Tim Hewett
@Hewett1Tim
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PhD Consultant and Aficionado of Biophysics, Biomechanics & Sports Medicine Research https://t.co/DhIxi859Mv Tweets our own RT’s not endorsements
Rochester and Minneapolis, MN
Joined April 2015
R PURPOSE STATEMENT: 1 PRODUCE the highest quality research, 2 EDUCATE the public on the latest research advancements and 3 TRANSLATE them into clinical practice! @TimothyHewett1 @TimHewett5 @ChadLavenderMD @3jjasko @MUHealthOrtho @MUSportsMed @MUSOMWV @marshallu @marshall_health.
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How does a Human Achilles Tendon Rupture . ? Here's how . check it out @MayoClinic Materials & Structural Testing Core @mayoclinicsport !
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Does anyone really think 🤔 they can stretch out this “tough band of fibers” with a foam roller. ?.
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Teaser. here are our major findings. : 1) Only 23% Athletes Pass RTS Criteria 2) Passing RTSC 👇 Risk Graft Tear 60% 3) Passing RTS Criteria 👆Risk of Contralateral Tear by 235% 4) YES . we said INCREASES RISK of a 2nd Contralateral Tear by 235% !.
Just finalised proofs for this one 👇which we started on my sabbatical with @Hewett1Tim in 2015! Looking forward to seeing it online soon.
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Basics of R ACL Prevention Portfolio:
No one knows more about preventing #ACL injuries than @Hewett1Tim from @mayoclinicsport! Great @MayoClinic video posted by @OREFtoday. Definitely worth a look. @ACLInjuryRehab @ACLrecoveryCLUB
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Plyometrics R KEY🔑4 Injury Reduction
NEW BLOG: Plyometrics are an important component in injury prevention programs and injury rehab; yet as physios, we often under-utilise them. In order to find out more, I sat down with S&C coach @lachlan_wilmot to find out more!. Blog ⬇️⬇️.
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Knee abduction moment is predicted by lower gluteus medius force and larger vertical and lateral ground reaction forces during drop vertical jump in female athletes.Ryo Ueno Alessandro Navacchia ChristopherDiCesare Kevin Ford Gregory Myer Tomoya Ishida Harukazu Tohyama Tim Hewett
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This belief is Simply WRONG!: combines all previous meta-analyses into a single source and shows conclusive evidence that ACL injury prevention programs reduce the risk of all ACL injuries by half in all athletes and non-contact ACL injuries by two-thirds!.
I believe that strengthening the muscles around the ACL can help with prevention, but I think non-contact torn ACL’s (which makeup about 85% of them) are simply a case of bad luck.
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Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations athletes achieve baseline joint health and function approximately 2 years after ACLR. delay return to sports 2 years!
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Biomechanical features are associated with ACL with increased activation of the gluteus medius. Targeted neuromuscular training to control frontal pelvic hip motion avoids injurious ground reaction forces, consequent knee abduction moment & ACL injury risk
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Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs: reduce risk of all ACL injuries by 1/2 & non-contact ACL injuries by 2/3.J Orthop Res. 2018.Webster KE Hewett TE2,3,4,5. @altmetric Score Now = 545 & climbing.
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This paper combines all previous meta-analyses into a single source and shows conclusive evidence that ACL injury prevention programs reduce the risk of all ACL injuries by half and non-contact ACL injuries by two-thirds
A Meta-analysis of Meta-analyses of Anterior Cruciate Ligament Injury Reduction Training Programs. Webster KE, et al. J Orthop Res. 2018. Webster KE Hewett TE.School of Allied Health, La Trobe Uni.Mayo Clinic Biomechanics Labs Orthop Surgery, Mayo Clinic
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Proper ACL Injury Prevention Programs reduce the risk of ALL ACL injuries by 1/2 and non-contact ACL injuries in girls and women by 2/3rds! .Meta‐analysis of meta‐analyses of anterior cruciate ligament injury reduction training programs
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In Short… ACL Injury Risk can be reduced by half (50%) in all athletes and by two-thirds (67%) in non-contact ACL injuries in women with well designed, targeted and well utilized and adhered to neuromuscular training
@JamesLNuzzo @Hewett1Tim @TimothyHewett1 I'm aware Tim has done quite a bit of work. Thanks for the suggestion @JamesLNuzzo! So, @Hewett1Tim @TimothyHewett1 would be great to just get short answer on injury rates in male football players as far as ACLs in the last 40 years or so? How much progress has been made? Still.
