ACL Injuries: From Injury to Recovery

Soccer Players

From professional football players to high school soccer players to recreational runners, anterior cruciate ligament (ACL) injuries can be devastating. However, with timely diagnosis, proper treatment, and the knowledge to lessen the chance of further injury, an athlete can get back to their game safely and successfully.

The ACL is the primary restraint that limits how far the tibia (shin bone) slides forward in relation to the femur (thigh bone). When the ACL tears and that restraint disappears, the knee becomes unstable and may unpredictably buckle or give way. The ACL may tear suddenly and without warning when an individual decelerates, cuts to the side, or lands awkwardly. Symptoms of a torn ACL include an audible “pop” at the moment of injury and the slippage of the knee out of its joint, accompanied by severe swelling and painful movement.

The best time to diagnose an acute ACL tear is within the first hour after injury, before the knee swells, but this is not always possible. The initial evaluation includes a complete history of the injury — how it happened, whether the knee was hyperextended, or other aspects of the “mechanism” of injury, such as whether the individual heard a pop, where and how badly the knee hurts, and whether the knee feels unstable — as well as details of previous knee injuries.

Once a thorough history is obtained, the physician performs a physical exam of the knee to assess the stability of the ligaments. Using specific tests, the physician can diagnose ACL injuries by applying force to the knee and feeling for abnormal motion. Additional studies, such as x-rays and an MRI, can be very helpful to give an accurate picture of the extent of the injury.

Acute Sports Injury Clinic

Now through Saturday, Nov. 7, UPMC Center for Sports Medicine offers a free Sports Injury Clinic each Saturday morning beginning at 7:45 a.m. To attend, parents or athletes should call the hotline at 412-432-3775 before 11 p.m. the Friday before you plan to attend. Visit our calendar of events for more information.

Treatment may be nonsurgical or surgical, depending on the patient’s desired lifestyle. The question is not so much the patient’s level of activity in the past, but the expectations for the future. If a patient’s goal is to continue an active lifestyle, surgery may be the treatment of choice because a torn ACL does not heal. Nonsurgical therapy consists of a period of protective bracing with progressive return to range of motion and muscle-strengthening exercises. The goal is to create natural stability for the knee by developing the quadriceps and hamstring muscles.

The physicians and clinical staff at UPMC Sports Medicine have a comprehensive approach to diagnosing and treating ACL injuries. Our board-certified physicians and specialty trained physical therapists, sports performance coaches, and certified athletic trainers can develop a plan focused on treatment and prevention of recurring injuries to get athletes back to their sport safely.

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ACL Prevention Program Goes Beyond the Treatment of Injuries

The experts at UPMC Sports Medicine aren’t just focused on treating injuries — they are focused on preventing them, too. Understanding the importance of injury prevention, UPMC Sports Medicine created an ACL injury prevention program to help athletes prevent injuries and simultaneously improve performance. By having the athlete undergo a comprehensive screening, our experts can determine any deficits that may predispose the athlete to injury and determine how the athlete can best promote athletic performance at its highest level.

The basis of this program follows the physical laws of nature and the principles of functional training. The majority of our exercises focus on the mechanics of movement and how things such as gravity, ground-force reaction, mass, and momentum can affect movement of the whole knee.

“Simply stated, the program is ground based, using no machines,” says Ron DeAngelo, director of the UPMC Sports Performance program. “Our experts train the athlete’s movement patterns to help the athlete become strong and powerful in every movement pattern necessary for their particular sport. Consequently, every muscle group must be involved in the exercise, doing its job, to help protect the athlete and promote optimal performance.”

The program is progressive, teaching proper vertical and horizontal landing, jumping mechanics, running mechanics, cutting mechanics, and proprioceptive exercises with a focus on developing adequate strength and power needed for the sport. This program also meets the needs of those athletes who have torn their ACL, gone through at least four months of rehabilitation, and still have not reached the level of performance experienced prior to their injury.

UPMC Sports Performance offers the ACL injury prevention program at both their south and north locations or can implement the program at the athlete’s choice of sites. Costs for assessment and on-going training sessions vary by location. For more information, contact UPMC Sports Medicine at 412-432-3700.

