How to Prevent an ACL Injury

How To Prevent An ACL Injury

Athletes, both professional and amateur, are prone to numerous injuries during their careers. The body takes a beating while engaging in sports. Many of the injuries athletes sustain can be prevented, allowing the individual to avoid uncomfortable procedures and medical devices as well as keeping them 'in the game'. One of the most preventable injuries in sports today is an injury revolving around the ACL.

What is the ACL?

The ACL - anterior cruciate ligament - is a major ligament that is found in the knee. It is responsible for keeping the knee from moving too much, limiting the joint's range of motion and stabilizing leg movement. The ACL is attached to the front and top of the tibia and stretches diagonally up to attach to the back and bottom of the femur. People who complain of their knee 'giving out' or 'popping' usually have some form of ACL injury.

How does an ACL injury occur?

ACL injuries can occur during sports related activities as well as during regular day to day activities. Most of them are due to sports but the ACL can tear during a motor vehicle accident, a fall, a work related accident, rough play or during other activities that causes the knee to move in a direction it is not supposed to naturally go in. The majority of ACL injuries fall under the heading of 'non-contact' injuries. This means that the injury happens without another person being involved. For example, an athlete can turn on their foot the wrong way during a pivot or land improperly from a jump and tear the ACL. A good sign that the ACL is injured is the knee giving out from under the person when the ligament is torn.

A torn ACL that is due to non-contact usually occurs when there is a rapid deceleration of the body and the knee joint. If the body is not properly placed during a sport or physical activity, the ACL can be stressed and overloaded. When this happens, the ACL will tear. The knee is not stable and the pressure from the hips and ankles place it in a state of weakness. The muscles in the shins and thighs attempt to control the deceleration of the body and this causes the aforementioned stress and overload to the ACL.

How can you tell if you have an ACL tear?

A person can have ACL problems without a tear being present but if the ligament is not checked prolonged injury could ultimately cause a tear. A good sign that a person has an ACL injury is the popping of the knee or the knee simply giving out and causing the person to fall. ACL tears usually come with swelling and pain, but a minor injury may not be painful. Going to the doctor and having the knee tested for instability and other stressors are used to diagnose the problem. Additionally, an MRI of the knee may be ordered to verify the injury and possibly any other injuries that could be associated with an ACL tear.

What is done heal an ACL injury?

Depending on the severity of the ACL injury will determine what type of treatment may be used by the physician who diagnoses the tear in the ligament. People who suffer ACL tears that do not participate in sports or who are suffering from a partial ACL tear may be required to wear a special knee brace for a few weeks to allow the ligament to heal on its own. If the tear is severe and the person is an athlete who relies on the range of motion provided by the knee, reconstructive ACL surgery may be recommended.

It should be noted that many athletes who suffer from an ACL injury such as a tear may never regain total mobility in the ligament like they had prior to the injury. Therefore, it is better to work towards preventing ACL injuries than dealing with them after they occur.

How do you prevent an ACL injury?

It takes more than just strengthening the legs to prevent an ACL injury. Everything from weak hips to the internal rotation of the knee itself can add to an ACL injury. In order to prevent this injury, core body muscles, external hip rotators, the gluteus medius muscle, lower abs and obliques all must be stretched and strengthened in order to help prevent an ACL injury. Quadriceps and hamstrings should also be strengthened in an even ratio to help in ACL tear prevention, especially in women who are not as muscular as men. Finally, good calf and ankle muscles are also required as they help control knee deceleration and provide the body with stability.

Athletes should engage in coordination drills and training in order to learn how to properly move during sports activities. Cutting - the quick side to side movements seen in many sports - as well as landing must be done so that the center of gravity in the body is lowered and the knee flexes more. The torso should remain upright at all times if possible and where it is feasible, additional movement after the cut or land is encouraged as it helps with the deceleration process in the knee.

Finally, the proper footwear for the activity is required. Shoes are important in that they provide stability for the body. They should have a good drip on the playing surface and prevent the person from slipping.

