Research Supports ACL Tear Prevention Programs Beginning at Age 11 for Girls

ACLTear

A recent study: Anterior cruciate ligament laxity and strength of quadriceps, hamstrings, and hip abductors in young pre-pubescent female soccer players over time: a three-year prospective longitudinal pilot study.

…whoo, long title… as I was saying, a recent study was published in Orthopedic Physical Therapy Practice that clearly demonstrates the timeframe and magnitude to which the strength balance of young females’ bodies begins to become unbalanced.

Here’s the abstract:

Purpose: This was a longitudinal study to determine the effects of maturation on anterior cruciate ligament (ACL) laxity and muscle strength in pre-pubescent female soccer players. Methods: ACL laxity and quadriceps, hamstrings, and abductors strength were measured annually from 2006 through 2008 in 22 pre-pubescent female soccer players, ages 7-12yrs. Results: ACL laxity increased 2.2 mm (p < 0.0002) in 2007 and 1.7 mm (p < 0.005) in 2008. Quadriceps strength increased 1.9 kg (p < 0.01) in 2007 and 2.1 kg (p < 0.009) in 2008. No significant change was noted in the hamstrings. Abductor strength decreased 3.0 kg (p < 0.0001) in 2007 and 2.3 kg (p < 0.0001) in 2008. Quadriceps to hamstring (Q/H) ratio decreased 0.4 kg (p < 0.02) in 2008. Conclusion: ACL laxity increased with age in pre-pubescent girls. The high Q/H ratio, and decreased abductor muscle strength, indicates an increased risk of ACL injury. Significant changes at age 11.5 occur both in ACL laxity and muscle strength, just one year prior to average age of menses. Girls may be approaching puberty with preexisting muscle weakness and imbalance that may expose them to ACL injury.

The critical pieces to pull from the abstract refer to the combined effects of a high strength ratio between the quadriceps and hamstrings (ideally, you want them to be well balanced and fairly even), the decreasing strength of the abductors (they keep the knee from "caving"), and ever increasing strength of the quadriceps.

It’s worth noting that this study was conducted on girls who are athletes, female soccer players to be exact. So, the increase in ACL laxity was not due to inactivity.

I think it is fantastic that the exact age – 11.5 years – has been pinpointed as the most significant time when this shift towards imbalance is occurring.

What should you do? Well, if you have a daughter, I’d suggest getting her started in a program that has a strong (and highly successful) ACL tear prevention protocol. Training to prevent ACL tears is serious business and, in the long run, it will cost a lot less to PREVENT a tear that to surgically repair and rehab a tear.

Get Started Today!

ACL Form

A Tip on Programming

If you truly want to become stronger it’s very important that you take careful consideration when planning your training program.  One of the biggest factors that comes into play when doing this is understanding your strengths and weaknesses.  Unfortunately when this task is undertaken solo the former rather than the latter becomes the focus of the program. Usually what happens when you write your own training program is that unbeknownst to you, you have programmed everything your good at and absolutely nothing you’re bad at.  Congratulations, you’re going to spend the next 12 weeks not getting any stronger!  So the question becomes, how do we avoid wasting 12 weeks of our life?  Simple, DON’T do your own programming. The best thing to do is to sit down with someone who is qualified and experienced when it comes to programming (do not ask your training partner, chances are they probably have the same problems you have and are just as biased).  Talk to them about your goals, strengths, and problem areas. Based on the information you give them and the programming knowledge they have, they will write you a program that you will absolutely hate!  Why will you hate it?  Because, it’s going to be filled with a bunch of stuff you’re not good at and honestly who wants to work 4-5 days a week on things they are terrible at?  Nobody! But, I promise that you WILL come out 12 weeks later a STRONGER person than when you went in.  Trust me I’m just as guilty of this as anyone else;I would much rather feel like Wolverine in the weight room instead of Howard the Duck.

