It’s an exciting time around the world as the torch will be lit today in South Korea to commemorate the start of the 2018 Olympic Winter Games. For the next two weeks, some of the finest athletes from across the globe will passionately compete for gold in sports like skiing, snowboarding, hockey and speed skating.
Amid this spectacle of athleticism, excitement and patriotism, the possibility of injury inevitably lurks in the background. And one of the most debilitating injuries that can occur in sports emphasizing speed and explosiveness is a tear of the anterior cruciate ligament (ACL).
I’m a physical therapist who has specialized in sports medicine for more than 20 years, primarily focusing on injury prevention. To say that I’m obsessed with movement assessment to prevent injuries and improve performance in the athletes I serve would actually be an understatement.
My career has been a very interesting journey, providing unique opportunities worldwide to work on the inside with innovative technologies and amazing people. When I started in the late 1990s, we utilized 2D video cameras (beta tapes) to quantify the movements of athletes in the clinic. I always felt if we could assess it, we could improve it.
By the early 2000s, we progressed to a type of slow-motion video technology called Dartfish, which represented a transformational period in my ability to assess human movement. With this technology, we began to perfect our techniques related to both movement assessment and corrective exercise.
In 2005, we launched our first research project in Division I athletics. The goal was to efficiently assess movement risk factors in athletes through mass physical examinations and create a standardized program that improved those factors. After multiple projects, which involved collecting data on more than 500 athletes and analyzing video for thousands of hours, we knew this wasn’t efficient and scalable. But we were limited by the technology.
Then in 2012, Microsoft released the software development kit (SDK) for the Xbox One. At that point, we began to work with Xbox personnel to program the system so it could automate movement assessment. But after two-and-a-half years, we determined this technology hadn’t yet reached a level that would enable us to accomplish our goals.
Movement Assessment for Athletes
So back to the drawing board we went. The introduction of wearable-sensor technology to the market was a game changer for us. DorsaVi is a technology from Australia that utilizes a medical-grade inertial measurement unit (IMU) and features a magnetometer, gyrometer and accelerometer. These components allow us to capture movement, rotation and acceleration data.
The ViPerform AMI (a DorsaVi product) is a device that uses this IMU to measure motion or stability within 1% of a Viacom system for the spine and knee. We’re now leveraging this technology to assess athletic movement in physical examinations. In conjunction with a program called ACL Play It Safe, these assessments can dramatically impact injury rates and improve athletic performance.
During the testing, each athlete is fitted with 3D sensors that measure motion, rotation and acceleration data through a sequence of athletic movements. The athlete performs three core tests, one bilateral test and four single-limb tests. During core testing, the sensors measure stability within 10 degrees of flexion, extension and rotation. The bilateral test, meanwhile, determines the degree of lumbar flexion and lateral shift (how much the hips move to one side or the other during the motion). For the single-limb component, sensors measure the degree of frontal-plane motion (varus and valgus) and speed of valgus that occurs at the knee.
Following the examination, this system provides an automated report with the collated data. Once the report is generated, we assign each athlete to one of four levels in the ACL Play It Safe Program, designed specifically to enhance performance in the tests we conduct. We hypothesized that if test results improved, we’d see an impact on injury rates and athletic performance. That’s exactly what has happened.
Our current studies apply to Division I athletes, tracking the impact on non-contact injuries, days on the disabled list, insurance-claim submissions and healthcare costs. For Division I volleyball players (N=23), we’ve seen a 60% reduction in non-contact, lower-kinetic-chain injuries, along with an average increase of 1.18 inches in vertical jump and 30 pounds in clean-and-jerk weightlifting.
When the testing is applied to Division I football players (N=205), we’ve observed a significant decrease in concussions (44%), as well as injuries to the knee (72%), lumbar spine (65%), lower leg (53%), ankle (48.5%), and foot (7%).
Additional current studies focus on soccer, basketball and lacrosse. On average, this methodology is generating $30,000 to $50,000 in annual healthcare cost savings per team, per season (not including football). As technology advances rapidly, the next five years will see dramatic changes both on and off the field. The result will be higher efficiency, improved outcomes, greater cost savings and most importantly, an enhanced ability to keep our athletes in the game and performing at their best.
Dr. Trent Nessler is a nationally recognized expert in movement assessment, and a practicing physical therapist with more than 20 years of clinical experience in sports medicine. He is the founder/developer of the ViPerform AMI, ACL Play It Safe Program, Run Safe Program, and the author of a college textbook on this subject. Dr. Nessler has performed more than 5000 athletic-movement assessments in the United States and abroad. He serves as the national director of sports medicine innovation for Select Medical, vice chairman of medical services for USA Obstacle Racing, and a movement consultant for numerous colleges and professional teams. Dr. Nessler is also a competitive athlete in Brazilian Jiu Jitsu.
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