Exercises to help prevent ACL injuries

About one month prior to any sports season starting, athletes should add stability strengthening exercises to their routine. Cross training with a stair climber or elliptical should be included in the cardiovascular routine to help the muscles warm up and stretch. Here are some strengthening exercises that can be included in the workout to help prevent painful ACL injuries. These exercises should be continued through and after the sports season.

Warm up

Because it is dangerous to stretch a cold muscle, warm ups should be done in order to prepare the body for the exercise and physical activity to follow. Warm ups should include:
o Line to line jog - slowly jog from one line or cone to another while keeping the hips, knees and ankles in a straight line. Knees should not cave in and the feet should not whip out to the sides while jogging.
o Side to side shuttle run - moving from side to side, the hips, knees and ankles remain in a straight line. The exercise should start in an athletic stance with the knees slightly bent. The participant pushes off with the back leg and sidesteps in one direction to a predetermined point and then reverses.
o Backward run - this warm up helps to prevent knee locking. The participant runs backwards from one line to another, landing on the toes lightly. The knees should remain bent at all times.

Stretches

Anyone who exercises should always stretch after warm up to limber up the muscles and ligaments in the body. Stretches allow the range of motion to be maintained and helps reduce joint stiffness, soreness after activity and injury. Never bounce or jerk the muscles during stretches. Instead, the stretch should be done to the point of tension in the muscle and held for 30 seconds. Breathing should be normal and the stretch should be muscle lengthening.
o Calf stretch - starting from a standing position, bend forward from the waist and lay the palms on the ground. The right knee should be bent slightly while the left leg remains straight with the heel of the foot on the ground. Hold for 30 seconds and then switch sides. This should be done two times for each leg.
o Quadricep stretch - this exercise is done with a partner. Lay the left hand on the partner's left shoulder and then grab the front of the right ankle with the right hand from behind. Bring the heel of the foot to the buttock with the knee pointing to the ground. The legs should remain close together and the knee should not go out to the side. Remain in an upright position and hold for 30 seconds before switching sides. This should be done two times for each leg.
o Hamstring stretch - sitting on the ground, stretch the right leg out in a straight line with the left leg bent and the left foot against the inside of the right thigh. Keeping the back straight, lean forward to touch the chest to the knee. If able, reach towards the toes and bring them back towards the head. Hold for 30 seconds and then switch sides. This should be done two times for each leg.
o Inner thigh stretch - while sitting, spread the legs apart and lower the upper body down while keeping the back straight. The muscles in the inner thigh will stretch. Sit up and reach over the right leg with the right arm while extending the left arm overhead to the right. Hold for 20 seconds and then switch sides. This should be done three times for each leg.

Strengthening

In order to build up stability in the knees and legs, strengthening exercises should follow the warm up and stretching exercises. It is important that the technique is followed closely and that the performance of the exercises is adhered to in order to get the proper results.
o Walking lunges - starting with the right leg, lunge forward keeping the front knee over the ankle. Push off with the right leg and lunge forward with the left, dropping the right knee down. The motion needs to be controlled with keep the knees from caving inwards. The toes should be visible on the leading leg. If they are not, the exercise is not being performed properly and the stance needs to be adjusted. This exercise should be done in three sets of 10 reps.
o Russian hamstring - with a partner, kneel on the ground with hands at the side while the partner holding the ankles. Lean forward from the hips with knees, hips and shoulders in a straight line and the back straight. Do not bend at the waist. The hamstrings in the thigh will be working. This exercise should be done in three sets of 10 reps.
o Single toe raise - standing with arms at sides, bend the left knee upwards and balance on one foot. Stretch the arms to the sides to help maintain balance and rise up on the toes of the right foot slowly. Hold and then lower. Repeat this exercise 30 times and then switch sides.

