Injury Sam Skinner - ongoing ACL recovery (it's fine everyone, Nunez just trialling psychological warfare)

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#76
Righteo, here's a condensed version of what I'm finding with ACLs.

Apologies as it's a bit longer than id hoped.

As always there kind of has to be a disclaimer just to provide a bit of context...

Despite how much effort we put into rehab and injury prevention I think we currently lack the necessary perspective to truly prevent them - which I think is more possible than we realise.

All of this is from my perspective as a Physio trying to solve a set of problems in my clinic. It's not true empirical research, but it's real time clinical findings - ones that seem consistent and repeatable. So please take from this what you want.

First things first - almost no ACL injury is an accident. It may appear that way, but it isn't. An ACL is seriously robust. It shouldn't fail from either landing or twisting particularly seeing as the majority of ACLs are simple, innocuous incidents.

Accidents happen on the footy field as someone can fall across your leg, but the key it seems here is that the quality of your leg mechanics going in to an accident will have a huge say in how well it stands up to the accident itself. Itll either cope and you'll be fine/fine-ish or it won't and you're out for the year.

Either way, this isnt a conversation entirely about strength and conditioning but the QUALITY of your leg mechanics. It's hugely underrated.

From my experience there is one major factor that seems to be present in every ACL I've ever seen.

Stiff ankles.

There are a few other items of note but this'll be a huge post if I go too deep.

The idea seems to be that if you add some stiffness to the joint below, the WHOLE leg has to find a way around it. You'll see a knee that caves in, you'll see a foot that may turn out, you'll see flat arches.

You'll see an ACL open to rupturing.

It's easy to get a sense of this when looking at someone squat.

Here's a pic of an old Indian lady squatting to FULL depth.



Here's a pic of Sam Skinner squatting to FULL depth.



Notice he's in a deep squat but his heels are a few inches off the ground... he's got stiff ankles, or at least he does if this pic is a true representation of how he squats.

If you can't squat to FULL depth with your heels down, feet straight, knees out and without wanting to fall backwards then you are missing something somewhere. The real kicker is that's supposed to feel normal. Thanks to the modern world - seats, heeled shoes, thongs etc we're batting pretty thin in the inherent flexibility stakes. Just instagram #babysquat or #asiansquat for a decent example of what we should all be able to do.

In summary ACLs (and most other knee issues for that matter) aren't a knee issue at all, they're a leg issue - or at least that's what I'm finding. Essentially the knee fails to cope with the way the whole leg is forced to work around restrictions. The moment an ACL goes is the moment it goes, but the mechanics of your leg leading up to that moment potentially set you up to fail.

There's a lot to cover with an ACL but the thing to take away from today s announcement is that Sam Skinner's knee didn't fail by accident. There's tangible, treatable factors that lead to such a terrible outcome. But you have to go hunting for them.

The biggest wrinkles are obviously his surgeries and rehabs which unfortunately are piling up. But for Sam and anyone else whose suffered an ACL you have to get at the original mechanical flaws, not just rehab the injury.

If he has stiff ankles, they have to go. All the strength and conditioning in the world can't buffer that enough. Clearly Sam's a unit as it is.

Anyway, hopefully that reads well enough, as I said earlier Ill have an in-depth post on this later on but it's a start.

Hope that helps.

This is absolutely fascinating and thank you for taking the time. Looking forward to more.
 

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sven_inc

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#78
Thanks sven, interesting stuff, are you saying that stiff ankles can be turned into flexible ankles or it is genetic and can't be remedied?

I played soccer during my youth (the 1960s/70s) and have played futsal for the last 16 years all year round so at a rough count I have played 800 games during that time and have never suffered a knee injury or a soft tissue injury, I have only suffered 2 sprained ankles in that time both resulting in 2-3 weeks off. I just tried the deep squat and can do it no problems. Anecdotal I know but there you go.
Well there you go, actually learned something on bigfooty, thanks for posting! Genuinely interesting.

