective eye-wear
- Rubber guards for the board's fins and nose
- Using sunscreen with both UVA and UVB protection (at least SPF 30) and reapplying as needed
- Wearing protective clothing such as rash guards or wetsuits and limiting sun exposure
between 10 a.m. and 4 p.m.
- Making sure weather and water conditions are safe
(ask a lifeguard about rip currents, stingrays and other hazards prior to paddling out)
"The use of a surfboard leash for protection is recommended but occasionally this strategy can backfire," says
Dr. Taylor. "Leashes keep the board near the surfer providing a flotation device in case of an accident. They also reduce the number of accidents caused by runaway boards hitting other surfers. Leashes, however, make it more likely for a loose board to recoil back at the surfer and cause serious injuries, such as eye damage. It’s important to always stay focused, and protect your head with your arms every time when surfacing from a wipe-out.”
Dr. Taylor, who provides medical coverage at the World Surfing Games held in exotic locations such as Tahiti, Portugal and Costa Rica says shark attacks are extremely rare. “Stingray injuries, while extremely painful are much more common and in most cases can be initially treated with hot water to inactivate the nerve toxin. Shuffling the feet while walking through shallow water can prevent stings, because bottom-dwelling fish scatter when they are alerted to human presence.”