Athena Study Final Review: Process, Final Results, and Next Steps

by Jordan Smothermon

In the previous report three weeks into our study, we outlined the stark risks female adolescent athletes face in suffering knee injuries, causes of these risks, and the methodology and reasoning of our Athena training program.

Now, after completing 6 weeks, a final reassessment and analysis of the results are being conducted. Though this report is not a comprehensive presentation of data, a number of findings are worth remarks.

Awareness

For those athletes who exhibited considerable knee stability issues, a common pattern emerged in their process towards establishing improved movement. The initial, crucial step in that process was simple awareness.

Most athletes had no awareness of what their knees were doing while moving. They didn’t realize their knees were diving. In cases where ankles were diving, they didn’t realize that either. The first step for them, then, was learning how knees should move, what it looks like from their perspective, and applying the proper correction to the appropriate fault they performed.

Primarily, each athlete with knee instability only had a single fault they performed over and over again, so they had to become aware of that particular fault, then learn what one correction to apply to get them into the proper position. One fault, one correction.

Still, some athletes performed a series of faults. For these athletes, the process of awareness was the same, only longer since they learned to correct a single fault at a time. For some athletes, correcting the initial fault fixed the rest. Yet for other athletes, it was piece by piece.

The difference between athletes who had a single fault to correct and those who had a series of faults is worth remarking on since athletes with multiple faults were able to progress the first correction at the same pace as those with one fault. Yet, as they became aware of and corrected the first fault, they then had to become aware of the next fault in the series before being able to correct it. This seems really obvious in retrospect, but illustrates that a bad movement pattern can be so ingrained that it requires detailed and diligent correction of each step in the faulty pattern.

Once they were aware, providing dedicated time to practice the correction became the focus in order to move them to the next progression of the plan of adding resistance or dynamism.

Correction and Progression

After athletes became aware and understood how they needed to correct their issues, they integrated those corrections into drills that required some degree of dynamic movement. Initially, corrections did not flow over to other drills and movements. In this way, the correction was only able to be applied under the conditions of a particular drill.

Understandably, athletes gradually gained the ability to apply the correction automatically across a number of movements and drills. This stage was highly dependent on the dynamism of the drill, though. As drills became increasingly dynamic, the ability to maintain the correction decreased significantly.

Then, athletes started to be able to apply corrections across various activities automatically though not consistently – they still reverted to poor movement patterns and exhibited the same faults before awareness began. The inconsistency of their performance during our study was caused by the continual progression of drills to becoming more and more dynamic.

This stage of inconsistent integration or correction is a delicate stage for athletes. Frustration accompanies inability. Positive feedback is essential to keep the athlete focused on how far they’ve come rather than the distance they still have to go. Our athletes could get caught up in a bad day of training, a bad drill, or even a bad round, which comes from the right intention of the athlete: it shows their strong desire to improve, to be perfect – yet can be destructive if they can’t get past this stage. We lost four athletes to voluntarily drops from the program because of the frustration associated with this stage, though not all at the same time (some athletes are more resilient and so will try longer). While it is necessary to continue progression to continue adaptation, the plan in its current iteration could be progressed too fast for every individual. Or perhaps, the plan needs an improved way to progress an athlete along based on their performance rather than simply week by week.

Athletes that persisted through the frustration of their own inconsistency subsequently began to make large strides of improvement. Much of their improvement came from increased confidence. As a result, they welcomed greater challenge. However, their improvement was not final as they still exhibited occasionally faulty movements if considerably fatigued or if the movement was drastically changed, for example, going from a bilateral to unilateral movement with the same dynamic demands. These factors indicate their improvement is not complete – a not surprising result for six weeks of training.

The real question still remains whether or not the incomplete improvements are permanent and can continue to be built upon as athletes exit the plan for sport seasons.

Results

Two results stand out: the Drop Jump Test and the Single Leg Squat Test.

The Drop Jump Test shows whether or not athletes will experience knee dive during the take off and landing phase of a vertical jump.

In the first assessment of knee stability parameters (we used a test developed by Frank Noyes, M.D., founder of Sportsmetrics called the Knee Injury Test), only three of 17 athletes scored “good” on the Drop Jump Test (a subjective scoring system of “bad,” “fair,” and “good”), where they exhibited no loss of knee tracking through the three phases of the test. That’s 17% of athletes who scored “good.”

Yet, in the final assessment, 13 of 17 scored “good” according to the same scorer. That’s 76% of athletes. A improvement of 59% of our population.

The Single Leg Squat Test identifies hip strength deficits indicated by one of three faults: pelvic drop (the hip of the lifted leg drops as the athlete squats), knee valgus (knee turns inward on the stance leg), and trunk lean (shoulders shift towards the stance leg to maintain balance). These faults are measured for each leg.

Initially, only a single athlete exhibited no faults for both legs. Yet, after the program, eight athletes improved to exhibiting no faults for both legs.

Next Steps

Now that we have some data, we’ll go back to the drawing board and improve our plan. Also, we’ll keep and eye on the athletes we’ve worked with to collect data on injuries. Initial revision ideas include:

Scale progressions to integration of stability. Easier said than done since the athlete needs to be able to reliably assess their own quality of movement. And quality of movement is subjective.
Improve transition between bilateral to unilateral movement. As the program stands now, there is a sharp cut from bilateral to unilateral movement. It may be better to shift the load of volume to single leg work more slowly by starting single leg work earlier. They’ll develop the specific intrinsic foot strength and balance needed earlier, so that when they move entirely to single leg work, it’s a smooth transition.
Possible earlier and more frequent use of resistance bands. Are resistance bands a crutch or essential tool? As it stands, the program utilizes resistance bands during the second half of the plan. It’s our inclination to allow the athlete to make the integration of proper movement on their own, then introduce bands to reinforce the recruitment. Many plans use bands in the beginning to teach glute muscles to fire, then take them away gradually, if at all. But is this right, or is it creating a “training scar” by forcing the athlete to rely on the band to force glute recruitment? Is the best practice to use resistance bands to teach, then remove them once the pattern becomes integrated? We’re not convinced they’re necessary or good, but their use does warrant more testing.
Follow-up with athletes. Now that athletes have transitioned into their spring sports, we will track and follow-up with athletes on any non-contact knee-related injuries they suffer.
Develop follow-up “in-season” program. A common practice for athletes on the strength side is to develop an in-season training program in the weight room that allows them to maintain most of the gains they made in the off-season during their competitive season. Perhaps a follow-on program to Athena is appropriate in this vein of logic.
Expand and conduct more studies. The most important next step is gathering more data. In general, we want to expand the testing and data collection of Athena by involving more schools and clubs. The more data points we obtain, the more we can revise and improve our plan. The better the plan, the fewer injuries and better performance these young developing athletes experience. Fewer injuries reduce the economic, emotional, mental, and health impact on athletes. Better performance increases the quality of life, competition, and development of athletes, allowing them to experience longer, more positive, and a greater number of healthy athletic years.