If you need any additional evidence I had numerous knee injuries / surgeries playing high level soccer as a junior and I would definitely fit your 'stiff ankles' description. Had to wear shoe inserts due to ankles tilting in.

Actually tried the squat thing and couldn't get my heels anywhere near the damn floor!
I can not do a full squat flat footed. My heals are a good 3+ inches off the ground.

I know I have stiff ankles and feet. I to have to wear podiatry inserts. I have very stiff ligaments in my feet and back of my legs. Yet as a kid I was a genuine barefoot athlete right up to my early teens. Then did tae kwon do and had good flexibility until I left school.
It's a little dodgy to recommend anything specific and individualized over the internet, but if I was to generically treat someone with stiff ankles id go straight for the stretch below. It's brilliant.

Without wanting to self promote any more than I already have, if you check Peninsula Physio on Insta and Facey I post a sh1tload about what I'm finding day to day.

Heaps about all this kind of bizzo.

Thanks for the kind words so far.
 

lions27

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#79
It's a little dodgy to recommend anything specific and individualized over the internet, but if I was to generically treat someone with stiff ankles id go straight for the stretch below. It's brilliant.

Without wanting to self promote any more than I already have, if you check Peninsula Physio on Insta and Facey I post a sh1tload about what I'm finding day to day.

Heaps about all this kind of bizzo.

Thanks for the kind words so far.
Nice work, we use those bands and movements(shoulders,hips,ankles) just about every mobility/stretching session we do at crossfit
 

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#80
Righteo, here's a condensed version of what I'm finding with ACLs.

Apologies as it's a bit longer than id hoped.

As always there kind of has to be a disclaimer just to provide a bit of context...

Despite how much effort we put into rehab and injury prevention I think we currently lack the necessary perspective to truly prevent them - which I think is more possible than we realise.

All of this is from my perspective as a Physio trying to solve a set of problems in my clinic. It's not true empirical research, but it's real time clinical findings - ones that seem consistent and repeatable. So please take from this what you want.

First things first - almost no ACL injury is an accident. It may appear that way, but it isn't. An ACL is seriously robust. It shouldn't fail from either landing or twisting particularly seeing as the majority of ACLs are simple, innocuous incidents.

Accidents happen on the footy field as someone can fall across your leg, but the key it seems here is that the quality of your leg mechanics going in to an accident will have a huge say in how well it stands up to the accident itself. Itll either cope and you'll be fine/fine-ish or it won't and you're out for the year.

Either way, this isnt a conversation entirely about strength and conditioning but the QUALITY of your leg mechanics. It's hugely underrated.

From my experience there is one major factor that seems to be present in every ACL I've ever seen.

Stiff ankles.

There are a few other items of note but this'll be a huge post if I go too deep.

The idea seems to be that if you add some stiffness to the joint below, the WHOLE leg has to find a way around it. You'll see a knee that caves in, you'll see a foot that may turn out, you'll see flat arches.

You'll see an ACL open to rupturing.

It's easy to get a sense of this when looking at someone squat.

Here's a pic of an old Indian lady squatting to FULL depth.



Here's a pic of Sam Skinner squatting to FULL depth.



Notice he's in a deep squat but his heels are a few inches off the ground... he's got stiff ankles, or at least he does if this pic is a true representation of how he squats.

If you can't squat to FULL depth with your heels down, feet straight, knees out and without wanting to fall backwards then you are missing something somewhere. The real kicker is that's supposed to feel normal. Thanks to the modern world - seats, heeled shoes, thongs etc we're batting pretty thin in the inherent flexibility stakes. Just instagram #babysquat or #asiansquat for a decent example of what we should all be able to do.

In summary ACLs (and most other knee issues for that matter) aren't a knee issue at all, they're a leg issue - or at least that's what I'm finding. Essentially the knee fails to cope with the way the whole leg is forced to work around restrictions. The moment an ACL goes is the moment it goes, but the mechanics of your leg leading up to that moment potentially set you up to fail.