Don’t believe me?  I’ll show you.  Below you will find two training days from two different programs.  The first was written for me by current strength coach, powerlifter, and friend Gabe Naspinski.  The basis of which can be found by reading Gabe’s article for EliteFTS.  The second is a day that I wrote for myself a while ago.

Gabe’s			Mine
A1)	Conventional DL from Deficit	9X2/60%	A1)	DE Sumo DL with Chains	8X3 50%+50lbs of Chains
B1)	SSB Low Box Squat w/ pause	4X6	B1)	Low Box Squat	4X8
B2)	Pullups throughout session	40 total	C1)	Barbell Rollouts	3XAMAP
C1)	Band Pull Throughs	3x15	C2)	Reverse Hyper	4X10
C2)	Static/Dynamic Ab Movement of my choice

I know they don’t seem completely different but let me explain why the day Gabe planned is better for me than the one that I programmed.  First let me give you a little background on myself.  I have been pulling sumo for the last two years because I’m better at it and that’s how I compete.  I am terrible off the floor when deadlifting but pretty good when it comes to locking out at the top.  I am also weak out of the hole of  my squat but again, pretty good at locking them out.  Lastly, I have weak glutes, hamstrings and upper back.  Just with that little bit of information it’s easy to see why Gabe’s training day is superior to the one I programmed.

Let’s look at A1; he has me pulling conventional AND from a deficit (this guy has it out for me).  This allows me to work on almost all of my weaknesses.  Pulling  conventional and from a deficit will allow me to get better out of the bottom due to the increased range of motion and it will work on my hamstring and glute weakness as well as my upper back.  Now is what I programmed bad?  No, but it’s not exposing nor is it helping me work on my weaknesses nearly as much as what Gabe gave me.

We’ll end with talking about the B series.  With this series we have two squat variations, again nothing to different.  The main difference is the type of barbell used and the utilization of the pause.  He has me using a SSB (safety squat bar) which positions the bar higher on my back causing a greater emphasis on back strength as opposed to a straight bar, thus allowing me to work on my upper back weakness.  Again, I’m weak out of the bottom of my squat and my glute strength is sorely lacking so naturally we are going to incorporate a low box, which Gabe and I both did.  There is one glaring difference though between his and mine….the dreaded PAUSE in the bottom.  Now the pause I’m using is only a second long but that one second pause is a dagger (I’m not joking, go try it).  This pause is going to allow me to get stronger out of the bottom while also putting much more emphasis on my glutes.  Lastly in the B series, you’ll notice the 40 pullups throughout session that are in Gabe’s program and not in mine.  Remember that whole weak upper back thing? Interestingly enough Gabe decided to give me upper back work EVERYDAY of my program (I told you this guy has it out for me).  But again, my back weakness has been my downfall and he’s making me face it every day forcing me to get stronger.

As I said at the beginning, it’s important for everyone to know their strengths and weaknesses (especially their weaknesses).  One weakness that we all share when it comes to training is thinking that we are unbiased when it comes to writing our own program.  You might work on SOME of your problem areas if you write your own program but I guarantee it’s not going to be the same as someone else writing it.  Don’t spend weeks on end not getting any better, it’s a waste.

Remember, friends don’t let friends write their own programs.

SAPT Exercise of the Week: Zelda Plate Carry

I realize that many of our readers don't have access to special equipment such as prowlers, ropes, farmer walk implements, etc. so I've been doing my best to be cognizant this fact during these little "Exercise of the Week" bits. For example, while an alligator crawl with a prowler attached to you is certainly challenging, looks awesome, and will make your abdominals rip into two pieces....

it's most likely NOT the most practical option the majority of you due to equipment limitations.

This being the case, I hope you find many of the ones I do feature on here requiring minimal equipment (things like turtle rolls, bodysaw pushups, stir the pot alphabets, goblet squat to stepback lunges, etc.) useful for your individual scenarios.

