Knee Injury Prevention with Duke Sports Medicine

Knee Injury Prevention with Duke Sports Medicine


[MUSIC] I’m Jocelyn Wittstein,
I’m an orthopedic surgeon at Duke. I specialize in sports medicine. My background is, I trained in orthopedic
surgery, sports medicine at Duke. I’ve practiced for
several years in Cooperstown, New York. I’ve been a team physician for
two colleges there, including men’s and women’s soccer,
including Division I soccer. I was myself a collegiate
Division I athlete. And I’m a lifelong athlete, but more importantly I’m
the mother of five athletes. I’m very interested in
community education, teaching, injury prevention research, particularly
in regards to ACL injury prevention. Dr. Lassiter is,
also happens to be my husband. He’s also a professor of
orthopedic surgery at Duke, specializing in sports medicine. He’s also been team physician at ECU. He has degrees from Duke, training
in orthopedic surgery, undergrad and MHA at UNC. So he really doesn’t know who to pull for
during football season, he’s. [LAUGH] Melissa Raddatz,
our nurse practitioner is here. She works with us,
she treats adolescents and adults. She’s herself a Division I
college athlete, an elite level marathon runner and
has worked at Columbia HSS, Cornell-Weil, and Memorial Sloan Kettering. Michael Messer, here up front,
is our PT who is basically kind of a delegate of FIFA. He’s affiliated with that organization,
is an expert in injury prevention and education on that subject, including
the FIFA 11 Injury Prevention Program. He’s also the physical therapist working
with the US men’s national team. We have some pictures of him up there. Jenna VonSecca here, we introduced. Duke is a FIFA Center of Excellence. And it you’re wondering what that means,
it means that we provide excellence in care of soccer related injuries,
as well as excellence in research on injury prevention and
treatment of soccer-related injuries. And there are only three of
them in the United States. The others are HSS in New York, and
then there’s another one in Santa Monica, California. So we’re the closest one to you and
we’re also available in Raleigh, Wake Forest, Knightdale,
as well as in Durham. So overall, I’m gonna have Janna start
with some discussion of concussions, and then we’re gonna transition
back to the more orthopedic, musculoskeletal aspect of things,
focusing a bit on ACL injury prevention. And Michael and I are gonna work together
to kind of go through the FIFA 11 Injury Prevention Program, which is a very effective way
to help prevent knee injuries. So I’m gonna kinda let Janna speak to you
guys, and then I will take over again.>>Thank you so much. So Like Dr. Wittstein said,
my name’s Janna Fonseca. I am an athletic trainer by trade,
even though right now I’m working as an administrative manager
for the whole division of sports medicine. But one of my clinical
passions is concussions. So I wanted to take just a few minutes to
talk about what a concussion is, what some common signs and symptoms are to look for,
and then what should be done to treat these injuries, knowing what we know now
in 2018 as it pertains to sports medicine. So, a concussion is
a traumatic brain injury. It falls on the spectrum of being
a mild traumatic brain injury, but it is still a traumatic brain injury. And the working definition that we as
sports medicine professionals use is a complex pathophysiological
process that affects the brain induced by traumatic biomechanical forces. So that could be ball to head,
that could be ball to ground, it also could be a situation
where it’s body to body and the head doesn’t actually strike anything,
but there’s enough force that’s transmitted through the body that
causes the brain to move inside the skull. So it can kind of be one of those
more nontraditional mechanisms. But that can still result in that brain
movement and result in the signs and symptoms. So there’s certain
characteristics that we look for. Like I said it could be
a blow to the head or it could be a blow
somewhere else to the body. Generally though symptoms
show up within a few minutes. They may also develop over
the course of a few hours. You might notice symptoms until
the day following an injury, when to try to stress your body or
when your son or you daughter tries to stress himself or
herself by going to school, or trying to go to do some form of
practice or some form of exercise. So generally,
those symptoms show up relatively quickly. But they eventually resolve over time,
