The purpose of this study was to determine if a sports-specific training program could improve neuromuscular indices in female high school volleyball players. We combined components from a previously published knee ligament injury prevention intervention program for jump and strength training with additional exercises and drills to improve speed, agility, overall strength, and aerobic conditioning. We hypothesized that this sports-specific training program would lead to significant improvements in neuromuscular indices in high school female volleyball players. Thirty-four athletes (age 14.5 years + 1.0) participated in the supervised 6-week program, 3 days a week for approximately 90-120 minutes per session. The program was done on the school’s volleyball court and weight room facilities. The athletes underwent a video drop-jump test, multi-stage fitness test, vertical jump test, and sit-up test before and after training. A significant increase was found in the mean VO2max score (p < 0.001), as 73% of the athletes improved this score. A significant improvement was found in the sit-up test (p = 0.03) and in the vertical jump test (p = 0.05), as 68% of the athletes increased their scores. In the drop-jump video test, significant increases were found in both the mean absolute knee separation distance (p = 0.002) and in the mean normalized knee separation distance (p = 0.04), indicating improved lower limb alignment on landing. No athlete sustained an injury or developed an overuse syndrome during training. This program significantly improved lower limb alignment on a drop-jump test, abdominal strength, estimated maximal aerobic power, and vertical jump height and may be implemented in high school female volleyball programs.

Patients travel great distances to visit Dr. Frank Noyes when they have serious knee injuries, and with good reason.

The Indian Hill resident has been named one of the top 25 kneesurgeons in the U.S. by Becker’s Hospital Review, a bimonthly publication offering business and legal news relating to hospitals and health systems.

Noyes specializes in sports medicine. He received his medical degree from George Washington University, completed his internship and orthopaedic residency at the University of Michigan and started the University of Cincinnati’s sports medicine program after joining the school’s orthopaedic surgery department in 1975.

Noyes said he’s devoted much of his medical career to the knees because when he began practicing, there was very little science devoted to the knees. He said knee and ligament problems were much more difficult to treat than they are today.

“We didn’t have the basic research or knowledge to deal with that,” Noyes said.

Joseph Siebenaler, who traveled from Hawaii to Montgomery to be treated by Noyes, said he went to numerous knee surgeons on various Hawaiian islands who couldn’t help him. He said upon doing research on his issues he found Noyes’s achievements in repairing knee ligaments.

Noyes actually invented the surgery Siebenaler needed to recover from his injury, which he’s been dealing with for two years. “Of course, I’m going to go with (Noyes),” he said. Siebenaler said doctors near his home gave his injury a 10 percent chance of recovery. He said after visiting with Noyes for several weeks, his chance of recovery is now 90 percent.

This study evaluated the effectiveness of a tennis-specific training program on improving neuromuscular indices in competitive junior players. Tennis is a demanding sport as it requires speed, agility, explosive power, and aerobic conditioning along with the ability to react and anticipate quickly and there are limited studies that evaluate these indices in young players following a multi-week training program. The program designed for this study implemented the essential components of a previously published neuromuscular training program and also included exercises designed to improve dynamic balance, agility, speed, and strength. Fifteen junior tennis players (10 girls, 5 boys; mean age, 13.0 + 1.5 years) who routinely participated in local tournaments and high school teams participated in the 6-week supervised program. Training was conducted 3 times a week, with sessions lasting 1.5 hours that included a dynamic warm-up, plyometric and jump training, strength training (lower extremity, upper extremity, core), tennis-specific drills, and flexibility. After training, statistically significant improvements and large to moderate effect sizes were found in the single-leg triple crossover hop for both legs (p < .05), the baseline forehand (p = .006) and backhand (p = .0008) tests, the service line (p = .0009) test, the 1-court suicide (p < .0001), the 2-court suicide (p = .02), and the abdominal endurance test (p = .01). Mean improvements between pre-train and post-train test sessions were 15% for the single-leg triple crossover hop, 10-11% for the baseline tests, 18% for the service line test, 21% for the 1-court suicide, 10% for the 2-court suicide, and 76% for the abdominal endurance test. No athlete sustained an injury or developed an overuse syndrome as a result of the training program. The results demonstrate that this program is feasible, low in cost, and appears to be effective in improving the majority of neuromuscular indices tested. We accomplished our goal of developing training and testing procedures that could all be performed on the tennis court.

