Today’s blog post comes from Trent Nessler, PT, DPT, MPT, CEO/Founder of Accelerated Conditioning and Learning (A.C.L.), LLC. He is also the researcher and developer the Dynamic Movement Assessment™ (DMA), author of the textbook Dynamic Movement Assessment™: Enhance Performance and Prevent Injury, associate editor for the International Journal of Athletic Therapy & Training, and Member of the USA Cheer Safety Council. For more information on the DMA or to attend one of their certification courses, you can go to

Figure 1: Following graph shows percentage reduction of injuries in D1 soccer players over 3 years.Over the last 15 years, researchers have published a plethora of studies looking at causative factors for lower kinetic chain injuries. Although the majority of this has focused on anterior cruciate ligament (ACL) injuries, it has helped physical therapists identify specific pathological movements (pathokinematics) commonly associated with all lower kinetic chain injuries. Part of the reason for all the research is due to the pure volume of injuries, the impact they have on performance (current and future), the overall cost of these injuries, and the impact on future injuries and health care costs. Annually, there are over 250,000 ACL injuries in the US. At an annual cost of more than $5 billion, the financial impact to the athlete, organization, insurance carrier, and health care system are astronomical. According to recent studies published in the American Journal of Sports Medicine, 20% of those who have an ACL reconstruction (ACLR) will have a second ACLR in two years, and 40% of those will have more structures involved (meniscus, MCL, etc.), which will prolong rehabilitation and increase cost. Furthermore, 79% of those who have an ACLR will have osteoarthritis (OA) in 12 years. This means increased risk for total joint procedures and/or surgery later in life. A method for evaluating pathokinematics clinically would not only positively impact outcomes and injury rates, but also help us develop a niche practice.

Studies are also finding that the impact of anterior cruciate ligament reconstruction (ACLR) on athletic performance, both current and future, is much greater than originally thought. In fact, recently published data on the return to sport after ACLR is significantly lower than expected. In a 2012 study (AJSM 2012), investigators found that only 63% of high school and 69% of college athletes return to sport following ACLR. Of those that do return, only 43% return at the same level. This puts not only future athletic careers at risk, but also jeopardizes potential scholarships for athletes that may not have other means for a higher education. So, the initial costs are astronomical; the downstream health complications are high; and the athlete’s ability to return to the same level of play is greatly reduced. Hence, as a practice owner and community provider, if we had a way to assess pathokinematics, we would not only be doing a great community service, but also would have another way to set ourselves apart clinically.

Figure 2:  Comparison of risk distribution for team in 2010 vs. current.  >20 % reduction in those at high risk.According to current research, more than 45% of non-contact sport-related injuries occur to the lower kinetic chain (defined in research as knee, ankle, and foot). If you include hip and low back injuries, more than 50% of athletic injuries are non-contact injuries to the lower kinetic chain. Studies also show that if you can prevent these pathokinematics known to be associated with ACL injuries, then you can also reduce all other non-contact lower extremity injuries. Traditionally, though, one could only assess pathokinematics in a biomechanics lab—that is, until now.

Accelerated Conditioning and Learning (A.C.L.), LLC has developed an athletic biomechanical analysis (Dynamic Movement Assessment or DMA) that uses advanced video technology to film, score, interpret, and improve pathokinematics on six core movements known to be associated with lower kinetic chain injuries. In their current study, being performed in association with the American Sport Medicine Institute and Andrews Sports Medicine, they have been using this advanced technology with physicals for Division one soccer players for the past three years. Using the information gained, they develop correctives to aid the team in reducing the pathokinematics identified, reduce their risk for injury, and improve their athletic performance. Figure 1 shows the impact on non-contact injuries to the lower kinetic chain, while Figure 2 shows the change in risk distribution for the team after using the correctives for two consecutive seasons. Besides the human benefits, over the last two years, this has resulted in a $200,000 health care savings for the university.

Youth sportsSo, what does this mean clinically? As clinicians themselves, the team at A.C.L., LLC developed the DMA for practitioners in an outpatient clinic to use to assess orthopedic patients with pathokinematics (movement dysfunction) of the lower kinetic chain experiencing orthopedic problems. Here are some of the most common orthopedic conditions treated with this technology:

  • Back: low back pain, SI joint pain, and facet syndrome 
  • Hip: labral tears, trochanteric bursitis, groin strains, and hamstring s/s
  • Knee: meniscal injuries, ACL, MCL/LCL s/s, PF syndrome, IT Band friction syndrome, and patellar tendonitis
  • Foot/ankle: shin splints, stress fractures, gastroc/calve s/s, and MT stress fracture

Although we developed DMA™ as an athletic biomechanical analysis, this tool is not just for athletes. The team at A.C.L., LLC are also having success when applying this analysis and technology to:

  • Recreational athletes and weekend warriors
  • Youth sports participants
  • Fire fighters and hotshots
  • Police officers
  • Military personnel
  • UPS drivers

In its current state, the Dynamic Movement Assessment is an extremely useful tool that clinicians can implement in any outpatient clinic setting.  When implemented, it can aid in driving practice patterns and outcomes and aid in developing a niche practice.

I cited a great deal of studies in this blog post. Click here to view the full list of references. Please share your thoughts and questions in the comments section below.

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