ACL Injuries | Why I Think It's Easy to Miss the Point. (ft. Nic Naitanui)

[footyboi1]

1. Not really unfortunately. More phat than fat to be honest.
2. Im not sure on the ETIHAD numbers but its not as important if your mechanics are normal enough going into it. Again, a surface can't genuinely create an issue in isolation - more so just expose a pre-existing one. But the hard thing is most pre-existing mechanical issues arent noticeable beforehand so it absolutely feels like it could.

My memory isnt great, but I thought the AFL removed the hard material in the center circle that the umpire would bounce the ball on. This was after Shaun Rehn busted his ACL landing on it?

 

[DarkPhoenix]

Interesting write up.

The linking of the squat to the ankles issue seems like a bridge too far to me though.

Surely it can just be explained away that if you're not exercising and executing a deep squat on purpose, that the raised heels position is just far more natural/comfortable to do in day to day life?

I have pretty mobile joints and I can guarantee if I absentmindedly did a full squat, my heels would likely be raised as it's just more natural.

 

[sven_inc]

Interesting write up.

The linking of the squat to the ankles issue seems like a bridge too far to me though.

Surely it can just be explained away that if you're not exercising and executing a deep squat on purpose, that the raised heels position is just far more natural/comfortable to do in day to day life?

I have pretty mobile joints and I can guarantee if I absentmindedly did a full squat, my heels would likely be raised as it's just more natural.

I get where you're coming from. The key thing here to realise is that if you absentmindedly come up on to your toes thats fine. But only if you can deep squat with good technique when promped as well. If the only way you can get to the bottom is by defaulting in to a bad mechanical shape, then that very same mechanism will occur without you realising when being active.

If you have full range and still cant express yourself in a mechanically sound way, then clearly your issue isnt restriction but motor control.

The end result is the same with the knee defaulting inwards.

To your point about coming up on to your toes being natural if you dont squat often - it is but in that instance "natural" isnt "ideal". Its a form of compensation.

We are designed to squat deep our entire lives. Its a resting position, one we are designed to use to go to the toilet, give birth in etc. As modern humans that deep squat isnt prioritised thanks to our dependence on seating, so we lose it over time unless you dance, do yoga, do martial arts, live in an eastern culture or take an interest in it etc.

You can see the result of stiff ankles on your squat in real time if you're interested. Deep squat with your feet straight, heels down, back straight etc and see how you feel. Then free your ankle up with a basic banded ankle stretch and immediately re-test you deepest squat with good form.
You should see an immediate improvement if youve freed up a stiffish ankle.

If that makes sense?

 

[sven_inc]

Shocking for Alex

 

[im_a_lazy_sod]

Only just saw the article now - a great read (especially for someone like me - I rolled my ankle about 10 years ago and hasn't been the same since & has lead to a mild tear in my knee and some dense scare tissue above the joint)

Have since re-assessed how ankles should feel and have worked hard to get them in good condition

But this has opened my eyes further in terms of what I could/should be doing as well as how I should feel

 

[Hundred_Thousand_Tigers]

That was embarrassing to read, with all due respect.

I don’t meant to be rude, but your assumptions about what doctors don’t understand are way, way off.

 

[sven_inc]

That was embarrassing to read, with all due respect.

I don’t meant to be rude, but your assumptions about what doctors don’t understand are way, way off.

Hi mate, I heard a quote a few years back.

It's goes something along the lines of "Everyone is entitled to an opinion, but that doesn't make them all worthwhile."

With all due respect of course.

 

[Hundred_Thousand_Tigers]

Hi mate, I heard a quote a few years back.

It's goes something along the lines of "Everyone is entitled to an opinion, but that doesn't make them all worthwhile."

With all due respect of course.

Opinions mean little in science and medicine.

Evidence is accumulated, refuted, and scrutinised by the collective.

You put your opinions/evidence on the internet. It attracts an observation. Your response? “Not listening, doesn’t matter”.

It’s foolish, and demonstrates a lack of perspective concerning the scientific method.

 

[sven_inc]

Opinions mean little in science and medicine.

Evidence is accumulated, refuted, and scrutinised by the collective.

You put your opinions/evidence on the internet. It attracts an observation. Your response? “Not listening, doesn’t matter”.

It’s foolish, and demonstrates a lack of perspective concerning the scientific method.

I agree opinions mean little.

You seem to be positioning yourself as an authority on the matter yet felt the need to label my article "embarrassing".