Plyometrics

Plyometric exercises are designed to help build up the power, speed and strength of the body. The key to performing these exercises properly is to remember to land softly when jumping. Always land with the weight on the ball of the feet and then distributing it back to the heel with the knees bent and the hips straight. It is important that the technique is followed closely and that the performance of the exercises is adhered to in order to get the proper results.
o Lateral hop over a cone - using a 6 inch high cone to the left of the body, hop sideways over the cone landing on the balls of the feet with the knees bent. Straighten the knee slowly. Hop back to the right to complete a rep. Do this exercise for 20 reps.
o Forward and backward hop over a cone - using the same 6 inch high cone, hope over the cone forwards landing on the balls of the feel with the knees bent. Straighten the knee slowly. Hop backwards over the cone to complete a rep. Do this exercise for 20 reps.
o Single leg hop over a cone - using the same technique found in the forward and backward hop over a cone, start with the right leg and complete a forward and backward hop for one rep. Do this exercise for 20 reps, switch legs and repeat.
o Single leg vertical jump with headers - stand straight with arms at side and knees slightly bent. Push off with the right foot and jump straight up, landing on the ball of the foot with the knee slightly bent. Do this exercise for 20 reps, switch legs and repeat.
o Scissors jump - using the same knee over ankle technique in the walking lunge, lunge forward with the right leg. Push off with the right foot and bring the left leg forward into a lunge position, maintain the knee and not allowing it to cave in or out. Land on the balls of the feet. Do this exercise for 20 reps.

Agilities

Agilities will help build up the range of motion in the ankle, knee and hip combination, allowing the participant to move more smoothly during exercise and physical activity. This will help stabilize the ACL and keep it flexible.
o Shuttle run forward and backward - using as many cones as desired, sprint from the starting line to the first cone and stop. Sprint to the next cone and stop. Continue this to the end and then reverse running backwards.
o Diagonal run - set the cones in a zigzag formation. Start at the line and run to the first cone to the left, pivot on the left foot, and run to the next cone on the right. Pivot off the right foot and run to the third cone. Continue to the end keeping the knee slightly bent and over the ankle. Repeat 3 times.
o Bounding run - run from one line to the other bringing the knees up high towards the chest. Land on the balls of the feet with the knees slightly bent and the hips straight.

Cool Down

The cooling down phase of any exercise routine or physical activity is important and should never be skipped. There should always be water at hand through this phase and it should take about 10 minutes. Jog slowly until the heart rate comes down and then stretch the hamstrings, calves, inner thighs, quadriceps and lower back with the exercises listed above and the following exercises.
o Alternate hip flex bridging - while lying on the ground, bend the knees and place the feet flat. Raise the buttocks off of the ground and squeeze, holding this as the right foot is lifted off the ground. Do not allow the hip to dip towards the ground. Lower the right foot and repeat the motion with the left foot. Repeat 30 times for each side.
o Abdominal crunches - while lying on the ground, bend the knees and place the feet flat. Lace the fingers behind the head with the elbows out. Breathe in and contract the abdominal muscles while exhaling. Do this 30 times. Drop the legs to the right to the ground and repeat the crunching of the muscles to work the obliques. Repeat 30 times and then switch sides.
o Knee to chest - while lying on the ground, bend the knees and place the feet flat. Bring the right knee into the chest while extending the left leg to the ground. Hug the right knee for 30 seconds, feeling the muscles of the lower back and buttocks stretching. Switch sides and then bring both knees to the chest. Repeat all three motions as a rep and do two times. If there is any pain in the lower back, discontinue the stretch.
o Figure four piriformis stretch - while lying on the ground, bend the knees and place the feet flat. Place the left ankle over the right knee. Holding this position, take hold of the right thigh and pull the right knee into the chest. Hold for 30 seconds and switch sides. This will stretch the gluteals and the sides of the thighs. Repeat the two motions as a rep and do two times. If there is any pain in the lower back, discontinue the stretch.
o Seated butterfly stretch - while sitting, bring the feet into the body so that the soles are touching. Place the elbows on the knees and slowly push the knees down to the ground. This stretches the inner thigh. Hold for 30 seconds and repeat two to three times.