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A Bone-Patellar Tendon-Bone ligamentizes in 12-18 months, a Hamstrings Graft in 18-24 months plus and an allograft requires 24 months plus to ligamentize or “heal.” Please See this analysis 4 more detail:
@Hewett1Tim What about autograft vs allograft? How does that play into the biology of healing? It was my understanding that a PT auto shows good healing by 6 weeks, a hamstring auto shows good healing by 3 months but allograft could take 2 years or more for healing.
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The ACL receives nerve fibers from the posterior articular branches of the tibial nerve. These fibers penetrate the posterior joint capsule and run along with the synovial and periligamentous vessels surrounding the ligament to reach as far anterior to the infrapatellar fat pad.
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Neuromotor Control of the Trunk PREDICTS Knee, Ligament & ACL Injuries in athletes .
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Yes it does as Knee flexes loads are absorbed & dissipated by hip & Knee musculature & ACL injuries don’t occur past about 50° C these:
@Hewett1Tim does knee flexion reduce the likelihood of an ACL tear? It looked like @JimmyG_10’s Knee was pretty straight when he tore his. What does research indicate?.
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Musculoskeletal Injury Risk After Sport-Related Concussion: A Systematic Review and Meta-analysis. McPherson AL1,2, Nagai T2,3,4, Webster KE5, Hewett TE Meta- indicated that athletes who had a concussion had 2 times greater odds of sustaining a MSK injury!.
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A Meta-analysis of Meta-analyses of Anterior Cruciate Ligament Injury Reduction Training Programs. Webster KE, et al. J Orthop Res. 2018. Webster KE Hewett TE.School of Allied Health, La Trobe Uni.Mayo Clinic Biomechanics Labs Orthop Surgery, Mayo Clinic
A Meta‐analysis of Meta‐analyses of Anterior Cruciate Ligament Injury Reduction Training Programs*. Kate E Webster Timothy E Hewett.@DrKateWebster @Hewett1Tim @TimothyHewett1 @TimHewett5
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NEW Webster & Hewett CJSM 2021 Umbrella Meta-analysis combines all prior reviews & shows OA risk increased 7-fold w ACL injury & 8-fold w surgery OA prevalence estimated @ 36% @ 10 years post-recon & higher w surgical Tx! #OA @DrKateWebster @TimothyHewett1 @CJSMonline @TimHewett5
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Yes, without a doubt this is an ACL Injury! What you’re seeing is a pivot shift which is the number one most specific clinical test for an ACL injury . basically it’s a forensic reproduction of the ACL injury mechanism. So it’s definitely an ACL!.
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There’s good research on the menstrual cycle affect on injury risk @Coach_Alejo @BohdannaZazulak @TimothyHewett1 @TimHewett5 #Menstrual.