and that’s what makes this, again, a mild brain injury. Generally those clinical signs and
symptoms reflect a functional injury. That being said, or meaning that if you go
to an urgent care or the emergency room if you have some of these signs or
symptoms and a CT scan is ordered, that CT scan very much is going to look normal,
because there’s no structural injury. This injury is a metabolic injury
that occurs at the cellular level, that does not show up on these common
neuroimaging, such as MRI or CT scan. And again, it can be loss of conciousness. It doesn’t have to be
loss of consciousness. Sometimes people used to think that if
you lost consciousness that means you’re concussed, but you can come out of it and
not have any signs and symptoms. Loss of consciousness is not
the only sign that we look for when it comes to recognizing a concussion. So we know it’s a metabolic injury. We know that it does
not show up on CT scan. And we know that these signs and symptoms can kind of present
in four different categories. They can be physical. So things like headache,
dizziness, nausea, vomiting, repeated vomiting, sensitivity to light,
sensitivity to noise. They can be cognitive. So people feeling like they can’t
concentrate, or they can’t focus. They feel like they’re mentally foggy,
or they’re in a fog, or in a daze, or in a haze. They might not be able to
answer questions quickly. They might seem slow to respond. They can also manifest themselves, these
signs or symptoms, in emotional ways. People might be more emotional than usual. They might react to
things inappropriately. They might seem more sad or
more irritable than usual. And then we also know that
concussion can affect sleep. You might have somebody that
sleeps a lot more than usual, or you might have somebody that
doesn’t sleep as much as usual because of those signs and symptoms
that are keeping them from sleeping. So those are very common things that you
can be on the lookout for as a parent or as a coach, especially following any type
of mechanism like I described before. So the main kind of take home points from
this are if you suspect a concussion, it’s best to remove that athlete from play and
do not allow them to return the same day. If they do return while they’re still
symptomatic and they sustain another blow to the head they might sustain what’s
considered second impact syndrome, which is sudden irreversible
brain swelling that can lead to catastrophic results such as
lifetime impairment or even death. So that’s why we’re so careful and
cognizant about intervening appropriately, once we suspect a concussion has occurred. So no same day return to play and
generally we want to see these athletes evaluated by a healthcare professional
with knowledge in concussion management, so to take them through
a full battery of tests. And we’ll be handing out some
informational material and a hotline phone number that you guys can call in
order to have that evaluation take place. Some things that we do look for as far as
when is it appropriate to call 911 versus when is it appropriate to simply kind of
take my child to a healthcare professional or a physician with training and
concussion management. If there is any type of suspected neck
injury where there’s I can’t move my arms. I can’t move my legs. I can’t feel my hands. Obviously that’s a time where
you would want to call 911. If there is significant disorientation,
and your athlete is not able to recognize
you or people that they should know or where they are,
that’s a reason to call 911. And a headache that gets severely
progressively worse over time, again, if they’ve been removed and
my headache, it’s killing me. It’s getting worse and worse and they’re
unable to recognize where they are, those are all reasons that
you would want to call 911. Again, going to a healthcare professional
with training in concussion management Is going to help the athlete return to both
school as well as sports in a safe and timely manner. And we’ve seen a huge shift in making sure the athletes are returned to
the classroom in a safe and timely manner. So making sure that the appropriate
steps and progressions are taken once these injuries occur, really allows
them to be back in the classroom and back on the field in a safe and
timely manner. So that is just my brief
spiel about concussions. Does anybody have any
questions about that now, yes?>>Is there a scale for concussions, or
is it either you have one or you don’t?>>So the question was, is there