Achilles Tendonosis - Battling a Tolerable Injury

It's been almost 2 years now since I started noticing the tightness, the twinge in my Achilles. I had just cranked out a personal best performance at the Notre Dame Cross Country Invitational and was now lying on the ground in pure enjoyment, as well as exhaustion. As I stood up to begin my cool down, I felt a certain tightness in my left Achilles tendon, one that was also sharp to the touch. After a couple of minutes of jogging around I thought a better solution would be to see our trainer, rather than aggravate it further. Following a deep massage on my calves, I was feeling slightly better but still had to limp my way to the team bus. This was the beginning of the "the limp."

This limp would follow me around for the next two years. Waking up in the morning, the first few miles of my run, after sitting down for any period of time, and following workouts and races. I was 21 years old yet would hobble around campus like an 80 year old man, the one you help across the street. Men in canes would look at me wondering if I need assistance. Runners are supposed to have extended lives due to their fitness level but what about hips, knees, Achilles? Are you to enjoy your 90 year lifespan sitting down after 40 because you have abused your body so much?

Back to the injury.

After seeing our medical training staff and finally researching the injury on my own, we concluded that it was Achilles Tendonosis. This is when micro tears occur in the Achilles tendon due to overuse, weakening the area and constraining blood flow. It is a disastrous injury to runners because with most being extremely OCD or already having race commitments, they often feel that rest is not an option. Instead they uncomfortably push through it, day after day, race after race, until it gets to a point where stopping is the only option. Otherwise serious damage will occur, rupturing of the Achilles.

I was one of those OCD runners who insisted on running day after day. After all, it was painful but tolerable. I could struggle through the first couple of miles, limping around, and then it would loosen up and I would be able to finish the run with only a slight twinge. Later that night however, i would be left with an extremely tight Achilles, very sensitive to the touch, and limping dramatically when walking. I always had another season around the corner: cross country to indoor track to outdoor track to summer base training. I felt that if I were to miss anything my performance would be hindered dramatically.

Meanwhile, I was trying anything possible to rid the problem. Here are some of the things that I tried:

Ice would bring down the swelling on the back of the Achilles, however, it would constrict the blood flow and make the area very sore, tight, and even walking would be a challenge.

Heat would be used before running so that the area would be warmed up. This helped a little in pain management but did nothing to actually get rid of the actual injury.

Ultrasound that is something that I tried but personally had minimal success with.

Strengthening the tendon, everything around the tendon, and everywhere else: Eccentric calf raises are the most effective thing in battling this injury, however, it just didn't work for me most likely because I was doing them along with 100 miles per week of running. You need to strengthen the weakened area to solve the problem and when I was doing the eccentric exercises along with running, I was most likely tearing down the area at a higher rate than the eccentric calf raises could strengthen it. After 6 months of calf raises with running, I gave up on them because they irritated the area and increased the swelling (which I didn't want to ice because it made it worse). I also strengthened everything imaginable around the tendon and anywhere else (including hips, it band, calves, soleus, shins, etc). I would do rigorous exercises to make sure nothing was putting extra strain on the Achilles tendon.

Massaging and "Scraping" the Achilles was not a fun process. With my Achilles inflamed and extremely tender to the touch, I would allow our trainers to massage the area and scrape it to try and increase the blood flow to the area and break down any scar tissue. This was an extremely painful task which often resulted in me gripping the massage table and sweat pouring from my forehead as I tried to deal with it. I noticed little/no success with this as it would further irritate the area and was just generally unpleasant.

Loosing up calves, soleus, plantar fascia before runs/workouts/races: Loosening up these areas through massage and stretching was something that we tried. With weak/tight soleus and calves most likely being the problem in the first place, I wanted to make sure that we weren't putting any further strain on the Achilles. Just like with strengthening everything around it, I didn't want the Achilles working harder than it had to. This was pretty effective in that it made running/working out/racing tolerable and eased the pain in the Achilles following workouts and races. Again though, it does not deal with solving the problem, just allowing for easier pain management.

Sleeping in a night splint was something that I tried for 4 months. This was completely ineffective for me and if anything made the injury worse/less tolerable. I would wake up in the morning even tighter because my Achilles tendon had been held in the same position all night. It restricted blood flow and made getting out of bed worse even worse than before.