Anyway, on to this week's featured movement:

Zelda Plate Carry

Why is it called the Zelda Plate Carry: If you don't know the answer to this, shame on you. Whenever Link (hero in the The Legend of Zelda series) picks something up, he holds it over his head and walks with it in a similar manner to the demonstration video. I suppose, technically speaking, this should be called the "Link Plate Carry," but more people are familiar with the name Zelda so I went with that one.

Giving full disclosure, this entire blog post may or may not be an excuse for me to somehow include my love for all things Zelda into a strength and conditioning website. I mean, come on, if you had played through Ocarina of Time six times in your youth, and eventually beat the game in under 24-hours in one sitting, wouldn't you want to find a way to incorporate it into your lifting routines?

Not that I did that, or anything, but just hypothetically speaking.

........

Okay, I might have totally done that. I'm not judging you though, okay?

Why I like it: See above. It resembles how Link carries heavy stuff around. Okay, just kidding (but not really). I like it because:

1. You can do it in virtually any gym. Heck, even if you live in the middle of nowhere you can perform it. Just pick up something heavy (a rock, backpack, whatever) and go with it. 2. It hammers scapular stability and shoulder mobility, along with providing a slight "cardiovascular" training effect. 3. You're practically forced to hold the plate in a neutral grip, which tends to be more "shoulder friendly" as it opens up the subacromial space within the glenoid.

How to do it: "Pack" the shoulder down and back, and don't allow your arms to drift forward or backward (think "keep them next to your ears) and keep the elbows locked. I also like to use this cue from Kelsey for overhead carries: "Think about shoving your shoulder down while simultaneously pressing your hand up through the weight. Like you’re trying to lengthen your arm." Brace your entire midsection, making a cognizant effort not to hyperextend ("over arch") your low back as you hold the plate overhead.

I would go for time ( beginning with :60-:90), or for a total number of steps (ex. 100 steps), and toss this in at the end of a workout for 3-4 rounds. You can increase the difficulty by adding the amount of time or steps you need to complete before setting the weight down. It's a great variation to toss in alongside other farmer walk exercises (dumbbells held at the side, in the goblet position, etc.), or in the middle of a conditioning circuit. You're only limited by your imagination in its application.

Breaking in a New Bench Shirt

This post is definitely a departure from SAPTstrength's usual fare (and essentially the antithesis to Stevo's Monday post). Not only are we diving headfirst into powerlifting preparation, but I'm talking about GEARED powerlifting! For the uninitiated, geared powerlifting involves using very snug fitting "shirts" and "suits" (think the tightest compression shorts or shirts you can possibly imagine and multiply that by 100) to aide in the power lifts: squat, bench, and deadlift.

So, what's the point of these aides? You can move more weight. Plain and simple. There is a huge cool-factor involved (read: ego-factor).

Up until this past summer, I had ONLY competed in geared events and I freaking loved it!

It is worth noting - and this cannot be UNDERstated - the training for geared powerlifting varies significantly from raw powerlifting. As you'll see in Sean's videos below, he has to work to simply get the bar down to his chest. He is literally having to PULL the bar down - hence why back work becomes so critical for the geared bencher. This can be very tough to imagine for someone who has never experienced a shirted bench.

Anyhow, my point here is not to convince you to be pro-gear. What I'd like to do is simply show an excellent progression to help learn the "groove" in a new bench shirt:

Sean starts his first set by touching a 3-board, the next set is to a 2-board, and the third set he is just able to touch his chest. This is a very intelligent way to learn to handle a new shirt. Some people get in them and simply pile on more and more weight until it finally touches their chest. Unfortunately, during this process they may never learn solid, safe, and effective form.

It is worth noting how well Sean is able to stay under control - you see very little, if any, breakdown in form: elbows stays tucked, chest stays up, and he is clearly actively pulling the bar down.

By the way, if you want to go to the true experts in powerlifting, you need to make your way over to EliteFTS.com and check out their training logs, the Q&A, and articles.