a severity scale that defines concussion? And as a health care professional, we
actually don’t really grade them anymore now until that concussion is resolved,
because one of the things that we use to define how severe the injury is, is how
long it takes that person to get better. So it’s very difficult to give
it a classification early on in the injury process. So generally it’s yes,
you’re concussed or no, you’re not. But one thing that we are learning a
little bit more is there’s different kind of subtypes of concussions. This is kind of research coming out of the
University of Pittsburgh Medical Center, where yes, you’re concussed but
you might be demonstrating signs and symptoms that are more consistent with
a cognitive fatigue type of concussion. Versus a post traumatic migraine, versus
a vestibuloocular type of concussion. And there’s a lot of
overlap with all of those. But we’re getting better about kind
of weeding out the differences and then also putting the appropriate
treatment interventions into play. So does that answer your question? Okay.>>So at this point we’ll move on to
the knee injury prevention aspect of this. I’m just gonna give you a little
background information about ACL risk associated with soccer. What we can do to reduce risk, what
are our injury prevention strategies, and what are some current concepts in how we
treat ACL tears, so, When ACL tears occur, they’re usually an acute injury,
usually a non-contact injury. There’s usually a player kind of on their
own running, stopping, planting to change direction, and they feel a pop,
and have swelling in their knee. When they get an MRI,
there’s this bruising of the bone, there’s rupture of the ligament. This occurs in a large number
of athletes in cutting and pivoting sports, soccer’s one of the more
at-risk sports, followed by basketball. People think football would be the one
that’s the bad actor, but actually, soccer’s pretty common. So there’s a big focus in
preventing these injuries. We think they’re increasing in frequency
due to increased athletic participation, more aggressiveness in sports,
more hours of exposure. People are playing in multiple leagues,
they’re playing year round, and just the sheer exposure could
increase the incidence of this. So we also have a problem when people tear
their ACL and we treat them surgically, you go back to at risk activity and
this can lead to reinjury. And there’s about a 20% chance of
either reinjuring your knee or your other normal knee. So we really wanna get people into injury
prevention to help minimize this risk. If you’ve had a prior injury,
you have almost 40 times the likelihood of having another injury as compared
to your uninjured cohort. When we look at return to sport, we see about 20% sometimes retear
of ACL reconstructed grafts. So some of the same things
that can prevent injury can also help reduce the reinjury rate. There’s a lot of things we’re doing
surgically now, that we didn’t do ten years ago that’s also reducing that
reinjury rate, but we need to kinda get that into the front end and reduce the
risk as much as possible through training. So the ways we reduce knee injury
rates such as ACL tears and reinjury rates are, maybe we could screen
for people who would injure themselves, and it turns out,
the screening mechanisms are not so great. It’s unclear, there’s some data that
says we can identify at-risk people with high predictability. And some data says, well,
we can kind of tell who might get injured. But it’s not so clear that we can say, these are the people who
need preventative work. It’s more like,
we need to reach out to everybody. Neuromuscular training, that’s what
we’re here to talk to you about today, injury prevention, dynamic warmup. There is good evidence that this helps,
and it helps a lot. So that’s what we’re gonna focus
on once I get through some of this other information. Like I said, there’s things
that we’re doing surgically. We’re doing more anatomic ACL
reconstruction that’s likely to reduce graft failure rates when you
do an ACL reconstruction. And sometimes when
someone’s had a reinjury, we’ll do things like new procedures,
like add something called an anterolateral ligament, which isn’t in
the scope of this discussion. But those are other things we’re
doing that can reduce reinjury rates. So predicting injuries, there are some
authors who have published on this that there are very
predictable screening mechanisms, like doing a drop landing and looking
to see what position the knees are in. This author in particular, Dr.
