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TRAZER®SportsInjuryPreventionProgram = By challenging the athlete’s musculoskeletal, sensory and cognitive systems, sport simulation can serve as the foundation for effective injury prevention programs. Alan W. Davis, M.D. Mark Schickendantz, M.D. Barry J. French, TRAZER® Inventor Edward J. Ash, PT, ATC, OCS, COMT, CSCS RECENT RESEARCH CONFIRMS THAT SPORT SIMULATION CAN BE A POWERFUL TOOL FOR SPORTS INJURY PREVENTION AND PERFORMANCE ENHANCEMENT PROGRAMS. TESTING AND TRAINING THE MIND AND BODY TOGETHER IS THE KEY. Serious, season-ending knee injuries are epidemic in sport. A lack of effective movement training and inefficient biomechanics can predispose athletes to non-contact knee injuries. Athletes may be left vulnerable to the intrinsic challenges of dealing with the unpredictable nature of competition if their training is unrealistic or devoid of the means to assess key performance parameters. Sports injury prevention programs based on pre-planned training activities do not replicate the unpredictability of sport, nor quantify the performance attributes essential to safe and successful play. And many are certainly not considered “fun,” resulting in low rates of compliance. The International Olympic Committee reported that “almost 80% of ACL injuries are noncontact…(and that) injuries often occur when landing from a jump, cutting or decelerating.”1 Based on this report, we believe that missing in current sport injury prevention programs are five capacities to: 1. Immerse the athlete in a realistic training environment that replicates the interactive, spontaneous, rapidly-changing nature of competition, which is prerequisite to training the athlete to anticipate both expected and unexpected forces in any combination of directions. TRAZER®SportsInjuryPreventionProgram 2. Monitor and control the athlete’s body core during sport-specific movement to ensure sufficient knee and hip flexion for safer movement including “soft landings” and biomechanically-correct cutting Successful athletes must perceive environmental cues, decide on the proper course of action, and then execute—all in a fraction of a second. Proper training reinforces efficient motor programs. 3. Provide real-time measures of the deceleration forces associated with braking and cutting The penalty for a slow response, improper execution or poor biomechanical posture and/or neuromuscular activation pattern is sometimes severe and season-ending. 4. Monitor both vertical fluctuations in the athlete’s core and horizontal movement speed to determine the athlete’s optimal athletic stance/posture 5. Apply a combination of simulation and progressive multi-directional resistance for both assistance and resistance to reinforce proper mechanics, build strength, power and stamina, and condition the athlete to deal with fatigue and the imposition of unpredictable forces The TRAZER® Sport Simulator’s more realistic training environment and real-time measurement of the previously immeasurable key components of sports-specific movement provides the athlete, coach or clinician with a powerful new testing and training tool for athlete development, sports injury prevention and rehabilitative programs. THE UNPREDICTABLE NATURE OF SPORTS COMPETITION EXPOSES ATHLETES TO KNEE INJURIES. The interaction between competitors “dueling” for advantage often appears chaotic. The abrupt changes in each player’s movement path necessitate that an athlete draw from a repertoire of sensory-motor skills which includes balance and postural control, stability and the ability to anticipate competitor responses, the ability to generate and control powerful, rapid, coordinated movements, and reaction times and anticipation that exceed those of the opponent. GAME PLAY CREATES DIFFERENT MUSCULOSKELETAL STRESSES THAN PRE-PLANNED TRAINING DRILLS. Conventional injury prevention programs rely primarily on pre-planned training protocols. Cone drills and similar prescribe a movement path known to the athlete in advance. While helpful for initial motor-learning stages, pre-planned training activities are less challenging than cues that assist in training the ability to sense –process – react – execute while maintaining proper body mechanics. Unfortunately, injury prevention programs delivering authentic sport-specific challenges to train athletes to safely