One of the clinical studies Dr Noyes presented was the longest clinical follow-up to date on the ability to successfully repair  knee meniscus cartilage tears using an arthroscopic technique with fine sutures  placed to repair complex meniscus tears with limited blood supply.  These meniscus tears are frequently not repaired and the meniscus removed. However with this technique the meniscus function can be saved in the majority of patients. These tears are a result of trauma and frequently with anterior cruciate knee tears in younger patients and not the degenerative type tears that occur with advancing age.  Lost of a knee meniscus results in arthritis in the majority of patients 7-15 years after their removal.  Patients travel from throughout the United States to have Dr Noyes repair damaged meniscus tissues often in conjunction with other knee ligament surgery to restore stability.

A valgus lower limb alignment is commonly documented during noncontact ACL injuries. We previously developed a videographic drop-jump test to measure overall lower limb alignment in the coronal plane as a screening tool to detect an such an abnormal (valgus) position on landing. A neuromuscular retraining program developed for female athletes was shown to be effective in improving lower limb alignment on this test immediately following completion of training. What remained unknown was whether these improvements would be retained for longer periods of time. Therefore, this study was undertaken to determine if these improvements in overall lower limb alignment would be retained up to one year after training. Sixteen competitive, experienced female high school volleyball players underwent the video drop-jump test and then completed the neuromuscular retraining program. The program consisted of a dynamic warm-up, jump training, speed and agility drills, strength training, and static stretching and was performed 3 times a week for 6 weeks. The athletes repeated the drop-jump test immediately upon completion of training, and then 3- and 12-months later. Significant improvements were found in the mean normalized knee separation distance between the pre- and post-trained values for all test sessions (p < 0.01). Immediately after training, 11 athletes (69%) displayed significant improvements in the mean normalized knee separation distance which were retained 12 months later. Five athletes failed to improve. The video drop-jump test, while not a risk indicator for a knee ligament injury, provides a cost-effective general assessment of lower limb position and depicts athletes who have poor control on landing and acceleration into a vertical jump.

Background Common lower limb postures have been found when noncontact anterior cruciate ligament (ACL) injuries occur during sidestep cutting tasks. These same postures have been linked to knee loadings known to stress the ACL.

Hypothesis Whole body technique modification would reduce knee loading.

Study Design Controlled laboratory study.

Methods Experienced team sport athletes were recruited for whole body sidestep cutting technique modification. Before and after a 6-week technique modification training, participants performed sidestep cutting tasks while ground-reaction force and motion data were collected. A kinematic and inverse dynamics model was used to calculate 3-dimensional knee loading during sidestep cutting.

Results At initial foot contact, the participants placed their stance foot closer to the body’s midline and held their torso more upright, in line with the aims of the technique modification training. This was accompanied by significantly lower peak valgus moments in the weight acceptance phase of stance. Both postural changes were correlated with the change in peak valgus moment.

Conclusion Whole body sidestep cutting technique modification resulted in reduced knee loading.

Clinical Relevance Implementation of whole body technique modification may produce effective ACL injury prevention programs in sports involving sidestep cutting.

Cincinnati High School Volleyball team credits training program as part of success

11.16.2009 – Ursuline Academy, fresh off its latest Ohio Division 1 volleyball championship and undefeated season, gives Sportsmetrics™ training from Cincinnati SportsMedicine and Orthopaedic Center much of the credit for this year’s success.

Entering the weekend ranked #2 in the country by PrepVolleyball.com, the Lions won their fourth state title and their first since 2002 by defeating Dublin Coffman in four sets at the state finals Saturday in Dayton. It was the second straight year the Lions had reached the state finals.

“The Ursuline Academy volleyball team has spent the last two summers participating in the Sportsmetrics™ program,” said Diane Redmond, Ursuline athletic director. “The six week Sportsmetrics™ program has been a great addition to the Ursuline volleyball team’s summer conditioning and has helped reduce injuries. The success that the volleyball team has experienced with Sportmetrics™ has led to the Ursuline Academy Athletic Department offering the program seven weeks prior to the start of the fall, winter and spring seasons.”

“Anterior cruciate ligament (ACL) injury rates are up to 10 times higher in female athletes than in male athletes,” said Dr. Frank Noyes from Cincinnati SportsMedicine. “Sportsmetrics™ not only helps prevent those knee injuries, but improves performance. Ursuline’s success shows how specialized training can help a good team become great.”