Hewett, has published on this. Others have tried to reproduce it, and
they’ve said, well when people jump and land and their knees collapse inward, it’s
kind of predictive of risk of injury, but not high enough to be
a good screening tool. So that leaves us to
what else can we look at. We have seen that people that have
weak hip external rotators and weak hip abductors are more
likely to injure themselves. But still,
we’re really trying to focus more on just incorporating injury prevention
into your regular training. Cuz that’s the best way to
get to the most people and reduce risk in the greatest
degree possible. This study here is a meta-analysis,
that means they looked at all the data on injury prevention programs,
which are basically consistent. Showing there is a significant reduction
in risk when we include a dynamic warmup program that has certain components. And we’re gonna go through
a common one of those. We wanna see, as a result of the work we
do in our injury prevention programs, which, again,
we’re gonna go over in a bit, we wanna see controlled
landings with soft knees. We wanna reduce impact. And we want the knees
to be generally flexed, as well as the hips flexed,
rather than landing in extension. We’re gonna go through some good and
bad examples. They may be demonstrated by my daughter,
who’s gonna [LAUGH] demo them, of what your knees should look like
when you’re landing and squatting. What we see, when we look at data and
injury prevention programs, is they can reduce a knee injury or a lower extremity injury by up to
50% when we look at severe injuries. And that’s a pretty impressive number. This requires two to three session
a week that take about 20 minutes. So about an hour a week of investment in
your time to reduce your injury rate, in terms of severe injuries, by 50%. This is dose dependent, so the more you participate in this,
the better the effectiveness of it. If you do it preseason, it’s more effective than doing
it just when you’re in season. So that kind of makes sense. So the blue line is injury rates among groups participating in
a dynamic warmup program. That’s an injury prevention program. The gray line is those not
participating in this program that we’re gonna demonstrate for you. There’s obvious reduction of in-game and
in-training injuries. So what’s included in these programs? There are some components of strength,
plyometrics, agility, flexibility, and balance. Flexibility really involves stretching,
that’s sort of in your cool down. We’re not gonna focus on that today. Stretching is actually not really
part of the dynamic warmup. Really, the dynamic warmup
focuses on strength, plyometrics, agility, and balance. So an important point about this,
this should be supervised. There should be someone who is somewhat
knowledgeable about the injury prevention program. This may a coach that’s been trained and
educated. It may be an athletic trainer, physical
therapist that’s working with the athlete. And there needs to be
feedback to the athlete. They can’t just go through the program and
do the exercises and not get feedback about what they can
improve on, what they need to correct. Cuz part of the point of doing
the exercises is to identify areas of weakness. The flexibility we talked about is really
working on stretching as part of the cool down process. There are added benefits to these
programs, including increased Strength, improved performance, less loss of time
out of play due to reduced injury. So overall, prevention is key. That’s why we’re focusing on it today. We talked about how much time
you need to devote to this and a 50% reduction in injury. So with that, I wanna demonstrate to you
guys what is the FIFA 11 Plus program. It is a dynamic warm-up program that has a
series of exercises broken into three main parts, with three levels of difficulty,
so to speak. So there’s a beginning level,
there’s an intermediate level and there’s a more advanced level. And depending on where the athlete
is at they may kind of be at a certain level of difficulty
within those exercises, and then they can progress through it
as they get more skilled at them. But again, this is something they’re going
to do in the pre-season, during season, and try to do this three days a week. So we’ll go through the parts, and Michael is going to help demonstrate
with Chloe kind of how this goes. Now the demonstration may take
a bit more than 20 minutes, cuz we’re gonna give you
a little bit of feedback. We’re not gonna go through
every level of difficulty, but you’ll get an idea of what
is included in this program. And it’s certainly feasible to include
this in a practice, it’s certainly feasible to include a shortened version
of this and the pre-game warm-up. And really, there are there things that
there’s benefits to including, regardless. So a lot of focus as you go
through each exercise, and that feedback that the athlete
needs is are they landing or doing these exercises with
proper body position? That’s a major focus of this activity. So, Michael’s gonna kind of