Ahhhh - Technical Trouble!

Sorry everyone, I'm having some technical trouble right now and can't get my video uploaded. Hang tight and I'll get it up later.

Max Effort Planks

I decided to continue the “core” training theme that Stevo started yesterday.  Oh and by the way I strongly dislike the word “core” because it’s such a huge buzzword but everyone knows what it means so I guess I have to use it.  Anyways, I’m going to get straight to the point with this and not bore you with all the science that goes behind why core training is so good for you. One of the best ways to train your core are planks.  Planks are the greatest thing since sliced bread because you can come up with a million different variations and depending on how hard you brace they will always be hard.  However, in the recent past with my personal programming and for the more experienced athletes that I program for I had been staying away from any real direct core work.  Why you ask?  I honestly questioned its effectiveness.  Keep in mind that I’m talking about VERY experienced lifters, not people with a young training age.  I believe people who are beginners to intermediate should be resisting extension and rotation all day every day.  In fact I think recess in elementary school should consist solely of planking and banded Pallof Presses (I’m joking but that would be wild to see).   I just didn’t know if it was that effective for our more seasoned athletes and for myself because of the already insane amount of core work that occurs during the other exercises they do, especially during squatting and deadlifting.  In my mind I kind of saw it as overkill (I feel like I’m going to get hate mail for saying all of this).  But alas I always have our athletes’ best interests at heart and started to think about how I could start implementing core work back into the programs but do it in a way that would give maximum benefits.  Enter the Max Effort Plank.  This is by far my new favorite exercise both for me and our upper level athletes.  There is really not much to it.  It’s simply a perfect plank performed for 10-20 seconds with as much weight as you can do while keeping the form in check.

Who Should Do It:  Please keep in mind that this should only be done if you are of a high training age.  The main criterion for being able to do a max effort plank is being able to hold a perfect bodyweight plank for at least a minute without ANY degradation in form.  This means chin tucked and neutral spine (posterior pelvic tilt, non-kyphotic t-spine).  You can use a dowel rod and make sure your entire spine is keeping in contact with it to maintain honesty. Shaking is not a concern of mine; if your bracing hard enough you should probably be shaking.

The Benefits:  Simply put, it’s going to make your stronger, and it makes you feel like Zeus.  You can pile on the weight for only a short period of time allowing you to brace hard as if you were getting ready to pull or squat heavy.  I feel it’s a little more strength specific rather than endurance specific like when doing 3 sets of 45 second perfect planks.  The short duration and heavy load allows for a much more strength oriented core exercise and since implementing this exercise my deadlift, squat, and bench have felt a whole lot better.  I feel so much stronger even just unracking the weight in my squat and bench and in the set-up of my deadlift plus the athletes I’ve given the exercise to have echoed the same feeling.

How To Implement It:  I usually program direct core exercises on lower body days so it’s usually two days a week.  I pick one of those days to be a “max effort day” and the other to be a “supplemental day”.  This allows me the best of both worlds; I get a core day just for overall strength as well as a more endurance oriented day for overall health purposes (I feel both are equally as important).  The heavy planks occur as 3 sets of 10-20 seconds waiving down from start to finish of a training block (meaning week 1 at 3X:20, week 2 at 3X:15, week 3 at 3X:10).  On the supplemental day is when I program my more endurance focused core movements.  Usually 3 sets of 30+ seconds of side planks or maybe 3X8-10 of banded Pallof presses with a 5 second hold.  I’ll also throw in a dynamic core movement such as a reverse crunch for 3XAMRAP or a barbell rollout for 3XAMRAP.

Again, please observe some caution when doing this.  Like I said I tend to only give this to people with a little more experience.  If you are programming this for yourself or for kids/adults with a young training age I encourage you to stick with a lot of bodyweight core exercises for longer durations.  This will ensure proper form and a proper progression.

May everyone’s days be filled with the resisting of rotation and extension.