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A Classic Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study.Hewett TE Am J Sports Med 2005 Knee motion & loading R predictors of ACL injury
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ACL Injury Reduction by 50 to 67% (half to two-thirds) is more accurate:
Neuromuscular training programs have been shown to reduce the incidence of ACL injuries by 40-65% (Gagnier et al., 2013; Donnell-Fink et al., 2015; Taylor et al., 2015; Soomro et al., 2016) @mickwhughes #VICSMA18 @SMA_Events
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Former NFL players who tore their ACL had approximately 2-fold increase in.muscular skeletal co-morbidities including knee joint replacement & arthritis & had more than 50% increased risk of myocardial Infarction compared with those without ACL tears. #ACLInjury @TimothyHewett1
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OKC is OK 👍 post-ACLR. both concentric and eccentric check
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We have 2 of TOP 10 Cited ACL Papers of ALL TIME and 10% (5 of 50) of TOP 50 ACL Papers of ALL-TIME . We LOVE IT! NOBODY loves our work better than US . Sincerely, @TimothyHewett1 @TimHewett5 @Hewett1Tim THANKS for the 'Heads UP' Dr. Krych @DrKrych
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Q-angle does NOT appear to be a major predictor of ACL injury risk. Check out these👇 4 details 👇
@efeldman62 @missEmitche11 @eo_performance @DocSoph There is enough information suggesting that Q-angle may not be an issue. Some studies showed the Q-Angle contributing when studied with other factors but not alone. @Hewett1Tim @DrKateWebster help us out here!.
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Hamstrings strength remains decreased ⏬on the hamstring's tendon harvested side at even three years post ACLR:
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The Difference Between Science & Science Fiction. is EVIDENCE @DrKateWebster @TimothyHewett1 @TimHewett5 #scifi
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Need to correct mechanics on the involved left side . look 👀 at valgus collapse of hip and knee with brace.
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Here’s a fact 4U. I presented this paper at an international Sports Medicine meeting two of the top Sports Medicine surgeons in the world, Dr. James Andrews and Dr. Freddie Fu both congratulated me and said we were absolutely right about the 2 year wait:.
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TrunkLean —> Valgus —> ACL Injury ….@TimothyHewett1 @TimHewett5 @MBourne5 @ChadLavenderMD @MUHealthOrtho @MUSportsMed @MUSOMWV @marshallu @marshall_health @HerdZone @muresearch @elonmusk
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@MayoClinic @mayoclinicsport Did the NFL Lockout expose the Achilles heel of competitive sports?@Seth0Neill .See R Achilles Tendon Figure JOSPT:
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We can’t either. #ACLreduction
I can’t figure out why the NFL doesn’t require teams to have ACL prevention training.
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Q-angle is over-stated & overrated . here’s a male to female comparison! #QangleDoesntPredictACLinjuryRisk
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WOW . 30% risk of contralateral ACL rupture after RTS . the high consilience of this 2nd injury data in the ACL literature is astounding @DrKateWebster @feller_julian Thanks 🙏 for the heads up and the great 👍 work @MikeReiman !.
83% of patients RTS, only 53% at prior injury level. Similar both males & females; males longer careers. Re-injury after returning to prior level: 30% contra & 11% revision). 52% females & 45% males-reason for changing level of RTS not related to knee function. @AJSM_SportsMed
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Yes . over 60% greater risk of an ACL tear on the new rubberized turfs compared to natural grass. .
@Hewett1Tim @BenDinnery @NFL Has there ever been any noticeable increase of ACL tears on artificial turf when compared to grass?.
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yes Yes YES !!! Absolutely YES!!!: This is conclusive evidence that ACL injury prevention programs reduce the risk of all ACL injuries by half in all athletes and non-contact ACL injuries by two-thirds in female athletes.
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21 Achilles Ruptures @nfl @NFLResearch this season with an average of 18 over the last 5 seasons… @TimothyHewett1 @TimHewett5.
Another one…. Clear video of the @MiamiDolphins Phillips’ right calf quiver and recoil as the Achilles tendon lengthens and ruptures. #NFL @injuryexpert @Hewett1Tim @PSchrags @AdamSchefter
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The higher rate of Hamstrings Graft failure in females (about double) is nearly Universal yet Hamstrings are still preferentially used in young females! WHY? #Disregard4Data !: hamstring autografts fail at a higher rate than bone-tendon-bone autografts! Y?.