I'm absolutely happy to openly discuss the article as it's important so I'm definitely listening to anyone and everyone. I just don't think what you have to say is worthwhile based on what you felt the need to say and how you said it.

You may know this, but you may not so I'll put it in anyway concerning the "scientific method".

In my field, evidence is more than research papers. Considering research is inherently flawed because of a number of potential biases, true "evidence" includes clinical findings.

My role as a Physio is to figure things out clinically with my patients in real time. I don't need to convince you that something is important because all I have to base things on are results. Something either works or it doesnt. There is either a real link or their isn't. There's no agenda, no bias and no opinion. Just results. If there are tangible results great, but it needs to work time and time again with the same person - and others. Otherwise it doesn't work.

In terms of ACL injuries, everything starts with pattern recognition and ends in results. From what I see daily, you'll be hard pressed to find someone with an ACL injury whose knee doesnt have a tendency to dump inwards for a number of mechincal reasons I dont need to go in to.

As unfortunate as Alex's injury was against the Dees - he still had that tendency prior to his injury. You can see it just by watching him move. Id love to get a hold of him and work him out.

My article is my way of getting across what I've come to know over years of assessing and treating ACL patients and finding repeatable results. If you've taken the time to read the article you'll hopefully notice that despite being very comfortable with what Im finding, I am not egotistical enough to assume that everything is 100% fact. If I was, then I'm closed off to more sophisticated ideas and the potential to refine things further.

To your wonderfully worded original post, I don't assume to know what Doctors are thinking and at no stage at all do I say that I do - I have no idea where you got that from. What I can comment on though is the medical industry as a whole - because I'm right in the middle of it.

From what I live and breathe every day, I can state that we do a wonderful job. What I can also say is that despite our best intentions we are still in the dark ages with these things. That may be an opinion, but its one based on years of experience.

If you have a problem with my article then good on you. There's nothing wrong with that at all. If, however, you are someone directly involved in the care or management of someone unfortunate enough to suffer an ACL AND you aren't open minded enough to at least consider this stuff, then that says more about you than me.

If you want to discuss things, pick apart what you don't agree with and let me know why. I'm absolutely all ears. I love this stuff and am more than happy to hash it out.

But again, if that's you're opinion and that's all you have to add, then I'm more than happy to defend myself and move on.

 

[Brad Goodman]

I doubt you'll see the utensil respond.

 

[sven_inc]

Hey all, random question for those that took an interest in the article 12 months ago. Recently my old website was corrupted and I basically lost this article. All I could recover was an old draft that was about 1/3 finished. Does anyone happen to have a random copy of it, or know a way to access one beyond the backend of the old site? It was a really important article and I'd like to elaborate and make it a more in-depth piece going forward. Cheers.

 

[The_Irony]

Hey all, random question for those that took an interest in the article 12 months ago. Recently my old website was corrupted and I basically lost this article. All I could recover was an old draft that was about 1/3 finished. Does anyone happen to have a random copy of it, or know a way to access one beyond the backend of the old site? It was a really important article and I'd like to elaborate and make it a more in-depth piece going forward. Cheers.

If you are hosting the website with a known provider, they normally back up their servers every month. You can try getting in contact with them.

 

[The_Irony]

If you are hosting the website with a known provider, they normally back up their servers every month. You can try getting in contact with them.

Also it loads on the following link. Hope it helps

https://web.archive.org/web/2018073...re-we-missing-something-nic-naitanui-edition/

 

[Coops93]

I haven't had a chance to read through the link yet, so it may be covered, but following the Denver Broncos there's a player named Jake Butt who's done 3 ACLs now, 2 in 1 leg and 1 in the other, he was on a radio interview where he briefly discussed what he was told about his ACLs and ACLs in general:

He was told after his second surgery on the previously injured knee that he had the tightest ACLs the surgeon had ever seen. Further to that, the previous surgery wasn't successful as the ACL wasn't repaired 100% in the "groove" (for lack of better term) that meant re-rupturing it was highly likely. So essentially what he was told was that most secondary ACL ruptures are actually due to an unsuccessful surgery moreso than bad luck or just having "bad knees" now after doing one in the past. The precision required for getting an ACL repair absolutely right is very difficult and if it's off only slightly there a high chance of re-injury. He was told that as a result of the tight ligaments and that the repair wasn't in the exact right location he was basically just an ACL rupture waiting to happen.


I suppose after all that my question is this, is it likely that secondary ruptures of the ACL are frequently caused by what appears to be ultimately unsuccessful repairs? Whether that be the repair is leaving the ligaments too tight, or not exactly in the position they need to be, or anything else along those lines? Clearly luck falls into this as well, as someone can just land awkwardly twice on the same leg etc, but outside of that...

