Playing with PEP

Posted: May 2, 2011

Originally published March 1, 2010

This story was named a national winner in the 2011 Quill and Scroll Writing and Photo Contest.


Program aims to limit knee injuries in female athletes

By Brigid Kelly
Talon staff writer

First you hear the “pop”, followed by concentrated pain and swelling, leading to an athlete’s worst nightmare-the dreaded diagnosis of an ACL tear.

“I knew it was bad, because I heard it,” said senior Rachel Hansen who tore her ACL nine minutes into the March quarter-final game of the 2008 class 3A state basketball tournament. “When they made the final diagnosis of the tear, I just started to cry.”

The anterior cruciate ligament is a small cable of fiber that connects the femur in the upper leg to the tibia in the lower leg. The ACL provides a stabilizing element as one of four ligaments found in the knee – the largest joint in the body. It takes a force of 2,000 Newtons to cause a complete ACL tear; it is usually accompanied by an audible “pop” and swelling of the knee caused by blood flooding to the joint. An ACL cannot be repaired, only replaced, calling for surgery and a lengthy rehabilitation process.

“The good news is that ACL reconstruction is a highly successful operation,” said Doctor of Physical Therapy Shannon Kegley. “With good rehab, 90 to 95 percent of individuals who undergo this surgery can expect to return to full sports within six months.”

The Beginning:

The early days following reconstructive surgery consist of minimizing discomfort and limiting swelling. These objectives are reached through frequent icing, elevation, and restricted use of the injured leg.

The Early Weeks:

The injured athlete generally works with a physical therapist to regain full motion through exercises focused on extension and flexion.

“It’s super important to be committed to your rehab as soon as you are allowed to begin,” said varsity volleyball coach Natalie Liffrig, who tore her ACL while attending and playing volleyball for the University of Wisconsin-LaCrosse.

Weeks 3-6:

Therapy focuses on strengthening the surgically repaired knee. Aerobic activity is increased and the knee’s range of motion grows.

Months 4-7:

Patience and determination mindsets are key through these months, as progress becomes less noticeable and frustration is often evident. Athletes are reintroduced to sport-specific activities and plyometric oriented exercises.

“I was always itching to get back out there playing,” said Hansen, “but in the end, it was worth sticking with the rehab for the entire time.”

“Reconstruction of a torn ACL is now a common procedure,” said Kegley. “Ruptures occur at a rate of 60 per 100,000 people per year and there are over 50,000 hospital admissions annually.”

The increasingly alarming numbers have attracted doctors’ attentions around the world – particularly the glaring statistics of female victims.

“Female athletes are two to eight times more likely to tear their ACL than males,” said Adam Meierbachtol, a physical therapist at TRIA Orthopedic Center in Bloomington, Minn.

So the question becomes: Can this grueling process and these glaring statistics be avoided and improved?


“The PEP program is a great, simple way to potentially avoid a large number of serious knee injuries and address the traditionally weak areas in female athletes,” said Meirbachtol.

Holly Silvers, a physical therapist and the director of research at Santa Monica Orthopaedic, and Bert Mandelbaum, a Santa Monica orthopedic surgeon, designed the ACL injury prevention program – PEP – Prevent injury and Enhance Performance.

The PEP program is a customized warm-up incorporating flexibility, strengthening and plyometric exercises. One of the top goals consists of strengthening the hamstring muscle rather than the quadriceps – which is often dominant in female athletes leading to knee vulnerability.

The program was published after a league of female soccer athletes between the age of 14 and 18 were studied during the 2000 season. The test subjects were split into two groups, one implemented the PEP program, the other acted as the control. Compiled results included a 74 percent reduction in ACL tears among athletes completing the PEP exercises.

“It takes about 15 minutes, so it may take a little bit longer than a routine warm up, but the pros outweigh the cons,” said Kegley.

Athletic trainer Rebecca VanderWerf brought the program to Minnehaha in spring 2009 as one of the first Minnesota schools to implement the program.

“After a series of ACL injuries during my first year here,” said VanderWerf, “I came across an article that pointed me towards the Santa Monica program for injury prevention.”

VanderWerf has encouraged the program for numerous Minnehaha athletics including soccer, basketball and lacrosse.

“The program has been generally well received, but hard to fit in,” said VanderWerf. “I often end up having to babysit the athletes and teams to complete the exercises”

One of the main supporters of implementing the PEP program regularly is the girls’ lacrosse coach Todd Wadsworth.

“Too many coaches and athletes just want to go straight to playing the game,” said Wadsworth. “If players do not prepare properly, then injury rates will be higher than necessary.”

The program calls for a 15-minute series of 19 exercises – including diverse movements such as shuttle runs, lunges, lateral hops and scissor jumps.

“I didn’t even really realize we were doing it,” said sophomore soccer and lacrosse athlete Cassie Boehm. “I thought it was just another way to add variety to warm ups.”

Though the benefits may not be immediately obvious, the long-term positive effects have been proven.

“I’ve seen the positive biomechanical change,” said VanderWerf. “There’s nothing to lose. Athletes develop better form while preventing injury.”


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