There's a lot to cover with an ACL but the thing to take away from today s announcement is that Sam Skinner's knee didn't fail by accident. There's tangible, treatable factors that lead to such a terrible outcome. But you have to go hunting for them.

The biggest wrinkles are obviously his surgeries and rehabs which unfortunately are piling up. But for Sam and anyone else whose suffered an ACL you have to get at the original mechanical flaws, not just rehab the injury.

If he has stiff ankles, they have to go. All the strength and conditioning in the world can't buffer that enough. Clearly Sam's a unit as it is.

Anyway, hopefully that reads well enough, as I said earlier Ill have an in-depth post on this later on but it's a start.

Hope that helps.
Thanks so much sven_inc for this further post. I genuinely enjoyed reading it, and fully understood all of it. You wrote in terms I could understand.

It certainly all makes sense to me......but I'm damned if I'm going to try your squat test, I'd never get up again, or fall flat on my, er, b.u.t.t.o.c.k.s!!:D
 

sven_inc

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#81
Nice work, we use those bands and movements just about every mobility/stretching session we do at crossfit
Great to hear. We owe this stretch to CrossFit to be honest. I do it, and I owe a lot too it.

By far one of the best mobility/rehab tools thats come on the scene since I've been around.
 

sven_inc

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#82
Thanks so much sven_inc for this further post. I genuinely enjoyed reading it, and fully understood all of it. You wrote in terms I could understand.

It certainly all makes sense to me......but I'm damned if I'm going to try your squat test, I'd never get up again, or fall flat on my, er, b.u.t.t.o.c.k.s!!:D
Haha. You won't be alone! If we lined up every single AFL player, I'd be amazed if literally anyone could still do it.

We all can at birth, if you live in an Asian society you probs still can, if you live away from the western world you'll probs never lose it.

When was the last time anyone here actually squatted deep for the sake of it?

As I mentioned above, unfortunately thongs, runners/school shoes/work boots with heels and our love of sitting gradually rob us of this ability as soon as we hit school age. You'd only maintain it if you danced, did martial arts or Olympic lifted to be honest.

Even then you'd be the exception to the rule.

Flat feet, achilles issues, Plantar fasciitis, Shin splints, growing pains, navicular issues, turf toe, ACLs etc. are all essentially cut from the same cloth.

They're just your body compensating for something else. But my industry really doesn't see it this way yet.

This is a massive aside, but when GWS came out a few weeks ago and said their severe run of injuries was 95% bad luck I nearly died. That's 95% of their injuries they literally have no answer for. It should be closer to 1%... They have an amazing strength and conditioning team but I can't help but feel we miss the point so often.
 
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#83
I can not do a full squat flat footed. My heals are a good 3+ inches off the ground.

I know I have stiff ankles and feet. I to have to wear podiatry inserts. I have very stiff ligaments in my feet and back of my legs. Yet as a kid I was a genuine barefoot athlete right up to my early teens. Then did tae kwon do and had good flexibility until I left school.
I can go down pretty well - getting back up is another matter altogether. I blame gravity.
 
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#84
Haha. You won't be alone! If we lined up every single AFL player, I'd be amazed if literally anyone could still do it.
Great info you have provided here, there is good stuff on your insta and website as well. Learnt a lot.

For what it is worth I am in my 40's and unfit and can do the squat easily ( the missus can't) that may explain why i have bowled 5000+ overs of pies over the last 20 years and never had a foot, ankle or leg injury in that time. Would be interesting with the aussie fast bowlers breaking down all the time what your theory is on that. Again thanks for the education, I am going to buy my missus one of those bands.
 
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#91
This is a massive aside, but when GWS came out a few weeks ago and said their severe run of injuries was 95% bad luck I nearly died. That's 95% of their injuries they literally have no answer for. It should be closer to 1%... They have an amazing strength and conditioning team but I can't help but feel we miss the point so often.
Yay, I'm finally part of he 1%.:D

IIRC I asked this on your JOM on the main board, you have great passion for this area of expertise, have you ever sought or applied for a job in the sporting industry re injury prevention.