The Sportsmetrics™ program is the first ACL injury prevention program proven to decrease serious knee ligament injuries in female athletes. Sportsmetrics™ also includes drills to work on strength, coordination and overall physical conditioning in sports-specific skills. Studies have shown that athletes going through the Sportsmetrics™ program have an average two inch improvement in jump height, 12% improvement in cardiovascular endurance and 54% improvement in knee separation distances, measured through drop jumps which are the main test used for injury prevention.

The Sportsmetrics™ program is available to athletes and teams through certified programs across the country, and certification classes are offered throughout the year. For more information on Sportsmetrics™ training, visit www.sportsmetrics.net for certification information and contacts.

Source: http://news.cincinnati.com/article/20091114/SPT0301/311140034/Ursuline+wins+state+volleyball+title

“I just didn’t want to get trampled,” the Ursuline senior said Saturday.

Reinert was talking about surviving the Lions’ celebration on the volleyball court at Wright State University’s Nutter Center after Ursuline dispatched Dublin Coffman 25-16, 25-19, 18-25, 25-17 to complete a 29-0 season and win the school’s fourth Division I state championship.

Reinert, Ursuline’s senior setter, cranked out 48 assists, helping set up senior Jade Henderson for 18 kills and junior Christina Beer for another 10. Junior Kori Moster logged 15 digs while senior Anna Prickel added 13 as the Lions completed a job they felt they’d left unfinished last season.

Ursuline also was undefeated going into last season’s championship match, which they lost to Olmstead Falls in four sets. Lions’ fourth-year coach Jeni Case felt that loss helped her returning players focus.

“We’ve been waiting all year for this,” said Case, who led Ursuline to its first state championship since 2002. “Last year was horrible. I didn’t forget all year. They didn’t forget all year. We took things differently this year.”

Operating on the theory that winning the state championship should be everybody’s goal, Case suggested that her players trade setting goals for making sacrifices – sort of a volleyball version of the Roman Catholic season of Lent, a period of cleansing that leads up to Easter.

She and her players gave up everything from soda to junk food. Others devoted more time to prayer or set self-imposed curfews.

The slightly-built Reinert’s “sacrifice” was to eat more and do pushups to build strength.

The Lions also drew motivation from junior Jamie Goldschmidt, who’s been unable to even practice for months because of medical problems. She still showed up for every practice and match, and she was on hand Saturday, wearing a brace around her midriff that didn’t clash at all with Case’s state championship medal hanging around her neck.

“She’s as much a part of the team as anyone,” Moster said.

With all of that going for Ursuline, which finished the season ranked No. 1 in the statewide Division I coaches poll, the second-ranked Shamrocks didn’t have much of a chance in their first trip to the state tournament.

“Ursuline came out tough,” Coffman coach Mary Anne Souder said. “You have to start very strong against that type of team. We knew Jade Henderson would get a lot of sets, but they have a lot of weapons. We’d set blocks, but they did a good job of getting around them.”

Ursuline, attacking from each end of the net, set the tone by jumping out to leads of 6-1 in the first set and 5-1 in the second. Coffman never led until the start of the third set.

Case figured that Ursuline’s experience would pay off.

“Coffman’s an awesome team, but like I told the girls before the game, experience has to count for something,” she said.

BACKGROUND: Meniscal and anterior cruciate ligament (ACL) injuries are common in college football athletes. The effect of meniscectomy and/or ACL surgery on the length of an athlete’s career in the National Football League (NFL) has not been well examined.

HYPOTHESIS: Athletes with a history of meniscectomy or ACL surgery before the NFL combine have a shorter career than matched controls.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: A database containing the injury history and career NFL statistics of athletes from 1987-2000 was used to match athletes with a history of meniscectomy and/or ACL surgery, and no other surgery or major injury, to controls without previous surgeries. Athletes were matched by position, year drafted, round drafted, and additional injury history.

RESULTS: Fifty-four athletes with a history of meniscectomy, 29 with a history of ACL reconstruction, and 11 with a history of both were identified and matched with controls. Isolated meniscectomy reduced the length of career in years (5.6 vs 7.0; P = .03) and games played (62 vs 85; P = .02). Isolated ACL surgery did not significantly reduce the length of career in years or games played. Comparing the athletes with meniscectomy or ACL reconstruction to athletes with combined ACL reconstruction and meniscectomy, a history of both surgeries, resulted in a shorter career in games started (7.9 vs 35.1; P <.01), games played (41 vs 63; P = .07), and years (4.0 vs 5.8; P = .08) than a history of either surgery alone.