respond to the unpredictable have been unavailable, and realtime, directly relevant feedback quite sparse. Yet weaknesses in the athlete’s ability to deal with spontaneous events may most directly relate to actual game performance, as well as to the risk for non-contact injuries. INJURY PREVENTION PROGRAMS BENEFIT FROM ‘AUTHENTIC” TRAINING ENVIRONMENTS. We believe that sports simulation, by simulating the ever-changing, unpredictable interaction between offensive and defensive opponents and the ball, better prepares the athlete to anticipate and react during game play. This type of training reinforces effective responses to 2 TRAZER®SportsInjuryPreventionProgram competition’s spontaneous events. In fact, a June 2009 article from Science Daily states, "If you expose [a person] to more scenarios, and train the brain to respond more rapidly, you can decrease the likelihood of a dangerous response."2 It is this type of training that strives to make injuries relatively rare. Simulation hones the athlete’s ability to react and anticipate sport-specific visual cues. It is designed to improve attentional skills, focus, reaction time, processing and execution. The same June 2009 Science Daily article reports, “…expanding the anticipated training to include shorter stimulus-response times could improve reaction time in random sports settings.” 2 While practicing movement strategies for improved reaction time and performance, athletes can also practice safer and more effective biomechanical postures and neuromuscular reactivity (firing patterns). With simulated play, athletes learn to successfully prepare for situational uncertainties that can predispose them to injury. Sports simulation works to “wire” the body so that the athlete’s senses, mind and body work together at maximum efficiency and safety. “The research suggests that training the brain to respond to unexpected stimuli, thus sharpening their anticipatory skills when faced with unexpected scenarios, may be more beneficial than performing rote training exercises…which is much less random than a true competitive scenario.” 2 TRAZER’S CONTINUOUS HIGH-SPEED TRACKING MEASURES THE PREVIOUSLY IMMEASURABLE. TRAZER® replicates the constantly changing, interactive relationship between offensive and defensive opponents engaging in actual competition. TRAZER reliably tests and effectively trains reaction time, power, acceleration, deceleration, velocity of movement, balance and dynamic posture over sport-specific distances. TRAZER’s realistic cues prompt a sportrelevant movement response from the athlete, while high-speed positional tracking enables real-time measurement of: • Reaction Time – The elapsed time from the presentation of a visual cue to the initiation of correct movement response • Start – The measurement of the athlete’s ability to accelerate (1st step quickness) • Stop – The measurement of the athlete’s ability to decelerate (braking) • Cut – By continuously tracking the athlete’s body core, TRAZER measures movement velocity and decelerations during rapid changes-in-direction • Dynamic Posture – Simultaneously tracking the depth of the athlete’s body core and horizontal movement speed enables determination of the stance/posture that maximizes agility and stamina • Jumping/Landing – The measurement of vertical changes of the body core to determine in real-time jump height and the depth of landings Teaching and reinforcing correct mechanics for sports-specific movement is an important step for an athlete striving to exceed his or her genetic potential, or to reduce the risk of injury. Refining movement biomechanics that lead to improved coordination of the hamstring muscles in concert with the contraction of the quadriceps is reported to reduce ACL strain. 3 TRAZER®SportsInjuryPreventionProgram “Cutting-edge research confirms that training the senses and brain may be key in preventing ACL knee injuries”2 INCORPORATING SIMULATION INTO SPORTS PERFORMANCE ENHANCEMENT AND INJURY PREVENTION PROGRAMS CAN INCREASE PERFORMANCE GAINS AND REDUCE RISK OF INJURY. We previously noted that most ACL injuries occur during a landing from a jump, cutting or decelerating. How then, do TRAZER protocols contribute to preventing injury during the execution of such movements? 