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The weather is changing, the snow is falling and the Winter sports season is upon us and as we know, with the excitement, also comes risk. Get ready for Winter Season and learn how to keep the risk of ACL and other knee injuries low! Check out this article courtesy of the fabulous team of MD’s, PT’s and ATC’s comprising the Seattle Pediatric Sports Medicine Group.


As our athletes head out onto the field, court, track and slopes we want to make sure they are ready to begin their training armed with tools to help them optimize their performance as well as to reduce their risk of an injury that will cut their season and possibly their career short.
Many athletes, especially those involved in cutting sports such as soccer, football and basketball, are familiar with and fear the possibility of sustaining an ACL injury. Tears to the anterior cruciate ligament sideline more athletes for longer periods of time than almost any other acute injury. It is an injury that brings a season abruptly to an end and often times changes or limits the athlete’s future career. For those of you who are not familiar with the ACL, let us enlighten you. The ACL or anterior cruciate ligament is one of the major ligaments in the center of the knee joint connecting the femur to the tibia and it is an important stabilizing ligament of the knee, serving to control hyperextension, medial rotation and varus/valgus of the knee joint.  These injuries generally occur in one of the following ways:
• Twisting the knee while keeping the foot planted on the ground
• Sudden stop while running
• Suddenly shifting from one leg to the other
• Landing on an extended knee
• Hyperextending the knee
• Direct blow to the knee


Injuries to the ACL most commonly occur in soccer, basketball, skiing, football and gymnastics and 70-90% of ACL injuries are non-contact. Also of note is that depending upon the sport women are 2-8x more likely than men to experience an ACL tear. An unrepaired ACL results in a four time increase in irreparable meniscus tears and an eleven time increased risk of joint surface damage. There are more than 200,000 ACL tears each year in the US alone and on average 175,000 ACL reconstructions each year. This results in >2 billion dollar cost of care and that’s just the dollars, what about the emotional cost to the athlete? Especially considering that the risk of injury increases significantly among girls aged 12-13 and boys aged 14-15 years. What’s the impact on the family, the coaches and the teammates?


There is a plethora of data about the impact of sustaining an ACL tear. This is a serious injury with both short and long term consequences for an athlete…but it doesn’t have to be. These injuries can be prevented. Evidence suggests that prevention rather than treatment is the pivotal issue in reducing the burden of ACL injuries. We all have the opportunity to train our athletes better, train them out of risky biomechanical patterns. Prevention programs incorporating plyometrics and strengthening exercises in combination with feedback to the athlete on proper technique are the most effective for reducing injury risk. Studies indicate that ACL injury rates are reduced 62-72% when neuromuscular retraining programs are utilized. The goal of these neuromuscular retraining programs is to “preprogram” safer movement patterns that decrease injury risk during activity through the utilization of simple warmup exercises. These programs help to instill patterns that specifically reduce injury risk during landing activities and pivoting motions or when the athlete responds to unexpected loads or perturbations.


Youth sports injuries are on the rise and youth athletes present unique risks and injuries when contrasted with the adult population and one of the most common youth sports injuries is an ACL tear. That is why we, at the Seattle Pediatric Sports Medicine Group, have opted for one of our first measures of action to be to combine the knowledge of area physicians, physical therapists and athletic trainers to develop a Warm-up Program designed specifically for coaches to help address the issue. The main concept of the program being that it can be easily incorporated as an active warm-up that would also provide strengthening and motor control activities necessary for injury prevention without additional cost or time out of practice.

This program was designed to both reduce the injury risk as well as to help achieve optimal performance in young athletes by educating athletes and coaches in ways to strengthen and train the body in more efficient and sport-specific patterns for improved motor control. The program consists of a collection of age-appropriate exercises based upon the current best evidence, assembled with the intent to enhance sports performance while reducing selected sport injuries. The program is based upon 4 tenants: dynamic mobility, strengthening, motor control and agility. Each exercise selected is based upon research that demonstrates benefit as far as enhancing each of these 4 tenants.
When used properly it serves to educate athletes on the proper biomechanics for athletic movements for injury reduction while empowering coaches with useful tools to incorporate into practice that will increase athletic performance.