Female athletes are two to eight more times likely to injure their ACL than males, however utilizing one graft repair treatment method in females may be more beneficial than another. #sportsmedicine #digitalhealth #mhealth
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Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations. Christopher V Nagelli 1 2 3 4 , Timothy E Hewett 5 6 7 8 9.Affiliations expand.PMID: 27402457.PMCID: PMC5226931
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This is really BAD information There is no evidence whatsoever that any of these 6 exercises prevent ACL injury
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The next ACL Injury Myth that needs 2B BUSTED: MYTH the anatomic Q-(Quads) angle is a cause of ACL injury? MYTHIC Logic: Women have wider hips (inaccurate) that gives >Q-angle (slight 1°>) that > ACL Risk (2 studies yes, 10+ studies show NO association between Q-angle & ACL Risk)
CLASSIC! Thanks for the share @LauraOpstedal . BUT wasn't that the LAST run of the day? That's the usual MYTHIC CLAIM!
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Anterior Cruciate Ligament Reconstruction Rehabilitation: MOON Guidelines @TimothyHewett1 @TimHewett5 High-level evidence exists to determine appropriate ACL rehabilitation guidelines. Utilizing this protocol follows best available evidence
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Hamstrings grafts have higher failure rates . Please check out this Meta-analysis of mid-term Outcomes in almost 50,000 patients with ACLR:
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4 Important Questions to ask your Medical 🏥 Practitioner B4 procedure:. “Is this really necessary?" ."What are the risks?"."Are there other options?"."What happens if I don't do anything?".
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Hot 🥵 OffTHE press !!!.Our latest paper on RTS after ACLreconstruction .Thank you 🙏 .@AlliGokeler @BartDingenen .our latest paper on RTS after ACLreconstruction .@TimothyHewett1 @TimHewett5 @BartDingenen .Full access!!👇.#ACL #RTS
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9-12 Months a safer time frame but objective criteria rather than Time is highly recommended. as there is no clear association between time from surgery with functional deficits in athletes after ACL Reconstruction check these:
@DrNikhilVerma Do you still believe that return to sport without restrictions at 6 months is still realistic, considering the recent research? I know your study is 5+ years old so curious what you recommend now?.
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Likely MORE than just ACL compromised.
I’d say the ACL is torn!
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Yet another Classic Dynamic Valgus Pivot Shift ACL Injury Mechanism. @TimothyHewett1 @TimHewett5 @Hewett1Tim @DrMasterBates.
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Compliance is absolutely KEY 🔑!!!
Really disappointed by study in today’s @AJSM_SportsMed that found no efficacy of FIFA11+ in reducing injury in high school population. Major reason is that NO ONE ACTUALLY DID IT! Only 32% of teams could do program 2x/week. Check this quote:.
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So what muscle(s) do you think 🤔 are being activated to cause this anterior translation of the tibia relative to the femur to reproduce this famous & fabulous ‘party trick. ?’.
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Great 👍 and important illustration: ligamentization of different grafts of the ACL: @TimHewett5 @TimothyHewett1
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Thanks 🙏Super D! Please ✅ Out these:
@brianmccormick Check out the work by @Hewett1Tim . His work has revolutionized ACL injury prevention.
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Return-to-Sport Criteria After Anterior Cruciate Ligament Reconstruction Fail to Identify the Risk of Second Anterior Cruciate Ligament Injury @TimothyHewett1 @TimHewett5.
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Knee Abduction Moment (KAM) PREDICTS future ACL injury Risk . WHO would have guessed ??? @TimothyHewett1 @TimHewett5 @gregmyer11 @ford_kr @Hewett1Tim
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“Dynamic Valgus” is most definitely a STRONG 💪 risk factor for ACL injuries. static Q-angle is not! Many, including good coaches and even good docs, physics, ATs etc. get the 2 confused 😐
@Hewett1Tim ha yes -- 'belief'🦄🧜♀️not a scientific term 😃 ok I'll look at these papers @LorneGoldenberg this was what I meant re data. this issue sort of out of the 'coaching' realm & into hard data. Thank Tim!.
