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Injury prevention strategy helps cut ACL tear rates 50% and reduces injury risk
Norwegian multidisciplinary approach shifts emphasis away from treating injuries.
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FLORENCE — Researchers at the Oslo Sports Trauma Research Center reported good results with their sports injury prevention trials after stepping up efforts in this area using a multidisciplinary approach.
A study of young handball players demonstrated the efficacy of warm-up drills and hamstring strengthening.“A simple warm-up program could reduce acute injuries in the 16- to 17-year-old population by 50%,” Roald Bahr, MD, PhD, said.
The goal of the strategy is to reduce the number injuries, particularly those of the ACL, occurring during such popular Norwegian sports as team handball, soccer and alpine skiing.
Bahr, the center’s co-chairman, reported on the prevention methods at the 2007 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, here.
The strategy he discussed included analysis of the consequences of sports injuries, pathophysiology, risk factors and injury mechanisms, coupled with long-term surveillance systems.
“I think we have found that ray of hope that many sports injuries can be prevented,” said Bahr, who is optimistic about the program’s impact on injury prevention and research locally and worldwide.
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Positive impact
According to Robert J. Johnson, MD, who moderated Bahr’s lecture, “I don’t think this will put us out of business completely, but it’s going to modify things in a very positive way.”
The center’s multidisciplinary approach is based on the following principles:
- estimating the magnitude of the problem;
- identifying causes of injury;
- introducing preventive measures; and
- testing the intervention.
To carry out these steps, Bahr and co-chairman Lars Engebretsen, MD, expanded the center’s staff to include epidemiologists, sports-specific specialists, biomechanics experts and health psychologists. The team looked closely at biomechanical causes of injuries, including different footwear and playing surfaces, warm-ups and neuromuscular status.
“Causation in sports injuries is also multifactorial, and we need to understand the causes before we can formulate a hypothesis for injury prevention,” Bahr explained.
Effective outcomes
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Once the investigators agreed on the hypotheses, two doctoral students conducted studies that introduced preventive measures and tested them. According to results of those studies, the new interventions had a major impact on outcomes.
One trial focusing on ACL injuries sustained by team handball players was preceded by visual inspection studies analyzing a player’s hip and knee kinematics at the time of injury.
For the study, players followed a 5-week training program involving balance training exercises with gradually increasing difficulty.
About half the athletes did not complete the program. They had a 17 times higher risk of injury, according to Bahr. “This is evidence of the impaction on risk,” he said.
Hamstring strengthening
A separate randomized controlled trial involved two groups of about 2,000 young handball players and control athletes each. Players who participated in a specific warm-up program, drills and hamstring strengthening exercises halved their acute injury rate. The control group sustained 10 ACL injuries vs. three in the interventional group.
“So, the program not only strengthens the lower extremity in general, but the ACL specifically,” Bahr said.
Sports trainers and coaches need to implement effective programs like these, he added.
“We should be thinking of ways to create programs that are fun [and] challenging, something athletes will like to do and enjoy doing in all sports,” Bahr said.
For more information:References:
- Roald Bahr, MD, PhD, can be reached at the Department of Sports Medicine & Oslo Sports Training Research Center, Norwegian School of Sports Science, P.O. Box 4014 Ullevål Stadion, Oslo 0806, Norway; e-mail: roald.bahr@nih.no. He has no financial conflicts to disclose.
- Robert J. Johnson, MD, can be reached at the University of Vermont Medical School, Department of Orthopaedics, 406A Stafford Building., Burlington, VT 05405, U.S.A.; +1-802-656-2250. He has no financial conflicts to disclose.
- Bahr R. What can prevention do in sports medicine? Highlight lecture #2. Presented at the 2007 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress. May 27-31, 2007. Florence.
- More information on the Oslo Sports Trauma Research Center’s programs can be found at www.ostrc.no.