Ibu Profin/Naproxin were drugs that I tried to deal with the issue. They would provide temporary relief as they would bring the swelling down slightly and make the pain slightly more tolerable. Over time their effectiveness wore off and I feel that my body began relying on them. I took naproxin consistently for over 6 months and ibu profin on and off for the 2 years that I had the problem.

Time off is something that would be the most obvious but again for an OCD runner this is not what I wanted to hear. However, at the end of each season, I would attempt to take 2-4 weeks off to finally deal with the issue. During this time the swelling would be reduced, the limping would subside, and walking was an enjoyable experience as opposed to a challenge. Yet, when I returned to running at the end of this absence nothing had changed. Within the first 400 meters of running the pain was back, just as bad as it had been before. My Achilles reacted as if it had no time off at all. The reason, to my understanding, is because the time off allows for the swelling to go down because you are not irritating it with one hundred mile weeks. This reduces "the limp" and allows you to walk easier. However, you still have the weakened Achilles to deal with. The Achilles is just as weak 4 weeks later as when you stopped running. The only difference is the swelling has been reduced and it is less irritated.

So what is the answer?

Surgery is an option that is available to runners with this problem. It is an evasive procedure in which the weakened tissue is removed and the stronger tissue is stitched together. However, if you never find the underlying cause of why you got this injury then you could weaken the area again and have the same problem.

Platelet Rich Plasma (PRP) injections - An innovative treatment in which platelet enriched plasma is injected into the area (in this case the Achilles). It enhances blood flow to the area, as well as stimulates the healing of tissue. This is something I looked into at UF, however, because it is a new treatment, Shands was not insured for it and it was not offered. Also because it is a newer treatment there are not a great deal of studies done on it and its effectiveness.

Eccentric calf raises: a basic exercise that you can do on a door step or slant board. You raise yourself up onto both toes and then slowly lower yourself back down on one. With this, you focus on the eccentric part (the lowering) which strengthens the Achilles. This is supposed to be an extremely effective way to deal with tendonosis. I believe that with time completely off from running and 12 weeks given to an eccentric exercise program that most people can completely rid their Achilles Tendonosis. The key is to stay regimented with consistent daily exercises with increasing weights and not to resume running until completion of the program.

Finally after almost two years of dealing with this issue I am taking the necessary time off to deal with it. I am about 4 weeks into the eccentric calf raises and walking around is almost completely pain free. There are days where the Achilles is inflamed because of the exercises and sometimes a little tight but it passes. I do the exercises 3 sets of 15 reps, 3 times every day. Along with this I strengthen my shin muscles and other areas with Theraband exercises so that I do not over compensate one area. I am also looking into the PRP injections to see if this is a possibility to go along with my exercises.

Although I am almost pain free, I am going to complete the 12 weeks because I know that if I were to resume running now the injury would flare up. When I can finally run again, I am going to continue doing the exercises as part of my daily routine. I also want to look into the underlying cause of what caused the issue in the first place: shoes, bad mechanics, tight/weak soleus and calves, weak hips, tight hamstrings, tight plantar fascia, or anything else.

If you have just recently begun experiencing Achilles pain and believe it to be Achilles Tendonosis I urge you to stop running immediately. I am not a doctor and I despise doctors generic answer of "stop running", however, this is an injury that will not get better on its own. The worse thing about this injury is how tolerable you can make it. Over time it will simply get worse and worse though. So if it's a new injury, take a little time off, deal with it, and make sure it doesn't progress to something serious.

If you have been dealing with it for a while but insist on running through it then good luck. I am not going to tell you to stop because that would be hypocritical since I was in your situation and continued running through it. However, complete whatever training cycle you are on and then seriously look into dealing with it. Take the 12 weeks off necessary and knock it out once and for all. Just imagine how much more enjoyable running will be when you are not limping through runs, walking in agony around your house, and straining to get out of bed in the morning? Think how much faster you will be when you don't have to worry about a possible tear/rupture of your Achilles during workouts and races.