comment on some of these as we go. But in general, you want to avoid
inward collapse of the knee, what we call internal rotation of
the hip and lack of abduction. And we want some alignment from the side. We want our shoulders to be over our
knees, to be over our toes, essentially. If you were a coach and
trying to set this up, this would be what your
field would look like. You’d have some rows of cones,
this is a partner exercise. It’s meant to be included
in a team activity, and that is also another benefit of it. Say you use two cones, and
I have this sort of set up for you here. Two lanes down the middle, and
then you jog back on the outside. So the first part is easy,
it’s a simple warm-up. It’s just jogging straight ahead,
and this is at a light pace. This is not a sprint or
anything like a maximal effort. You’re just gonna jog down [LAUGH]. And then she would jog back, and there would be another
person paired up with her. Again, simple motion, but if you’re
looking at someone from the front when they’re running, they shouldn’t be
collapsing inward with their knee. How’d she do?>>That right knee.>>Yeah, her right knee
a little bit collapsing inward. [LAUGH] We ran through this last week so
we already picked on her a bit so, okay. Number two is,
you might do this in your practice, you might hear it referred
to as open the gate. So you sort of jog to each cone and
then you stop and open the gate with your [INAUDIBLE].>>Can I say one thing?>>Yeah.>>So for those of you that play, a lot of the things that you see in this
today will probably look fairly familiar. And a lot of coaches,
even players just kind of know, these are some of the things you
associate with the soccer warm-up. But the key point from what we’re talking
about today is it’s not just doing it, it’s about how you do it. So I’ll go out, I’ll watch
a soccer practice, a soccer game, and I see some of these things. But there’s kids out there kind of like,
>>[LAUGH]>>How many of you guys recognize that from your practices? Does that look pretty familiar? So it’s not just doing what’s up here,
but it’s about how you do it. So as we go through, really pay
attention to some of the cues for what it’s suppose to look like because
that’s how you get the benefit from it. So Chloe, go ahead and continue.>>Mm-hm, so keeping the pelvis level,
not drooping over to one side. And then you can jog back. Yeah.>>Jog back?>>Mm-hm. So kind of in the image there, the correct
one on the left, the pelvis is level. On the right, there’s some leaning,
there’s some inward collapse of the knees. Those would be things you would look for
in terms of detecting weakness. So the next one is similar but
now we call it closing the gate. So instead of flexing and rotating out,
she’s going to bring it in, so. Mm-hm, keep going. Good, and
again we want the pelvis to stay level and the leg that’s bearing the weight
to not collapse inward at the knee. That’s good, you can run back. She’s pretty good at those I think,
yeah okay. All right, so in this one,
a little confusing to explain, but it’s running with circling your partner. So you would do this with a partner, you
would kind of run to the next cone, and then you would circle each other, and
then you run to the next cone, and circle each other. So it’s just a little bit of agility,
kind of. So do you guys want to
try demonstrate this? [LAUGH] That’s right. [LAUGH] So they’re getting kind of warmed
up with a little side-to-side motion, awareness of where other players are,
that kind of thing. Okay, this one’s also kind of fun, and you can see how this would engender
some sort of team camaraderie. It’s running with shoulder contact, so
you start to progressively see little exercises where you’re sort of
having some perturbation of balance. Or something sort of that could get
you a little bit off balance, and then continue onwards. So they’re gonna jog,
shoulder to shoulder, now Michael’s got a little bit
of an advantage over Chloe, but she’s pretty tough, so they might,
we’ll see how it goes. [LAUGH] So they’re gonna job and
do a shoulder to shoulder contact, so they kind of like bump each other. You jump up and bump each other. Jump, and then they run. And at the next cone they do it again. So they kind of rebound off each other,
land, and keep jogging. [LAUGH] Okay.>>Yeah, real quick, so did anybody notice any differences
between what I did versus what Chloe did?>>[INAUDIBLE]
>>Do you see that a little bit?>>Right.>>And was she a little more
upright when she landed, as opposed to kinda sitting down into it?>>Yeah, right, so-
>>So again, just something to pick at as we go.>>Yeah, so Michael sort of taking off and
pushing over and then landing with soft knees
>>And Chloe, cuz she’s not as practiced at it,
was sort of leaning, listing over into him, and then kind
of landing a little bit buckled over. So all right, but not bad. You haven’t done this very much. Okay, running quick forwards and
backwards, fairly self-explanatory. But again, when someone is watching your
