ACL: Injury, Treatment & Prevention

April 6, 2016 by Liz

Come and meet Dr. Dhar and Brian McLean, DPT on April 28th at 6:30 PM inside the lobby of Club Fit Briarcliff. Attend the lecture from 7:00-8:00 PM (upper conference room).

ACL treatment with Dr. Yasmin Dhar
Dr. Yasmin Dhar will offer advice on treating ACL injuries

Collegiate and High School females are 9-10 times more likely to suffer a non-traumatic Anterior Cruciate Ligament (ACL) injury than males in similar sports. This is the result of an anatomical increased angle at the knee in women, also known as a “Q” angle, which puts more pressure on the inside of the knee . However, according to Dr Yasmin Dhar, “It is more common to tear the ACL from a noncontact injury, like hyperextending or landing and twisting the knee, than a direct contact injury.”
Does a torn ACL have to be fixed with surgery?

From Dr. Yasmin Dhar’s experience with ACL tears, “The ACL cannot heal on its own, but not all tears of the ACL need surgery; treatment can depend on your activity level and amount of instability in your knee. People participating in sports or activities where they plant their feet, and twist or cut are susceptible to having an unstable knee and may be better off with surgery. Also if they are unable to modify their activities and desire an unrestricted lifestyle, they should consider surgery to have the best chance of returning to their pre-injury functional level. On the other hand, people who do not perform many cutting or pivoting activities, have no feeling of looseness in their knee, or lead a sedentary lifestyle may be able to function well with physical therapy to strengthen the leg, and possibly a brace. However, even sedentary people can experience giving way with simple activities such as going down stairs or stepping off a curb. When there is instability or giving way with simple life activities or sports, surgery is needed to restore normal kinematics and stability to the knee, preventing further damage to other structures in the knee.”

Come and learn more about ACL injuries and treatment options from Dr Dhar. www.YDharMD.com

Ways to Prevent and Minimize Knee Injuries

In order to prevent or minimize knee injuries, Brian McLean, DPT and Director at Ivyrehab Briarcliff will discuss the ACL Screening & Prevention Program that is currently being performed at Ivyrehab Briarcliff and Ivyrehab Jefferson Valley. By using a video analysis of the athlete’s knees in several positions of jumping (start position, before and after jumping), suggestions are made on the athlete’s exercise program, which is recommended to be done 3 times weekly for 6 weeks.

The ACL injury prevention program consists of an exercise program that includes: (1) warm-up exercises for maximum efficiency and conditioning, (2) integrating the components of ACL injury prevention for muscle and joint preparation with (3) combining flexibility and strengthening exercises and (4) plyometric exercises and agility drills that can facilitate a quick transition into practice activities.

Dr Yasmin Dhar is the Sports Medicine and Arthroscopic Surgery Specialist for Specialty Orthopedics in Harrison, New York. She completed her orthopaedic training at Westchester Medical Center, a level 1 trauma center, and her Sports Medicine fellowship at University of Pennsylvania. She is board-certified in orthopedic surgery as well as sports medicine. An avid athlete herself, her clinical practice focuses on the prevention and treatment of sports-related injuries of the shoulder, elbow, hip and knee.

She currently serves as the Chief of Sports Medicine at Montefiore New Rochelle Hospital, Assistant Clinical Professor of Orthopedic Surgery at New York Medical College, an affiliate physician for the LPGA tour, team physician for a number of local schools, and an Associate Master Instructor for the Arthroscopy Association of North America. http://www.ydharmd.com/

For additional information about attending this presentation please contact Ivyrehab Briarcliff at 914-762-2222.. You can also visit our website at www.ivyrehab.com.
Space is limited so call or stop in the register.

Ivy Rehab

Prevent Skiing Knee Injuries on the Slope

February 8, 2016 by Liz

BY: Meryle Richman, PT, DPT, Senior Director of Ivyrehab Briarcliff and Jefferson Valley

As the cold weather approaches, many of us turn out thoughts and energy to the ski slopes. With this ever increasing interest, we gathered information to enhance conditioning for downhill skiing to help prevent common knee injuries.

The most common skiing injuries that occur in the lower limb, as a result of collisions and falls, are knee sprains/tears, which include Medial Collateral Ligament (MCL) and Anterior Cruciate Ligament (ACL) sprains/tears. With new advances in ski equipment today such as releasable bindings, the statistics have changed to decreasing leg fractures to 90% and 30% for knee injuries.