This is one of the most frustrating injuries for me because it allows you to run on it, it gives you hope. Instead of a stress fracture knocking you out of commission for 6-8 weeks, this allows you to run on it day after day but progressively gets worse. Eventually it reaches a point where running is not an option and you only hope that the recovery process that you have been putting off will cure it.

Almost two years after the Notre Dame invitational and many runs, workouts, race, and Personal bests later, I am finally taking the time off necessary for this injury. I am four weeks into the recovery and hope that I may run injury free in the future. Running over the past two years with this injury has been aggravating and unpleasant but I love the joy I have had from competition. Now, I just hope that I will be able to compete in the future. I hope that I didn't sacrifice the rest of my competitive career for something that could have been fixed in a matter of 12-14 weeks.

Stop Knee Pain Without Knee Surgery

There are many factors that predispose the knee to injury, bad alignment, different leg lengths, and loose joints to name just a few. You can't do anything about those knee pain risks on your own. There are many small changes to your lifestyle, however, that will prevent "bad knees" from becoming painful knees.

1. Drink fluid throughout the day

Sometimes the simplest cure for sore knees is staying hydrated. Adequate fluid intake nourishes the cartilage supporting the knee and leg muscles by increasing circulation. It also makes it easier for the bloodstream to remove the lactic acid that makes muscles "burn" after intense exercise.

You don't really have to drink eight glasses of water every day to promote knee health. The goal is constant hydration, not trying to flood your tissues with water. Drink throughout the day to keep tissues hydrated.

2. Replace your exercise shoes every 300 to 400 miles (480 to 640 km)

Constant wear and tear on your shoes makes them less flexible, leading to constant wear and tear on your knees. It is especially important to replace shoes regularly if you are active in high-impact sports like basketball, jogging, or tennis.

3. Exercise at different times every day

This gives your knees a chance to adjust to varying conditions. It also helps prevent overexercising with the release of the stress hormone cortisol.

4. Avoid "knee killing" motions

Jumping, bending at the knees, and deep squats are the most common causes of knee injury. Any exercise that uses springy or bouncing movements to lengthen muscles can cause the muscle to contract rather than to stretch. If you have a history of knee pain, do safer exercises like biking, walking, or swimming.

5. Get glucosamine, chondroitin, and calcium

Glucosamine and chondroitin help cartilage stay in shape. Calcium, which you shouldn't take in doses of more than 500 mg at a time, is essential bone density that prevents fracture and strains on the ligaments, tendons, and muscles that support the knee.

More Alternative Pain Relief Methods Here

Acupuncture Arthritis Knee Ankle Pain Can Heal

There are many different treatments for arthritis. If you are interested in trying some alternative forms of therapy, try acupuncture arthritis knee ankle pain. Acupuncture can be a very effective method of treatment for all forms of arthritis pain, including rheumatoid and osteoarthritis. It has been shown by scientific studies to be particularly effective when it comes to knee and ankle based pain.

What is Acupuncture?

Acupuncture is an ancient Chinese medical procedure in which certain points of the body are stimulated. American acupuncture incorporates a number of different cultures processes. The whole idea originated more than two thousand years ago, but it became well known in the seventies in the United States. Most Asian countries, including China, Japan, and Korea have their own forms of this helpful procedure. For many, acupuncture arthritis knee ankle pain procedures are quite helpful. The most studied, and most practiced form of acupuncture in the United States involves first a massage of the affected area, then the joint in question in penetrated with thin, solid needles made of metal.

Who Can Use Acupuncture?

You do not need an arthritis diagnosis to need acupuncture help. Because most acupuncturists are not licensed doctors, you will not even need to consult your insurance company, as most do not pay for alternative therapies like this one. If you want some names of good acupuncturists in your area, check with your doctor or your herbalist. They should be able to refer you to competent professionals. Be sure to check your acupuncturist's credentials, as there are some good national acupuncture organizations that may help narrow your search. You may be able to find some websites that list these acupuncturists in your area. Remember that your acupuncturist is not a doctor, so they cannot offer you a diagnosis for your joint pain. They can only offer you pain relief.