Maybe Lions_Insider could bring your website and related articles to the relevant peoples attention, at the very least it would be worth their time to have a read.
 

sven_inc

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#92
Great info you have provided here, there is good stuff on your insta and website as well. Learnt a lot.

For what it is worth I am in my 40's and unfit and can do the squat easily ( the missus can't) that may explain why i have bowled 5000+ overs of pies over the last 20 years and never had a foot, ankle or leg injury in that time. Would be interesting with the aussie fast bowlers breaking down all the time what your theory is on that. Again thanks for the education, I am going to buy my missus one of those bands.
Cheers HB.

At risk of taking this too far away from Sam, the deep squat is one of two indicators that seem to match up with injury risk in my eyes. The other is your ability to keep your back in a good position - particularly when you sit.

All the back issues in the world for most the part seem to come back to the boring basics and id imagine our fast bowlers are no different. They almost have to be getting in to bad shapes when they're not being awesome athletes - on the couch, flying internationally, team meeting whatever.

Just to labour the point here's a pic of a beautiful girl in a beautifully straight
sitting posture.



And here's a tweet Freo put out yesterday when Garrick Ibbotson announced his retirement...

Its a screenshot but notice the front two rows in particular. Also, it may not be a coincidence, but pay special attention to the man in red ...



There are so many basic things that have nothing to do with how fit or strong you are that seem to be setting us and our athletes up to fail time and time again.
 
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sven_inc

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#93
Did you ever look into getting into research sven_inc? I know a few people mentioned it when you were talking about JOM earlier in the year.
Unfortunately not as much as I probably should have. It's just a time thing tbh. Young family, sick wife, running a business and my Supercoach team all seem to take priority atm.
 

sven_inc

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#94
Yay, I'm finally part of he 1%.:D

IIRC I asked this on your JOM on the main board, you have great passion for this area of expertise, have you ever sought or applied for a job in the sporting industry re injury prevention.

Maybe Lions_Insider could bring your website and related articles to the relevant peoples attention, at the very least it would be worth their time to have a read.
Tbh I really like what I'm doing atm with my clinic, but I'm always up for anything new. Please feel free to pass anything on to anyone, if makes even the slightest of difference to someone's issues then I'm all for it.
 

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Yay, I'm finally part of he 1%.:D

IIRC I asked this on your JOM on the main board, you have great passion for this area of expertise, have you ever sought or applied for a job in the sporting industry re injury prevention.

Maybe Lions_Insider could bring your website and related articles to the relevant peoples attention, at the very least it would be worth their time to have a read.
its the new clique!
 

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#97
I admit to trying to squat, couldn't resist after all the talk.

Stupid woman!! I couldn't even get halfway down and still nearly fell over, bloody old age!:(;)
Doesn't the old saying go you are only as old as you feel ummm.. or is it you are only as old as the person you feel? ahh I don't know, It's something like that anyway.
 
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#99
I'm 35, have prorated ankles, shin splints, multiple Achilles problems,torn ankle ligaments, grew a foot in two months during puberty and I can still do the full squat! Yay! Although my mechanics give me plenty of problems with both my medial and lateral knee ligaments. My hips are almost frozen from all the sitting I do though.

Very interesting conversation. Thanks.

On the topic of Sam Skinner, he's obviously so talented and seems determined to make it but I would understand if he couldn't put himself through the rehab for a third time. I wish him all the best though, no matter what decision he makes.
 

Back2Back2Back

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Thanks guys, now my colleagues are looking at me weird and asking why I'm squatting at my desk and grabbing at my ankles. The best I can return with is that Sam did his ACL and a guy on the internet said he probably had stiff ankles. They're asking why that relates to me, seeing as how I'm not a professional footballer and would probably not do my ACL from behind my office desk.

You knew this was going to happen.

Jerks.
 
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