athlete do this, they’re looking for that posture of the knee, so to speak. Do you want to run forward a bit? So run down and then backpedal? All right. And in the actual handbook,
which we can share a copy of this, you run forward and then back one cone,
and then run forward and back one cone. So it’s kinda like a progression of
running down to a cone and back, running down a couple and back one. But running forwards and backwards, so
getting some of that backpedaling in. All right, this gets into the harder part,
some of the strength and plyometrics. So this is where you have
the three different levels. So this is for core stability. This is called the bench,
the easiest to hardest. There’s a static bench,
there’s a alternating legs bench, and then there’s a lift and hold. So do you want to demonstrate
just a static bench?>>Yeah, just a plank basically. So [LAUGH] that’s not bad. Now, show them alternating legs and
keep your butt down, yeah. Okay, and then the hardest one,
you would hold it 30 seconds at a time. So she would hold one and
try not to let her hips rotate. Try to keep them level, try to keep
her butt from going up in the air, and then try not to sag in her lower back. So Michael’s kinda giving her a little
feedback about the error she’s making. And it’s pretty hard if
you’ve never done it. Actually, if you just wanna get into
workout as an adult, you can do this entry professional program [LAUGH] a few
days a week, it’s pretty good. Okay, that’s quite good, all right. Now, next one is the sideways bench. So this one, again, easiest to hardest. On this slide I have for
you the correct version on the left, the sort of errors on the right. The sideways bench is basically
a side plank on your elbow. You go from just holding it to raising and lowering your hips off the ground,
to doing a leg raise off to the side. The key things are here,
you wanna obviously not sag in the middle. So you’re using your hip abductors,
keep your hip up off the ground. And then you’re using your core
to avoid rotating forward. So the tendency would be to rotate
forwards to your forearm, but you wanna stay straight up and down. So it involves the core and
your hip abductor. Now, that’s the easy level. Do you wanna try the straight legs out and
raise your hips up and down, or do you want Michael to demonstrate it? [LAUGH]
>>[INAUDIBLE]>>Okay, [LAUGH] So this one’s pretty hard. So this would be level two of this, so
he’s gonna raise and lower the hips, so that’s using a lot of abductor and
core work. And then the highest level of difficulty
would be the holding it and leg raises. So that’s the most advanced level, so
all right, so he’s pretty good at that. Okay, so
this is definitely a partner exercise. You may have heard of a Nordic
hamstring curl, it’s similar to that. We’re doing just the lowering
down version of it. So basically, the way this progresses in level of
difficulty is you just do more reps. So when your athlete just learning how to
do this they might just do five wraps and you build up to something like 12 to 15. But basically the partner holds
the ankles down while the athlete is leaning forward and trying not to
bend at the hips or the waist. So you’re really isolating the hamstrings,
they lower down as far as they can and then catch themselves. [LAUGH] Good, so you just go as slow as
you can until you can’t slow yourself down anymore with your hamstrings and
then catch yourself. And again, you just advance in difficulty
by doing more repetitions of that. But that’s a really good
hamstring strengthening exercise. Next one is the single-leg stance. The easiest version of this is
simply holding a ball and balancing. We then progress to throwing a ball
back and forth to your partner, and then a shared sort of balance
disruption where you’re kind of tapping each other back and forth. So they’re kind of already on to
the second level and you can try, and you’re gonna do it on both sides, so
you’re gonna try one side, then the other. And you’ll find that you’re better at
balancing on one side than the other, based on oftentimes your
abductor’s strength. So they’re just sort of at the highest
level, kind of tapping each other to get themselves a little bit off balance, and
trying to maintain that single leg stance. [LAUGH] Okay, I won’t tell you what Chloe did to
Michael the first time she tried this. She basically pushed him
as hard as she could. [LAUGH] So, okay, so next is squats. Proper squatting technique leads to
really proper landing technique as well, and this is a really important
thing to visualize in athletes. There’s so
many athletes that squat with this sort of inward collapse of their knees and
have really poor technique. So the first level of this is
a simple squat to a toe raise. And then the next level is walking lunges,
and then single leg squats which
are really pretty challenging, so. Do you wanna face this way, Chloe, and
stand in the middle and face that way? And so show us a squat to going up
on your tiptoes, so squat down.>>Like a jump?>>Not a jump,
