Mick Hughes:
Sports & Exercise Physiotherapist
M. Sports Physio, B. Physio, B.Ex. Sci.

Here is a really interesting paper with some surprising findings. 192 young , highly active ACLR athletes (ave age 21yrs, Tegner Activity Scale level were assessed at 6 months post-op and then followed for the next 2 years to see if they sustained a 2nd ACL injury. The authors wanted to identify if or what possible risk factors that may help explain any 2nd ACL injuries that occurred. Unfortunately 28% of this group of young athletes had a 2nd ACL injury, with half of them s

Ryan Timmins and colleagues have produced a tremendous body of work in the hamstring injury rehab and injury prevention space. Timmins et al 2016 paper looking at risk factors of future hamstring strain injuries in professional soccer players was a groundbreaking paper that identified shorter fascicle lengths of the long head of biceps femoris (<10.5cm) had a 4x greater risk of future hamstring strains in the next season; but increasing the length of the fascicles by 0.5cm ha

There's often a belief that the knee has to be rested following ACL injury. However there's strong evidence that supports high load strengthening exercises - such as this program developed by Eitzen et al 2010. This program has been shown to be well tolerated and importantly, shown to improve many post op outcomes including function, quality of life and increased chances of returning to pre-injury sport compared to patients who didn't do this program prior to surgery. This pr

Once the knee has settled following ACL injury, consistent evidence that we're seeing in the ACL literature from the Delaware-Oslo ACL research team is that the athlete/patient should perform at least 5 weeks of high quality rehabilitation prior to a decision regarding ACLR vs ongoing exercise rehabilitation is made. Click on the link here to get access to this high quality program (see appendix section of the paper for the rehab protocol) Note: The only exception are those A

The Beighton Score is the most commonly reported measurement tool for differentiating between those with and without Generalised Joint Hypermobility (GJH). There is however disagreement in the literature as to age & sex specific cut-offs that differentiate those with and without GJH; with a Beighton Score cut-offs ranging from >4 to >8 identified in the literature. Despite this, a score of >5 is suggested for females aged 8-39yrs and >4 for males aged 8-39yrs (Singh et al 201

10 years on from the game-changing research from Frobell and colleagues who showed that non-operative management of ACL injuries can be just as successful as early or delayed ACLR, not much unfortunately has changed with ACLR rates around the world increasing instead of decreasing. The COMPARE trial looked to replicate the work of Frobell and colleagues (KANON trial) by randomising 167 ACL injured patients into either an early ACLR group (85 patients) or a delayed ACLR group

A great study here by Kasmi et al (2021) looking at the benefits of plyometrics and eccentric exercises in female ACLR athletes. After 14 weeks of rehab, the athletes were randomised into 4 different groups that performed these extra training sessions on top of their regular ACLR rehab: - plyometric only (n=10) - eccentric only (n=10) - combined plyometric and eccentric (n=10) - control group that performed usual rehab (n=10) After 6 weeks of intervention, the group that perf

Can foot position influence hamstring muscle activity? In some exercises, yes it can. In this fascinating paper by Beuchat & Maffiuletti (2019), they found in a group of ACLR patients (9-15 months post-op) who had a hamstring graft, that when compared to a neutral foot position, an internally rotated foot position (foot turning inwards) during a prone hamstring curl significantly increased the activity of the medial hamstring muscle group. However the authors found that durin

In one of the first research trials of its kind, the Nordic Hamstring exercise was studied in a group of professional female soccer players in Brazil. In a 8 week pre-season, Nordics were performed in a progressive manner 2x per week alongside their usual training sessions. The primary outcomes being investigated were changes in eccentric knee flexor strength and long head of biceps femoris fascicle length. The Nordic program can be seen below After the 8 week program, eccent

A battery of 4 single-leg hop tests are commonly used to evaluate readiness to return to training and sport in ACL injured athletes. There are some published hop test data sets in healthy adults (Myer et al 2014), but there is very little published in healthy children & adolescents to allow us to make better return to training and sport decisions in our young ACLR athletes. Until now... 531 healthy 9-15 year olds were invited to participate in this study and their hop perform