For more information on other forms of alternative therapy for your arthritis pain, whether it is in you knee or ankle joints, see some of the other articles on this site.

Leadership and Project Management

One of the more interesting questions I am often asked about project management is: do I need leadership skills to be an effective project manager? And I use the word "effective" carefully, because, to me, all effective project managers have strong leadership skills.
That's not to say you can't become a project manager with poor leadership skills, but you are unlikely to become an effective project manager.

So what is leadership, and can you teach yourself these skills?

One of the most insightful descriptions of leadership I have read was given to the student-officers at a Training Camp at Fort Sheridan, by Major C. A. Bach during World War One. These men were about to be commissioned and sent to the front in France. Excerpts of his talk follow:

"In a short time each of you men will control the lives of a certain number of other men. ....When you join your organization you will find there a willing body of men who ask from you nothing more than the qualities that will command their respect, their loyalty and their obedience. They are perfectly ready and eager to follow you so long as you can convince them that you have these qualities. When the time comes that they are satisfied you do not possess them you might as well kiss yourself good-bye. Your usefulness in that organization is at an end. In a few days the great mass of you men will receive commissions as officers. These commissions will not make you leaders; they will merely make you officers. They will place you in a position where you can become leaders if you possess the proper attributes."

In much the same way, having the title "Project Manager" does not make you a project manager, nor a leader of that project.

"But you must make good, not so much with the men over you as with the men under you."

I despair when I see Project Managers who focus all their efforts and communication to senior management and the executives of a company, rather than working with their team to achieve the project objectives. Especially if they are brought into an established project team - an effective project manager spends more time with the team than with the "brass".

"Men must and will follow into battle officers who are not leaders, but the driving power behind these men is not enthusiasm but discipline. They go with doubt and trembling that prompts the unspoken question, "What will he do next?" Such men obey the letter of their orders but no more. Of devotion to their commander, of exalted enthusiasm which scorns personal risk, of self-sacrifice to insure his personal safety, they know nothing. Their legs carry them forward because their brain and their training tell them they must go. Their spirit does not go with them.

Great results are not achieved by cold, passive, unresponsive soldiers. They don't go very far and they stop as soon as they can. Leadership not only demands but receives the willing, unhesitating, unfaltering obedience and loyalty of other men; and a devotion that will cause them, when the time comes, to follow their uncrowned king to hell and back again, if necessary."

If you have ever worked on a project that has faced a crisis, this will ring especially true. Only a cohesive project team with a strong leader will do whatever it is that needs to be done to "fight through" a crisis and emerge successful. Projects with weak project managers, those who care only for themselves, will surely fail.

"You will ask yourselves: Of just what, then, does leadership consist? What must I do to become a leader? What are the attributes of leadership, and how can I cultivate them?
Leadership is a composite of a number of qualities. Among the most important I would list Self-confidence, Moral Ascendency, Self-Sacrifice, Paternalism, Fairness, Initiative, Decision, Dignity, and Courage.

Self-confidence results, first, from exact knowledge; second, the ability to impart that knowledge ...... to lead, you must know! You may bluff all of your men some of the time, but you can't do it all the time. Men will not have confidence in an officer unless he knows his business, and he must know it from the ground up. ..... And not only should each officer know thoroughly the duties of his own grade, but he should study those of the two grades next above him."

Whilst in Project Management I do not necessarily believe that the Project Manager must know, in detail, how to do every role on the project, it is important that the project team respect the skills and knowledge of the project manager. Have you ever worked on a project where the Project Manager is clearly out of their depth? Any project where the team has no respect for the project manager (be that their skills or just in general), trouble will surely follow.

"While self-confidence is the result of knowing more than your men, Moral Ascendency over them is based upon your belief that you are the better man. To gain and maintain this ascendency you must have self-control, physical vitality, and endurance and moral force. You must have yourself so well in hand that, even though in battle you may be scared stiff, you will never show fear. For if by so much as a hurried movement or a trembling of the hands, or a change of expression, or a hasty order hastily revoked, you indicate your mental condition it will be reflected in your men in a far greater degree.