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Concussion in Sport: Awareness is Key

By Jamie Pardini, PhD, Sports Concussion

Concussion in Sport: Awareness is Key

For almost nine years, the UPMC Sports Medicine Concussion Program has been evaluating and managing concussions for athletes and non-athletes alike. Knowledge about concussion has grown. However, there are still many misconceptions and questions about concussions.

What is a Concussion?

A concussion typically occurs when there is trauma to the head. With concussion, there is no structural damage to the brain, like a bleed or swelling, rather the injury causes dysfunction in brain neurometabolism. Concussion may or may not involve a mental status change such as amnesia, loss of consciousness, confusion, or feeling “stunned,” and is characterized by the presence of one or more of the following symptoms: headache, nausea, dizziness, balance problems, visual disturbances, emotional changes, thinking changes, and sleep problems.

What should you do if someone has sustained a concussion?

  1. Consult a medical professional immediately. Most athletic events have medical personnel on-site to assist during a medical emergency. Once the initial evaluation rules out other trauma and indicates concussion, seek evaluation at the UPMC Sports Medicine’s concussion program, or with your primary care provider. An injured athlete should call an emergency service provider or go immediately to an emergency department if there has been a loss of consciousness, vomiting, abnormal on-site neurological evaluation, or gross changes in balance or speech.

    UPMC Sports Medicine’s concussion program will perform an evaluation to provide information on the overall severity of concussion symptoms and concussion-related cognitive problems, such as memory, attention, thinking, or speed. The evaluation can be used to make appropriate recommendations regarding school and sports participation, activity levels, and other potential referrals.
  2. Remember that rest is important in concussion recovery. In the typical course of recovery from a concussion, complete physical rest is recommended until the athlete becomes symptom-free. Once symptoms subside, the athlete begins a gradual progression through increasing levels of non-contact, non-risk physical exertion. Although procedures for this graded return to exertion vary among professionals, light aerobic exercise followed by moderate levels of activity and heavy levels of non-contact activity are common. The athlete must remain symptom-free at each step prior to beginning the next level of exertion.

    Concussion results in a wide variety of physical symptoms, such as headache, sleep disturbance, and dizziness. This brain injury also produces deficits in short-term memory and learning, attention, concentration, and multitasking. Based on the severity of concussion symptoms, the overall level of impairment may make full day school attendance impossible or ill advised. Schoolwork and the school environment can worsen symptoms, so the extent of a child’s school participation must be carefully weighed. Accommodations may be made to help control symptoms and maximize the concussed student’s participation in school. Basic accommodations for mild concussion include notifying teachers of the injury, removal from gym class and other school-based physical activities, taking breaks to control symptoms, extra time on tests, and allowing students to turn in assignments late if symptoms are severe.

For more information on concussion and the UPMC Sports Medicine’s Concussion Program, visit the concussion program on-line or call 412-432-3600.

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Returning to Physical Activity after a Concussion

By Sean Learish, MPT, coordinator, Concussion Services

While many advances have been made in diagnosing and treating concussions, questions remain as to when and how an athlete should return to physical activity after a concussion.

Most sports-related concussions are evaluated and effectively managed by team trainers and physicians. Locally, we are fortunate to have many schools that participate with neurocognitive testing, allowing for good management and informed decisions regarding return to sport. However, many athletes have symptoms and deficits that linger for extended periods of time, often beyond a sports season, which cannot always be closely followed and managed. In instances of non-sports related concussion (such as bicycle or car accidents, or falls) it is still important to follow up with concussion experts, such as those at UPMC Sports Medicine. Regardless of the cause of injury, post-concussion symptoms can linger. A structured rehabilitation process often promotes a quicker recovery time.

The doctors and physical therapists at UPMC Sports Medicine Concussion Program have established a formal rehabilitation program focused on the safe management and return to physical exertion after a concussion. The concussion rehabilitation program involves a comprehensive physical evaluation of balance, vestibular, and exertion, with treatment emphasizing close symptom monitoring and gradual progression of physical activities. This program is appropriate for any individual suffering from post-concussion symptoms and who has questions regarding their return to physical activity. Proper medical evaluation is recommended, including neurocognitive testing, prior to initiation of any physical exertion when symptoms persist.