CONCLUSION: A history of meniscectomy, but not ACL reconstruction, shortens the expected career of a professional football player. A combination of ACL reconstruction and meniscectomy may be more detrimental to an athlete’s durability than either surgery alone. Further research is warranted to better understand how these injuries and surgeries affect an athlete’s career and what can be done to improve the long-term outcome after treatment.

(Source:http://www.auburnpub.com/articles/2009/11/10/lake_life/lakelife02.txt)

Tuesday, November 10, 2009 12:30 AM EST

The first scientific knee injury prevention program, Sportsmetrics, has multiple branches to target specific needs. There is a program that can be utilized following an injury and/or reconstructive surgery, or it can be used strictly as an injury prevention program. The injury prevention program is titled Sportsmetrics Speed and Agility (SAS).

SAS is a six-week program that incorporates each of the aspects that were discussed in a previous article: dynamic warm-up, jump training, speed and agility, strength training and flexibility. The program is broken into three different two-week phases that include each of the five aspects.

The dynamic warm-up prepares the body for increased activity by increasing blood flow to the muscles and lengthening the fibers of the muscles. This portion takes approxiamately 10 minutes and will change as needed based the rest of the programming.

Jump training is the primary focus of the program. Here the athlete learns to land with soft feet, distributing the stresses and taking additional pressure off of the knee joint. Maintainence of the athletic position – hips, knees and feet in alignment – is enforced throughout this segment to help alleviate the valgus (knock-kneed) positioning of the knees. The jumps are progressive in nature and build on each previous phase to increase stability and teach athletes how to jump and land off of one foot versus both feet. Each jump is designed to build leg strength and proprioception (the ability of a joint to perceive its position in space), re-training the body to maintain particular positions throughout the jumping motion.

The next segment, speed and agility, incorporates reaction drills and is an intense 20 minutes of anaerobic activity. The drills are comprised of quick feet, sharp cuts, straight sprints, backpedaling and unpredicted agility. Again, proper techique is emphasized when cutting, pivoting and decelerating – all activities that are highly associated with ACL injuries. Body positioning/posture is the most important aspect of this segment, decelerating in more of squat position to keep the knees from going over the toes and not allowing the muscles to pull the knees into the valgus positioning. Power, explosion and correct running form during each drill are key for the athlete to work on when in this aspect of the SAS program. In this segment, drills can be curtailed to each individual sport based on the dynamics of the group.

The strength training portion of SAS is designed to be portable and can be used in any setting, on the field or in the gym. Traditionally, therabands are used for resistance and each activity is done for a time versus repetitions. Strengthening does include upper and lower body, as well as core strengthening. For the most part, exercises will alternate between upper and lower body to not fatigue one muscle group over the other. Hip stabilization and core training are addressed at each session to help balance leg musculature and relieve unwanted stresses on the knees. Through proper hip strength, the valgus (knock-kneed) position is diminished, thereby decreasing the number of serious knee injuries. Weight rooms can be utilized for the strength training portion of the program depending on the facilities that are offered.

When performing the flexibility, proper techniques are stressed to optimize the greatest lengthening of the muscle fibers and diminish injuries that occur from poor stretching. Each muscle group will be addressed. Stretching after activity is important when trying to maintain and/or increase full strength gains. Any athlete, recreational or on a team, should always stretch following activity so that the muscle fibers do not tighten up and begin a vicious cycle of tightening and sudden stretching from increased activity.

SAS is a vigorous conditioning program that promotes power, speed and endurance while focusing on proper technique to decrease serious knee injuries. When participating in Sportsmetrics Speed and Agility, the athlete will participate three days a week for an hour and a half each session. It is to be utilized as a precursor for an upcoming season. Ideally, an athlete should not be in season when participating in SAS, since excess fatigue could hinder the progress and/or techniques that an athlete is trying to instill through this program. The program is designed and structured to progress the athlete from technique development to performance enhancement. SAS offers athletes, coaches and parents the same benefits of an injury prevention program along with the added benefits of a complex conditioning/performance enhancement program.

For more information on the Sportsmetrics injury prevention/performance enhancement program, feel free to contact Erin Johnson, ATC, at 658-7544. She is a certified Sportsmetrics trainer and also spent a six-week internship at Cinncinnati Sports Medicine working with Dr. Noyes and his certified Sportsmetrics staff during the spring of 2009.

Dr. Marc P. Pietropaoli is a board certified/fellowship trained orthopedic surgeon/sports medicine specialist and is president of Victory Sports Medicine & Orthopedics in Skaneateles