The Region’s Leader
Athlete’s
Update
Keeping you informed about sports-related injuries | Spring 2009
When ACL Reconstruction
is Not the Answer
By Timothy P. Quinn, MD
Anterior cruciate ligament (ACL) tears of
the knee are an unfortunate and
common problem in today’s athlete.
ACL tears in skeletally immature
individuals (children and
adolescents) are being seen with
increasing frequency and
management remains controversial.
Delaying surgery until skeletal
maturity is reached is one approach
to avoid growth plate problems
(tunnels are made in the bone for
the ACL graft). Activity modification,
wearing a knee brace, and
rehabilitation are recommended
but the outcome is usually poor.
Meniscus “cartilage” tears can
result during the “wait period.”
Newer surgical procedures have
been developed to prevent
growth plate injury.
Over the past 29 years, I have performed
thousands of ACL knee surgeries on
both athletes and non-athletes. The
mantra of an orthopedic surgeon is
usually, “If it is torn or broken, fix it.” The
giving way episodes and damage to the
knee that result from ACL tears
necessitates surgery in most cases.
However, there are instances and
situations when certain individuals will
potentially do better if they do not have
ACL surgery or if they wait for a period
of time before surgical reconstruction.
When the
ACL is torn,
a main
stabilizing
force in the
knee is
compromised
resulting in
“giving way”
or “pivot
shift” of the
bones of the
knee. Athletes usually can’t function
at a high level of performance with a
torn ACL.
After an acute ACL tear, studies have
shown that delaying the initial surgery
until the inflammation and swelling
have subsided and full range of motion
is obtained leads to the best surgical
result. “Pre-habilitation” (rehab prior to
surgery) of the knee is done and can last
for 2-4 weeks.
Less active, older, or sedentary people
may not be candidates for ACL surgery.
If a person in this category is not
experiencing painful “giving way”
episodes and can rehab their knee and
perhaps wear a knee brace, surgery is
not needed. Restoring muscle strength
and some activity modification is
paramount.
Most ACL tears occur in active, athletic
individuals. In my practice, these
people need surgery for the best result.
A successful knee surgery requires a
very successful post-op recovery and
rehabilitation program before an
athlete can return to full activity.
Timothy P. Quinn, MD, is an orthopedic
surgeon and sports medicine specialist
and a partner with Far Oaks
Orthopedists, Inc. He is a graduate of
the University of Dayton and the Ohio
State University College of Medicine.
Dr. Quinn is a board certified orthopedic
surgeon and he is a team doctor and
orthopedic consultant for UD. Dr. Quinn
is also the Associate Director of Sports
Medicine/Orthopedic Strategic Planning
and Business Development at Miami
Valley Hospital.
Understanding Reaction Time
By Aaron Perry, LAT, ATC
Reaction time is often the deciding
factor for who gets the ball, who
scores the touchdown, or who wins
the race. If you are able to out react
your opponent, your odds of success
greatly increase. To facilitate agility
and reaction time we must first
understand a little bit about how
it works.
First, our bodies have two primary
types of muscle fibers. Type I fibers,
also called slow twitch and type II
fibers, also called fast twitch fibers. The
type that is responsible for agility and
reaction time are the fast twitch fibers. Just as it sounds, fast twitch muscle fibers respond to short
bursts of intense activity that require little or no oxygen. Fast twitch fibers are responsible for anaerobic
activities such as weight lifting or short sprints up to about 400 meters. It is generally accepted that our
bodies have a set amount of each type of fiber and there is little that can be done to change it.
The second aspect of muscle fibers to understand is their recruitment order. Type I fibers have smaller
diameters than Type II fibers and therefore are more easily excitable. Because of their smaller diameter
they are recruited first. Fast twitch fibers
require a much larger amount of force to
be recruited and therefore will only be
trained through specific requirements.
The force must be such that the body
moves from slow twitch recruitment to
the more powerful fast twitch fibers. By
teaching the body to react quicker to a
stimulus you teach the body to recruit
fast twitch fibers more efficiently.
Some easy ways to train agility and
reaction time include ladder drills, reaction balls, and specialized plyometrics. As a
coach, athlete, or just someone interested in improving their performance, adding
this type of training can drastically change your game. Incorporating agility and
reaction drills will take your game to the next level and can give you the edge you
have been looking for. The athlete who gets the first step, gets the best step!
Aaron Perry, LAT, ATC, is a certified
athletic trainer at Miami Valley
Hospital Sports Medicine Center.
He graduated from Wright State
University with a degree in athletic
training. Aaron previously worked
with a strength and conditioning
team in Indianapolis and has
worked with athletes from the
junior high level up through the
professional level. Aaron also
serves as the head athletic trainer
for Bellbrook High School.