Michael will do it with you. Squat and toe raise, up on your toes. So as she’s going down,
you wanna keep your, basically, knees going straight over your toes and
up and not collapsing inwards, not getting
out too far in front of the feet. So she’s getting a little far forward,
right? She’s a little pitched forward
over her toes, but not bad. Okay, so do you wanna talk about the lunges or demonstrate that? So you wanna lunge down? Yeah, so with the lunges, you want
a 90-degree angle of both knees, so you’re stepping a little far. Yeah, that’s good. Don’t step quite as far, pretty good.>>[LAUGH]
>>That’s good. So you want 90-degree angles. That’s good, okay, that’s good. And again, you want with your lunge,
your knee to go directly over the toe, and we don’t really want
the knee to extend past the toes. Now, this is a combined partner exercise. This is the more difficult level. They’re doing single leg squats. I do this a lot with patients in clinic
to see how their strength compares side to side. Cuz a lot of people on one side
will have a lot worse control and a lot more inward collapse of their
knee in the single leg squat. Good, and again,
someone would be watching and giving some feedback about
any abnormalities there. Jumping, so we progress from a vertical
jump to lateral jumps to box jumps. So vertical jump is simply taking off and
landing and trying to land with proper
position of the knees. So you can stand here and face forward. Just jump up and land. Okay, any feedback for her [LAUGH]?>>So just what we talked about before
when we did the shoulder contact, Chloe, why don’t you to face that way,
so no, no, no>>In the middle, face Michael.>>Just face, very good, and
then do the jump in place again.>>Jump and land.>>Now, you did better that time.>>Yeah.
>>[LAUGH] So the first jump again, just a little more through the knees and
not as much through the hips. So we want to see you absorb
through the hips, too. One more, good.>>Yeah, good, so she’s absorbing
force through flexion in the hips and the knees, soft landing,
not landing with rigid knees. Lateral jumping is sort of,
so a side to side jump. You wanna face forward and-
>>[INAUDIBLE], one leg->>Yeah, so taking off on one leg and landing on the other. Mm-hm, and try to sort of control
your landing on each side. So this kind of involves balance, hip
abductor strength, All coordination here. It’s pretty good, yeah. And then box jumps are basically
jumping in a square. So it’s a forward jump, a side jump,
a back jump, a side jump, a forward jump. So you’re kind of creating
a box when you’re jumping and trying to maintain the good position
in the knees while doing that. Now, you wouldn’t be doing all three
of these levels as you progress, so it wouldn’t take this long. You would see where the athlete is,
at what level, and you wanna demonstrate that one? So forwards, yep, backwards,
side, and forwards. So for most pretty athletic people,
they’re probably, wouldn’t you say for the most part, high level players
are doing these at the higher level? The more complex level, unless
they’re not able to strength wise, so. So you just want to make
sure whatever you are doing, you are doing with good form and
doing it properly. So this gets, sort of the final set of exercises which
you’re doing at more of a sprint pace. So there’s a few of these things. One is just running across the pitch. So they’re gonna go, kind of,
75 to 80% max speed. They’re gonna do two sets of running
across the field, and then they jog back. So sprints across, jog back,
do you want to sprint for us? [LAUGH] And she would jog back. It would be a little wider, because it would be going all
the way across the field. Bounding, so this is more of
a bigger spread of each step. So there’s some more hip flection,
you’re pushing off. You’re swinging the arms more, it’s a very
kind of dynamic, big, forward step. You wanna try it? Right, and you would do that for two sets and jog back. And then the running plant and cut is sort
of obviously progressing more towards like what you’re actually doing in soccer. So it involves, you’re sprinting between
the cones, you had sprint to a cone, plant, cut to the other side, sprint
forward, plant, cut to the other side. And you would do that across the pit,
jog back, and then repeat that. The idea is you sprint for about five
steps, decelerate, change direction, sprint, decelerate, change direction. So, again, two or three times a week,
once the team gets practiced at this, this should take about 20 minutes. You may progress up to the higher level
of difficulty as you get better or more trained at it and
you’re able to do it with good form, shows about 50% injury reduction. And so I just wanna say thanks,
thanks to Soccer Genome for letting us educate you here today. We’re happy to take questions,
we’re happy to kind of go through some of the exercises with you
one on one if you want. We have some handouts that sort
of go through the whole program. All right, well, thanks, everybody.>>[APPLAUSE] [MUSIC]

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