The concussion rehabilitation program involves a graded progression from low-intensity activities through more dynamic and aggressive exertion activities in three or five stages dependent on the individual’s goal — whether it is sports or non-sports related. The initial stages focus on a variety of cardiovascular, strength and conditioning, and dynamic balance activities that are necessary for typical recreational activity and exercise. The later stages are intended for athletes preparing for a return to competitive sports. Throughout the program, priority is placed on the monitoring and facilitating of healing in conjunction with medical reexaminations to ensure a safe return to physical exertion and sport activity.

Originating at the UPMC Center for Sports Medicine and Jordan Center for Balance Disorders at the UPMC Eye and Ear Institute, the concussion rehabilitation program is now available at multiple Centers for Rehab Services locations around the greater Pittsburgh area. For more information, contact the concussion rehabilitation program at 412-432-3600.

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In Pursuit of Excellence: Goal Setting

By Aimee C. Kimball, PhD, director, Mental Training

In Pursuit of Excellence: Goal Setting

Every athlete has a goal. Whether it’s to win races, achieve a personal best, or simply make it through a grueling practice, goals undoubtedly exert influence on our performance. However, there’s more to goal setting than just stating what you ultimately want to achieve. To get the motivational support and performance boost that goals can provide, athletes must set goals systematically and have various types of goals. By following six specific steps, you can set goals to improve your performance, satisfaction, and quality of practice. While this article is geared to your sport-related goals, the same steps can be used to set goals for all areas of your life.

Step 1: Know where you are headed

What do you want to be doing one year, or even five years from now? At the end of this season, what do you want to have achieved? Long-term goals are important to write down because they give you something to which you must commit. It also is important to identify why you want to achieve these goals. Reexamine your end-of-season goal weekly. It is okay if you need to adjust it, but make sure you keep your season goal in mind as you practice so you are aware that what you do today connects to what you want to achieve in the future.

Step 2: Know how to get there

Having a path towards your long-term goals is extremely important. Make sure you always have a short-term, specific goal you are working on. Each day ask yourself, “What can I do today to get myself one step closer to where I want to be?” Whether it’s a technique goal, a mental goal, or a nutritional goal, keep focused on your daily and weekly objectives so you can give yourself the best chance to reach your ultimate goals.

Step 3: Identify milestones of success

Having intermediate markers of success can help enhance motivation, such as setting a personal record, qualifying for a specific event, or mastering a fundamental skill. These milestones provide set standards to monitor your progression along your goal path. They give you confidence, encouragement, and enhance your commitment.

Step 4: Identify obstacles

It’s important to look at your long-term and short-term goals and identify obstacles that may prevent you from reaching them. Injury, strength of the competition, and burnout are some of the obstacles you may face. If you list an obstacle you can’t control, cross it off your list. If it is something you can control, plan to deal with it when it comes up. Make sure obstacles do not become excuses. Identifying and prepare to overcome them.

Step 5: Create a system

Everyone sets goals differently. Some set daily goals. Others focus on what they want to accomplish on a monthly basis. Create a system that you can stick to that allows you to set specific and challenging goals, measure progress, gain motivation and encouragement, and focus on these goals every practice.

Step 6: Set different types of goals

One of the biggest mistakes athletes make is setting outcome-oriented goals. These goals are important, but are often out of your control. Therefore, it is essential to set process and performance goals as well. Ultimately, you want to focus on your process goals since the more fundamentals you master, the more likely you are to reach your performance goals. When you reach your performance goals, you give yourself a better chance of achieving your outcome goals. By focusing on the process and what you control, you are trusting that the way you perform will lead to the outcome you want.

Regardless of age, goals are vital in providing direction, creating motivation, and enhancing commitment. Goals provide guidance so that you can stretch your abilities as far as possible. Few people achieve every goal they set. The progress you make towards these goals and the effort you exert in pursuing them determines your success. If every day you get a little bit closer to where you want to be, consider that a successful day.

Whether you are looking for help in setting and achieving goals, preparing to return to activity after injury, or delivering consistent athletic performances, the UPMC Sports Performance Mental Training Program can help. Find out more online or call
412-432-3777 for more information.

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Calendar of Events

March 7
Sixth annual AT River Run 5K and 1 mile challenge

March 20 to March 21
UPMC Sports Medicine presents the All Sports Expo and Conference at Heinz Field

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