According to the American Physical Therapy Association, (http://www.moveforwardpt.com/resources), (1) Medial Collateral Ligament (MCL) injuries are more common in the beginner and intermediate skier when the ski tips are pointed towards one another in a snow plow positon, when the skier is trying to slow down or stop.

Prevention Tips for MCL injuries:

● Make sure your weight is balance when you are in a snowplow position
● Stay on comfortable terrain

(2) Anterior Cruciate Ligament (ACL) injuries occur when the skier lands from a jump with their weight back on the boot. This causes a significant force on the back of the boot and the force pushes on the calf, which results in spraining or tearing the ACL

● Another common ACL tear is the “phantom foot” phenomenon. This occurs when the skier tries to stand up in order to prevent a fall. All the weight goes on the outside of one ski, and the arms and trunk rotates away from that leg.


Prevention Tips for ACL Injuries:

● Land safely with your weight forward. Start with simple jumps and gradually advance to more difficult jumps
● Do not try to stand up and go with the momentum of the fall and maintain good ski technique

Tips for Preparing for the slopes:

1. Make sure you have the proper equipment and take a skiing lesson if you have not skied in a while. Prepare yourself to three to four weeks before you go skiing with the recommended flexibility, strengthening and endurance program recommended below:

2. A safe and enjoyable ski season begins with a pre-slope program designed to promote adequate flexibility, strength and endurance. The scope of the conditioning program is dependent upon the physical condition of each individual.

Flexibility is among the most vital components of an effective conditioning program. Primary consideration should be given to maximizing the flexibility of the quadriceps, hamstrings, gastrocnemius, soleus, trunk rotators, shoulder girdle and low back musculature. Long, slow static stretching of these muscle groups is recommended.

Strength is another consideration. The quadriceps muscle group is of primary concern to the heavy demand placed on it when downhill skiing. Strengthening of the gluteals, hip adductors and the arms are also recommended. Inadequate strength affects ski technique and increases injury risk.

Endurance should also be addressed in a ski conditioning program. As with the other components of strength and flexibility, the amount of endurance training is relative to the fitness level of the individual. One can choose from running, swimming, cycling, rowing and Elliptical trainer. Endurance workouts may also incorporate a plan that strengthens the muscles used in skiing, as well as increasing endurance. Examples of ski- oriented training are: traverse running; box jumping.

Skiers should also prepare themselves with an adequate warm-up of stretching the upper extremities and the back before getting the skis on in the morning and can even include jumping jacks or jogging in place. Due to the nature of the physical demands of the sport, a run or two on an easier slope is recommended as a final warm-up.

Fatigue is inherent in a full day of skiing. Studies have shown that injury rates are increased toward the end of the day. Beginners should consider skiing a half day until their endurance improves. Care should be taken to monitor physical status and pacing your runs on the slopes with adequate food and water breaks in order to have a safe day.

Recommended Flexibility Program:

• Standing quadriceps stretch – pull heel toward buttock until a stretch is felt in front of thigh, hold 30seconds, repeat on opposite side.
• Standing hamstring stretch – Place heel on a bench. Slowly lean forward reaching down towards your shin until a stretch is felt at the back of the thigh. Keep the knee straight and back straight, hold 30 seconds, repeat on opposite side.

• Calf stretch – Keeping back leg straight, with heel on floor and turned slightly outward, lean into wall until a stretch is felt in calf, hold 30 seconds, repeat on opposite side.

• Standing trunk rotation stretch – Turn shoulders to one side while keeping hips forward, hold 30 seconds, repeat on opposite side.
• Standing trunk lateral flexion stretch – Reach over and upward while sliding opposite arm down leg, hold 30 seconds, repeat on opposite side.

Recommended Strengthening Exercises:

• Circuit training
• Free weights
• Isometric strengthening in the “downhill position”

Have fun on the slopes!
Ivy Rehab

Prevent Skiing – Knee Injuries on the Slope

January 19, 2016 by Liz

Screen Shot 2016-01-19 at 12.37.05 PMBY: Meryle Richman, PT, DPT, Senior Director of Ivyrehab Briarcliff and Jefferson Valley

As the cold weather approaches, many of us turn out thoughts and energy to the ski slopes. With this ever increasing interest, we gathered information to enhance conditioning for downhill skiing to help prevent common knee injuries.