 

[sven_inc]

Also it loads on the following link. Hope it helps

https://web.archive.org/web/2018073...re-we-missing-something-nic-naitanui-edition/

Mate thank you so much. You have no idea how grateful I am for this. I was looking at web.archive earlier today and couldn't get it to work. Thanks for taking the time to help me out! Also, was there a trick to doing it? Copy and pasting the link didn't work for me.

 

[Belnakor]

I suppose after all that my question is this, is it likely that secondary ruptures of the ACL are frequently caused by what appears to be ultimately unsuccessful repairs? Whether that be the repair is leaving the ligaments too tight, or not exactly in the position they need to be, or anything else along those lines? Clearly luck falls into this as well, as someone can just land awkwardly twice on the same leg etc, but outside of that...

so Morabito's 2nd ACL iirc was basically because the graft didn't work correctly. As you said it was waiting to happen.

Its a combination of alot of things which makes is hard

1) previous poor ACL surgery
2) knee structure that means ACL is more likely (ie: females, which is why you see an ACL every game in AFLW)
3) poor muscle balance (ie: the classic "innocuous incident") - often on the alternate knee
4) bad luck (ie: impact injury similiar to Jonathan Patton's 2nd one or Wards recent one)

 

[The_Irony]

Mate thank you so much. You have no idea how grateful I am for this. I was looking at web.archive earlier today and couldn't get it to work. Thanks for taking the time to help me out! Also, was there a trick to doing it? Copy and pasting the link didn't work for me.

No problems. I just copy and pasted man, not too sure if I did anything different. Maybe just involved a bit of luck

 

[sven_inc]

No problems. I just copy and pasted man, not too sure if I did anything different. Maybe just involved a bit of luck

Haha, well you're a genius either way

 

[Upgrayedd]

The Physio who worked on rebuilding my knee's hamstrings mentioned that Nic Naitanui would do a second ACL because of his form

General i think it's a theory fairly new to the physio world that bad form/mechanics plays a huge part. Now we wont ever eliminate some injuries. However proper form, muscle usage is a huge one.

For example. When i was fairly young i really wanted to make the NBL/NBA. however a couple of knee injuries really forced me out of the sport, i Came back older at 24/25 however I could not stop rolling my ankle. So i had about 3 bad ankle rolls a year. meaning i would play about 10 games, roll and ankle and not play for about 6. Untill i decided to go to a physio after 2 years of "Giving up" which he talked about the shape of my legs as in being pretty bowed.

So after about 10 weeks of Pilates strengthing my hips i havent had a major injury in 17 months, Which honestly is the longest consistency i've had since ages 10-15 months. I'll argue that posture, Strength through the hips and mechanics plays about 50% of the chance of you doing an injury rather then blind luck. However i think in todays game a lot of physio's are pretty onto it.

We're seeing a lot of it in the NBA where guys like Rose, Embiid and Smith who are known to have had some bad leg injuries will rather fall over then catch themselves in bad positioning with their legs out.

 

[sven_inc]

Hey all, if anyones interested I've just updated the OP article to make it far more comprehensive.

If you're looking to better understand ACLs and potentially why that happen, the article covers what I've come to understand as a Physio trying to solve these issues. I've used Nic Nat's misfortune as an example of what I'm finding.

Hope it's interesting, and let me know what you think.

 

[avishka5]

Bump.

sven_inc Nic's current injury anything to do with the points you raised?

 

[sven_inc]

Bump.

sven_inc Nic's current injury anything to do with the points you raised?

Obviously can't comment specifically, but I'd expect it to be related.

Stiff ankles set you up for so many potential issues - ACLs being the big one, but general ankle issues another.

If you take a basic ankle roll, being already stiff underneath decreases your ability to buffer an accident when it arises. When the ankle rolls, the joint doesnt have as much give in it so you're more likely to bust through the ligaments instead.

Restoring normal ankle flexibility gives you back your natural buffer to accidents.

But for some reason ankle stiffness still seems to consistently get missed IMO because it often doesn't hurt and is something you have to look for specifically to find.

As an aside it's the reason a team like FREO seem to blame the ground surface over there as well as bad luck for their spare of leg issues. It's the reason GWS and GCS blame bad luck for a lot of their seemingly never ending leg injuries. From what I can see it why Bennell's calves chronically fail etc.