1. Determining and reinforcing optimal dynamic posture • Use TRAZER to determine the athlete’s optimal Dynamic Posture • TRAZER play provides real-time feedback of the athlete’s core during movement to ensure proper knee and hip flexion • TRAZER reinforces correct posture via realtime visual display of the moment-tomoment CG elevation • TRAZER also allows the coach or athlete to pre-set CG ranges to enforce the athlete’s Optimal Posture As the athlete becomes “comfortable” with their optimal posture, substantial gains in their agility, power, balance and stamina, elimination of unnecessary energy expenditures and a reduction in the risk of injuries is expected. 2. Safe landings TRAZER’s real-time display of the athlete’s core provides the critical feedback needed to ensure sufficient knee and hip flexion for a welldampened jump landing. 3. Improved agility – safer changes-indirection TRAZER’s real-time display of the athlete’s core elevation during cutting maneuvers acts to provide valuable information regarding knee and hip flexion for safer and more effective changes-in-direction. Post-drill, TRAZER provides measures of the key elements of agility – accelerations and decelerations in 8-vectors. 4. Introducing fatigue— improving strength & power The application of progressive, multi-directional resistance for both assistance and resistance during TRAZER play teaches the athlete to maintain proper mechanics during the imposition of unpredictable forces as it builds functional strength, power and stamina. This progressive, multi-directional resistance also induces fatigue, which acts to condition the athlete to maintain proper mechanics and responsiveness during game play. It is also believed to increase hamstring strength and power to correct quadriceps to hamstring imbalances. 5. Safer knee position— restoring symmetry Research indicates that avoiding excessive dynamic valgus of the knee (“knock-kneed”) and landing straight-legged can reduce the risk for injury. Women were observed to land with less knee flexion, and in general, maintain a straighter knee during game play. Particularly troublesome are hard landings with valgus when the knee is near extension. 4 TRAZER®SportsInjuryPreventionProgram Though TRAZER does not, at this time, specifically measure knee valgus, visual observation by the coach during TRAZER play regarding foot work strategies and knee position can be very beneficial. The use of an elastic band just above the knees provides proprioceptive feedback to assist in correcting knee valgus. “Mental imagery or virtual reality technology can immerse athletes to very complex athletic scenarios, thus teaching rapid decision making.” 2 IN CLOSING…TRAZER CAN BE THE MISSING LINK IN MODERN INJURY PREVENTION PROGRAMS. IT CHALLENGES BOTH MIND AND BODY BY RE-CREATING THE COMPLEX PHYSICAL AND MENTAL DEMANDS OF COMPETITION TO BUILD A SAFER, MORE EFFICIENT AND PREPARED COMPETITOR. References: 1. Renstrom, P., Ljungqvist, A., Arendt, E., Beynnon, B., Fukubayashi, T., Garrett, W., et al. (2008). Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 42 (6), 394-412. Retrieved August 18, 2009, from http://bjsm.bmj.com/cgi/reprint/42/6/394. The Authors: Alan Davis, MD, is a Cleveland Clinic orthopaedic surgeon, and the team Physician for the Cleveland Barons American Hockey League (AHL) team. He was an academic AllAmerican at Michigan State, and has served as Traq Ltd’s medical director since 2007. Mark Schickendantz, MD is an orthopaedic surgeon, director of the Cleveland Clinic Center for Sports Health and head team physician for both the Cleveland Indians and the Cleveland Browns. Edward J. Ash, PT, ATC is the owner of ACTIV PT, a private practice in Richfield, OH. He developed the TRAZER Rehabilitation 2. University of Michigan (2009, July 27). Knee Injuries May Start With Strain On The Brain, Not The Muscles. ScienceDaily. Retrieved August 18, 2009, from http://www.sciencedaily.com/releases/2009/07/ 090724102915.htm Protocols for Knee, Ankle, Hip, Balance, Vestibular, and Knee Prevention. Barry J. French, the inventor of TRAZER, pioneered the application of simulation for the enhancement of health/fitness, physical performance and kinesthetic learning. He has been awarded more than a dozen U.S. patents. The technologies claimed by these patents are currently being used by the vast majority of mainstream video game makers. He has demonstrated TRAZER on Oprah for the Surgeon General, and has appeared on numerous other national TV shows. 5