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Hips & Hamstrings are crucial for whole body neuromuscular control . don’t sacrifice them! @TimothyHewett1 @Hewett1Tim @TimHewett5
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What is the Evidence for and Validity of Return-to-Sport Testing after Anterior Cruciate Ligament Reconstruction Surgery? A Systematic Review and Meta-Analysis | NO validity of current RTS test batteries to reduction of risk of graft contralateral ACL tear
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What a BLAST lecturing on ‘Can We Truly Prevent an ACL Tear?’ Turns out that we unequivocally CAN Prevent ACL Tears! #Prevention #ACL #AOSSM #aaos2019 #SpecialtyDay #AAOS #JOR #ORS #ors
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Are 6-Month Functional and Isokinetic Testing Measures Risk factors for Second Anterior Cruciate Ligament Injuries … Patients 6 month postACLR w higher isokinetic quad in injured limb had higher rate of subsequent ACL injury than pats w lower peak torque!.
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Patients treated with HT autografts have a significantly higher, activity-dependent risk of revision surgery and experience more ipsilateral graft ruptures than subsequent contralateral ACL injuries when compared with patients treated with QT! #LaudTheQuad
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Great 👍 Illustration of The VERY Clear Connection between prior concussion and subsequent Lower Extremity Injuries. @Hewett1Tim @TimHewett5
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UNDERSTANDING AND PREVENTING ACL INJURIES: CURRENT BIOMECHANICAL AND EPIDEMIOLOGIC CONSIDERATIONS - UPDATE @timothyhewett1 @timhewett5
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Full Text of R Meta of Meta-Analyses now out @ORSsociety @OREFtoday Thanks 🙏 for the outstanding 👍 👍 work Great Kate @DrKateWebster Sincerely, Tims @TimothyHewett1 @TimHewett5 @Hewett1Tim
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Hamstrings Contraction Regulates the Magnitude and Timing of the Peak ACL Loading During the Drop Vertical Jump in Female Athletes.Ryo Ueno et al Orthop J Sports Med 2021 @TimothyHewett1 @TimHewett5 #ACL #Biomechanic
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YES 🙌 👍 tell them that OKC if AOK 4 ACL!: @TimothyHewett1 @TimHewett5
@Hewett1Tim is the present consensus that full ROM resisted knee extensions are safe s/p ACLR? Despite all of our physician protocols that state 90-40 degrees?.
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The Great 👍 Dr. Lynn Snyder-Mackler spreads her wisdom here in Lost Vegas on Return to Sport after ACLR. Thanks 🙏 for the pearls @doclsmack and for showing US the way!
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Early OKC 4 ACL is A-OK 👌 👌 👌 both safe & effective! @ForelliFlorian @AJM_Rambaud @TimothyHewett1 @TimHewett5 @ChadLavenderMD @3jjasko @MUHealthOrtho @MUSportsMed @MUSOMWV @marshall_health @marshallu @HerdZone @marykmulcaheymd #ACL @BohdannaZazulak #OK.
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Proper ACL Injury Prevention Programs reduce the risk of ALL ACL injuries by 1/2 and non-contact ACL injuries in girls and women by 2/3rds! .Meta‐analysis of meta‐analyses of anterior cruciate ligament injury reduction training programs. @DrKateWebster
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Agreed . there is no such this as "outdated research. " The Theory of Relativity is NOT invalid because it's 75+ years old . this concept of "outdated research" is actually quite ridiculous! Now "Invalidated Research" is an entirely different matter. .
I just wanted to take a moment to clarify the idea of “outdated research”. This is not a thing. A study does not become “untrue” due to the passing of time. INTERPRETATIONS of those data become outdated.
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Return-to-sport testing following ACL reconstruction revisited.Webster KE & Hewett TE BJSM 2019.Allied Health, Human Services LaTrobe University .Br J Sports Med. 2019 Oct 18. pii: bjsports-2019-101362. doi: 10.1136/bjsports-2019-101362. [Epub ahead print]
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Yes indeed this a Pivot Shift. on the pitch! the Pivot Shift Exam forensically reproduces on the exam table the dynamic Valgus ACL Injury Mechanism that occurs on the pitch and field and court. @TimothyHewett1 @TimHewett5.