Again, obviously I'd love to get my hands on some of these guys to see for myself, but from what I've come to understand clinically it's most likely to be the foundation of guys like Nic Nat's run of issues.

With Nic Nat I'd be willing to be his already strong ankle stiffness set his ankle up to fail when it did.

Hope to see him back out there soon!

 

[KermitJagger]

Obviously can't comment specifically, but I'd expect it to be related.

Stiff ankles set you up for so many potential issues - ACLs being the big one, but general ankle issues another.

If you take a basic ankle roll, being already stiff underneath decreases your ability to buffer an accident when it arises. When the ankle rolls, the joint doesnt have as much give in it so you're more likely to bust through the ligaments instead.

Restoring normal ankle flexibility gives you back your natural buffer to accidents.

But for some reason ankle stiffness still seems to consistently get missed IMO because it often doesn't hurt and is something you have to look for specifically to find.

As an aside it's the reason a team like FREO seem to blame the ground surface over there as well as bad luck for their spare of leg issues. It's the reason GWS and GCS blame bad luck for a lot of their seemingly never ending leg injuries. From what I can see it why Bennell's calves chronically fail etc.

Again, obviously I'd love to get my hands on some of these guys to see for myself, but from what I've come to understand clinically it's most likely to be the foundation of guys like Nic Nat's run of issues.

With Nic Nat I'd be willing to be his already strong ankle stiffness set his ankle up to fail when it did.

Hope to see him back out there soon!

It's extremely odd that ankle mobility seems to get very little focus outside of professional lifting circuits. It's incredibly important in things like Olympic Lifting because tight ankles compromise your ability to get into a natural deep squat position whilst keeping your heels planted.

Melbourne train in the same facilities as Melbourne Storm, performing similar movements and they had an influx of foot issues over the past year or two. I have the feeling that it comes from prioritising strength work without addressing the underlying mechanical weaknesses of the players.

I think it's something that has held Hawthorn in good stead, in particular, that they have quite an extensive list of consultants that they work with in different capacities and seem to put a concerted effort into stability.

 

[sven_inc]

Just a small bump. I just got around to watching a Twitter video the Hawks posted from Will Golds - the poor lad who suffered an ACL injury earlier this year.

It's a video where Will was nice enough to record himself doing a few basic rehab exercises 4 weeks after his right knee reconstruction back in mid-Feb. I thought it would be really interesting to re-post here for anyone interested in better understanding how ACLs happen.

Here's the twitter link:

If you have a look, pay close attention to two exercises he does in particular.
1) single leg sit-to-stand (0:45)
2) single leg balance (1:56)

More specifically watch what happens to his knee as he lowers himself down during the squat, and then later while balancing. If you have a keen eye you'll see his leg/knee shunt inwards quite obviously at various times.

From the article I posted a while ago, this inward collapse is horrible for the knee long-term. It's most commonly a consequence of ankle stiffness - which judging by the thick heel on Will's shoes in the video, might be heavily in play here too. In this video Will is only 4 weeks post-op so obviously he won't have his full function back, but it does highlight the type of mechanism that he really needs to eliminate to make sure he doesn't succumb to a 3rd ACL injury.

Anyway, just thought it might be interesting to point this out for anyone who's into this kind of thing or has had an ACL themselves in the past!

 

[kaiserchief13]

Just a small bump. I just got around to watching a Twitter video the Hawks posted from Will Golds - the poor lad who suffered an ACL injury earlier this year.

It's a video where Will was nice enough to record himself doing a few basic rehab exercises 4 weeks after his right knee reconstruction back in mid-Feb. I thought it would be really interesting to re-post here for anyone interested in better understanding how ACLs happen.

Here's the twitter link:

If you have a look, pay close attention to two exercises he does in particular.
1) single leg sit-to-stand (0:45)
2) single leg balance (1:56)

More specifically watch what happens to his knee as he lowers himself down during the squat, and then later while balancing. If you have a keen eye you'll see his leg/knee shunt inwards quite obviously at various times.

From the article I posted a while ago, this inward collapse is horrible for the knee long-term. It's most commonly a consequence of ankle stiffness - which judging by the thick heel on Will's shoes in the video, might be heavily in play here too. In this video Will is only 4 weeks post-op so obviously he won't have his full function back, but it does highlight the type of mechanism that he really needs to eliminate to make sure he doesn't succumb to a 3rd ACL injury.

Anyway, just thought it might be interesting to point this out for anyone who's into this kind of thing or has had an ACL themselves in the past!

His legs are tiny, needs to start hitting the squats to stop another acl occuring