LIGAMENT DAMAGE PREVENTION

Children’s Knee Clinic has developed the ASK warm up protocol to introduce a clear direction for teachers, parents and sports coaches to help our young people avoid injury. ASK stands for, Activation, Strength & Kinetics. If you don’t know the best way to warm up then ASK!

The combination of exercises in the ASK protocol will play a significant role in reducing the number of non-traumatic knee ligament injuries in the young. The protocol is based on the FIFA 11+ and AIS netball warm up programmes, both of which have reported improvements of up to 40% reduction in the incidence of these injuries occurring following their implementation.

Seeing children running about a sports pitch, or enjoying ski school is a great sight, and one we all actively encourage, both as parents, teachers or one of the army of volunteer coaches. However, the number of knee ligament injuries in children is accelerating at a rapid level, with some predictions suggesting the year on year increase to be as high as 147.8%.

This rapid increase in injury levels could have long term consequences on children’s future activity levels.

There are a number of factors proposed as responsible for this increase. Our children in the UK are incredibly active, with 88% of 5-15 year olds taking part in sport at least once a month. However, it is the increasingly competitive nature of school and local sports teams and the enthusiasm post 2012 for growing the next generation of Olympic medal winners, which could be having an impact on children’s bodies and leading to injury.

Other factors include: an increasing role of strength and conditioning in youth sport; all-year round pitch availability; improvements in footwear technology and increasingly accurate diagnosis. As children play faster and more skilfully change direction more frequently resulting in more stress being placed through the knee more often.

As well as children playing more sport and competing at a younger age, better detection via MRI scans and greater patient awareness have meant that more children and young people are being diagnosed with ligament damage, hence greater numbers being referred on to knee specialists.

Whilst several sports bodies around the world have introduced simple injury prevention exercises to try and mitigate this problem, here in the UK we are behind the curve and need to do more. A greater understanding of the impact on their knees of specific activities and the application of simple warm up exercises could make a real difference.

There are some great of examples of how specific warm up exercises and activities can protect children from sustaining ACL injuries.

Work in Norway and Australia over the past few years have demonstrated significant findings when assessing the role of specialist warm up programme in cutting the occurrence of non-traumatic ligament injury during pivoting sports.

Professor Lars Engebretsen, a consultant orthopaedic surgeon in Norway, identified the value of pre-exercise warm up to reducing the incidence of ACL injury in young people through programmes implemented with the Norwegian national handball team. Subsequent research concluded that injury can be reduced by up to 50%. The research found that that pre-sport exercise programmes need to include a combination of balance/co-ordination, strength, plyometric and technique exercises. These ideas have subsequently been included in schools across the country. Children can quickly learn how to avoid the movements that are associated with an ACL tear.

In response to the growth in ACL injuries, Netball Australia has developed ‘The KNEE Program’, which is an on court warm up programme, which has a target of reducing ACL injuries by 40-70%. It has been designed to educate athletes, coaches and support staff of the benefits of warming up and provides a different set of exercises for junior players.

The International Federation of Association Football (FIFA), have introduced FIFA 11+, a simple, and easy to implement, sports injury prevention programme, which consists of 10 warm up exercises. A study reviewing the impact of implementing the programme, found that there was a 30-70% decrease in the incidence of injuries amongst amateur teams which had used the exercises.

Take advice from knee specialists, both surgeons and physiotherapists when you come into contact with them. They can give you expert advice and point you in the right direction.