2 Miami Valley Hospital • The Region’s Leader
Editor’s Note:
In the previous issue of the
Athlete’s Update the article on
“Losing to Win” should have stated
the recommended amount of
protein as “.6 not 6 grams of
protein per pound of body weight.”
An ODE pupil activity
course will be held at
Fairmont High School
on July 29
Key Components of Off-Season Workouts
By Dan Mueller, MS, ATC
Bigger. Stronger. Faster. These are three goals in which offseason workouts are geared towards for the high school athlete.
These workouts should be part of an entire season training
session with different goals for each section. Off-season
workouts should differ significantly from those that occur
during the season (yes it is important to have lifting for
ALL sports during the season). This article will give
recommendations for exercises and regiments to implement
for both in-season and off-season workouts.
The typical off-season regiment involves a combination of
exercises designed to focus on specific aspects of your athletes’
abilities that needs improvement. These can involve exercises and specialized drills
to increase strength, speed, jump height, lateral movement, endurance, flexibility,
or overall mass. The workouts should be 3-4 times a week for 6-10 weeks. It takes
an average of 6-8 weeks to notice measurable changes in muscle from weight
training.
In all periods of exercise there should be a variety of types of exercises used to train
the entire body. Free weights, machines, speed training, abdominal exercises, and
cardiovascular work should be built into the entire program. Resistance and
duration of exercise should increase as the athletes are able to handle it. This is
vastly different than the type of exercises the athlete should be doing during the
season.
In-season weight training goals are an attempt to maintain gains achieved during
off-season training and to help keep the athlete healthy. In-season training should
also be 2-3 times a week for lesser time intervals and should not be as intense to
help recover from the rigors of the season. Too much training during this stage can
have a negative effect on the athlete and can help contribute to the body breaking
down during the season. A good combination of off-season and in-season workout
will help your entire team come closer to achieving your goals. Bigger. Stronger.
Faster.
Dan Mueller MS, LAT, ATC,
joins the Miami Valley Hospital Sports
Medicine team after spending two
years as the athletic trainer for men’s
basketball at East Carolina University.
Along with his duties at the sports
medicine clinic, Dan also serves as an
athletic trainer at Fairborn High
School. A native of Milwaukee, WI, Dan earned his
bachelor’s degree in athletic training from Xavier
University in 2003. After earning his undergraduate
degree Dan served as a graduate assistant athletic trainer
at Indiana State and as an athletic trainer at Terre Haute
North High School while obtaining his master’s degree in
2004. Dan is a certified member of the National Athletic
Trainer’s Association (NATA) and certified clinical
instructor.
Sample Exercises for Off-Season Workouts
Olympic Lifts
Cardiovascular exercises
Abdominal and Core
• Good mornings
• Ladder drills
• Crunch
• Power cleans
• 100’s
• Russians
• Squats
• 400’s
• Superman’s
• Lunges
• 1600’s
• Anterior reaches
• Bench press
• 3200’s with sprints
• Posterior reaches
• Incline DB press
• Start drills
• V-ups
Athlete’s Update 3
The Miami Valley South
Emergency Department –
Your Choice for Emergency
Athletic Injuries
By Cathy Hall, Director of Clinical Operations – Miami Valley
South Health Center
Our team is here for your team! The full service Emergency
Department at the Miami Valley South Health Center campus
is available twenty four hours a day, seven days a week. Our
team of board certified emergency physicians, registered
nurses, physician’s assistants and technicians have trained to
provide assessment and interventions using state of the art
diagnostic testing for the emergency evaluation and care of
your athletic injuries. We are your neighborhood emergency
facility providing convenient access to where you live and
train.
We know you have trained to be the very best athlete. We
know that being an athlete is part of who you are. We know
that an injury or illness can be painful and create anxiety
around your future ability to continue to compete. We know
the emergency care we provide is critical to your ability to get
back into the game.
We know that our job is you!
• Our job is you if you slide into second and suffer a sprain or
fracture.
• Our job is you if you catch a hurdle on the track and need
sutures for a laceration.
• Our job is you if you become dehydrated while training in the
heat of the day.
• Our job is you for exercise induced asthma.
• Our job is you if you fall off your bicycle and need evaluation
for a possible head injury.
We have available, on site, state of the art digital radiology,
CT scan, MRI and ultrasound to our emergency physicians to
assist them in diagnosing your injury. We are part of Miami
Valley Hospital and have specialists available for consultation
or continued care when admission is required. Your continuum
of care is enhanced by our electronic medical record allowing
our specialty physicians to remotely access your x-rays and
emergency department medical records.
Of course, the Miami Valley South Health Center campus is
home to our Sports Medicine Center, outpatient diagnostic
testing, and specialty physicians such as orthopedic and
hand surgeons which are all available for direct referral for
follow-up care.
Our team is here for your team!
Visit us on the web at mvh.org/sportsmed
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