The most common skiing injuries that occur in the lower limb, as a result of collisions and falls, are knee sprains/tears, which include Medial Collateral Ligament (MCL) and Anterior Cruciate Ligament (ACL) sprains/tears. With new advances in ski equipment today such as releasable bindings, the statistics have changed to decreasing leg fractures to 90% and 30% for knee injuries.

According to the American Physical Therapy Association, (http://www.moveforwardpt.com/resources), (1) Medial Collateral Ligament (MCL) injuries are more common in the beginner and intermediate skier when the ski tips are pointed towards one another in a snow plow positon, when the skier is trying to slow down or stop.

Prevention Tips for MCL injuries:
● Make sure your weight is balance when you are in a snowplow position
● Stay on comfortable terrain

(2) Anterior Cruciate Ligament (ACL) injuries occur when the skier lands from a jump with their weight back on the boot. This causes a significant force on the back of the boot and the force pushes on the calf, which results in spraining or tearing the ACL

● Another common ACL tear is the “phantom foot” phenomenon. This occurs when the skier tries to stand up in order to prevent a fall. All the weight goes on the outside of one ski, and the arms and trunk rotates away from that leg.

Prevention Tips for ACL Injuries:
● Land safely with your weight forward. Start with simple jumps and gradually advance to more difficult jumps

● Do not try to stand up and go with the momentum of the fall and maintain good ski technique

Tips for Preparing for the slopes:

1. Make sure you have the proper equipment and take a skiing lesson if you have not skied in a while. Prepare yourself to three to four weeks before you go skiing with the recommended flexibility, strengthening and endurance program recommended below:

2. A safe and enjoyable ski season begins with a pre-slope program designed to promote adequate flexibility, strength and endurance. The scope of the conditioning program is dependent upon the physical condition of each individual.

Flexibility is among the most vital components of an effective conditioning program. Primary consideration should be given to maximizing the flexibility of the quadriceps, hamstrings, gastrocnemius, soleus, trunk rotators, shoulder girdle and low back musculature. Long, slow static stretching of these muscle groups is recommended.

Strength is another consideration. The quadriceps muscle group is of primary concern to the heavy demand placed on it when downhill skiing. Strengthening of the gluteals, hip adductors and the arms are also recommended. Inadequate strength affects ski technique and increases injury risk.

Endurance should also be addressed in a ski conditioning program. As with the other components of strength and flexibility, the amount of endurance training is relative to the fitness level of the individual. One can choose from running, swimming, cycling, rowing and Elliptical trainer. Endurance workouts may also incorporate a plan that strengthens the muscles used in skiing, as well as increasing endurance. Examples of ski- oriented training are: traverse running; box jumping.

Skiers should also prepare themselves with an adequate warm-up of stretching the upper extremities and the back before getting the skis on in the morning and can even include jumping jacks or jogging in place. Due to the nature of the physical demands of the sport, a run or two on an easier slope is recommended as a final warm-up.

Fatigue is inherent in a full day of skiing. Studies have shown that injury rates are increased toward the end of the day. Beginners should consider skiing a half day until their endurance improves. Care should be taken to monitor physical status and pacing your runs on the slopes with adequate food and water breaks in order to have a safe day.

Recommended Flexibility Program:
• Standing quadriceps stretch – pull heel toward buttock until a stretch is felt in front of thigh, hold 30seconds, repeat on opposite side.

• Standing hamstring stretch – Place heel on a bench. Slowly lean forward reaching down towards your shin until a stretch is felt at the back of the thigh. Keep the knee straight and back straight, hold 30 seconds, repeat on opposite side.

• Calf stretch – Keeping back leg straight, with heel on floor and turned slightly outward, lean into wall until a stretch is felt in calf, hold 30 seconds, repeat on opposite side.

• Standing trunk rotation stretch – Turn shoulders to one side while keeping hips forward, hold 30 seconds, repeat on opposite side.

• Standing trunk lateral flexion stretch – Reach over and upward while sliding opposite arm down leg, hold 30 seconds, repeat on opposite side.

Recommended Strengthening Exercises:

• Circuit training

• Free weights

• Isometric strengthening in the “downhill position”

Have fun on the slopes!
Ivy Rehab