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This is BOTH the most CITED study in 2005 & ALL TIME in @AJSM_SportsMed For the 50 Year Anniversary of AJSM We discuss with @DrKateWebster the actual rationale for it. videos will be released by @AOSSM_SportsMed @AOSSM_STOP April & May & address this attack well! @TimothyHewett1.
This 2005 paper is perhaps the most cited ACL injury prediction research to date. I figured it was past time to perform a deep analysis on this paper, especially given the information we’ve learned over the past 17 years. Let’s kick this off…. 🧵
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Predicting Anterior Cruciate Ligament Reinjury From Return-to-Activity Assessments at 6 Months Postsurgery: A Prosp… Returning high-functioning patients to activity at <8 months post-ACLR may place them at an increased risk for reinjury! @TimothyHewett1.
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Check out “Neuromuscular Training Improves Self-Reported Function and Single-Leg Landing Hip Biomechanics in Athletes After Anterior Cruciate Ligament Reconstruction” !✅ now published and is available at @TimothyHewett1 @TimHewett5
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An Ode to R ACL: OUR dear ACL, we ALL kneed U so well! When U rupture U go “POP” & hurt like HeLL! U resist anterior translation across the femur 🦴 & R nation! A combination of that & valgus & internal rotation make U go “POP” but R Reduction Programs by 50-67% make this STOP 🛑
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Do torn ACLs really “HEAL” …???. @TimothyHewett1 @TimHewett5 .@ChadLavenderMD @3jjasko @DanaLycansMD @Herd_SportsMed @MUHealthOrtho @MUSOMWV @HerdZone @MJofMWV @MarshallMenSocc @HerdMBB #ACL #ACLhealing #MRI @DrLeeRubin #BeSkeptic
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The Myth that injury prediction is about predicting which individual athlete is going to be injured & telling them that is utterly ludicrous.
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Dear Friends and Colleagues,.Our 16th Annual ACL Workshop Registration is open - see link below: We can’t wait 😊 to See YOU at Mayo in May! @mayoclinicsport @MayoClinic Sincerely, @Hewett1Tim @TimothyHewett1 @TimHewett5 PLEASE RT!.
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Hop tests can result in higher limb symmetry index values.than isokinetic strength and leg press tests in patients following ACL reconstruction Peak knee extension torques + associated w hop distance and leg power leg press BUT hop LSI values NOT reliable!.
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Time often tells a terrible tale .
Zlatan back playing 7 months after ACL surgery! Fearless or foolish? I guess time will tell. 🤔
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These inaccurate statements in lay press and even in Medical Journals📓 that the reason women R more susceptible to ACL injuries is they have ‘wider hips’ is hurtful to solving this important and impactful problem in AFLW. Not only is it NOT cause BUT women DONT have wider hips!!
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Valgus + Internal Rotation of the tibia! Ski ⛷ & Foot 🦶 R in External Rotation, while the tibia 🦴 is in Internal Rotation relative to the femur 🦴 @TimothyHewett1 @TimHewett5 #ACL.
ACL injury happens most often in response to valgus loading in combination with external tibial rotation or to hyperextension with internal tibial rotation. Learn more with Biomechanics of Injury, Third Edition #biomechanics #sportsinjuries
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ACL INJURIES A to Z - Dr. Hewett discusses EVERYTHING ACL from Anatomy, . via
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WAY too much VALGUS biebs!!.
New stache. New tattoo. New hands? . @justinbieber's getting ready for Jordan Binnington (@binnnasty). 👀 (🎥 IG/justinbieber)
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Check out the relationship between the Glutes & the Posterior Chain and ACL injury and ACL Strain. A Kinetic CHAIN!:
The glutes are the largest most powerful muscle group in the body and they control femoral position and hence knee joint position & load abs
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