In garrison or camp many instances will arise to try your temper and wreck the sweetness of your disposition. If at such times you "fly off the handle" you have no business to be in charge of men. For men in anger say and do things that they almost invariably regret afterward.

Be an example to your men!"

By definition, a project manager should be someone who is good at controlling, not just tasks, but other people and themselves. And what better way to show behaviors and attitudes that are acceptable to your team than to demonstrate these yourself.

"Self-sacrifice is essential to leadership. You will give, give, all the time. You will give of yourself physically; for the longest hours, the hardest work and the greatest responsibility are the lot of the captain.

You will give of yourself mentally, in sympathy and appreciation for the troubles of men in your charge. This one's mother has died, and that one has lost all his savings in a bank failure. They may desire help, but more than anything else they desire sympathy. Don't make the mistake of turning such men down with the statement that you have troubles of your own, for every time you do that you knock a stone out of the foundation of your house."

An effective project manager is not only focused on the task, but also on the individuals within the project team. Only a team can succeed, and the project manager's role is to ensure that the project team is functioning effectively. This means taking an interest in the people within the team.

"When I say that paternalism is essential to leadership I use the term in its better sense. I do not now refer to that form of paternalism which robs men of initiative, self-reliance and self-respect. I refer to the paternalism that manifests itself in a watchful care for the comfort and welfare of those in your charge.

Soldiers are much like children. You must see that they have shelter, food and clothing, the best that your utmost efforts can provide. You must see that they have food to eat before you think of your own; that they have each as good a bed as can be provided before you consider where you will sleep. You must be far more solicitous of their comfort than of your own. You must look after their health. You must conserve their strength by not demanding needless exertion or useless labor.

And by doing all these things you are breathing life into what would be otherwise a mere machine. You are creating a soul in your organization that will make the mass respond to you as though it were one man. And that is esprit."

Taking an interest in the people on your project is not a weakness, and it's not the preserve of women project managers. Displaying genuine respect for the people in your team will repay itself in kind, over and over again.

"You cannot treat all men alike! A punishment that would be dismissed by one man with a shrug of the shoulders is mental anguish for another. A company commander who, for a given offense, has a standard punishment that applies to all is either too indolent or too stupid to study the personality of his men. In his case justice is certainly blind.

Study your men as carefully as a surgeon studies a difficult case. And when you are sure of your diagnosis apply the remedy. And remember that you apply the remedy to effect a cure, not merely to see the victim squirm. It may be necessary to cut deep, but when you are satisfied as to your diagnosis don't be diverted from your purpose by any false sympathy for the patient."

It is as important to follow up poor performance or behavior as it is to follow up great performance or behavior with your team members. But any follow up for poor performance has to focus on the task and behaviors, not the person. If you counsel someone regarding improvements needed in their work, you are actually giving them the opportunity to learn and grow. It should not be seen as distasteful work.

"Hand in hand with fairness in awarding punishment walks fairness in giving credit. Everybody hates a human hog. When one of your men has accomplished an especially creditable piece of work see that he gets the proper reward. Turn heaven and earth upside down to get it for him. Don't try to take it away from him and hog it for yourself. You may do this and get away with it, but you have lost the respect and loyalty of your men. Sooner or later your brother officers will hear of it and shun you like a leper. In war there is glory enough for all. Give the man under you his due. The man who always takes and never gives is not a leader. He is a parasite."

A true leader is not afraid to share the glory when things go well. Individual recognition for a job well done not only lifts the spirit of the individual so recognized, it lifts the spirits of the whole team, as they know that good effort brings rewards.

"There is another kind of fairness - that which will prevent an officer from abusing the privileges of his rank. When you exact respect from soldiers be sure you treat them with equal respect. Build up their manhood and self-respect. Don't try to pull it down.
Consideration, courtesy and respect from officers toward enlisted men are not incompatible with discipline. They are parts of our discipline. Without initiative and decision no man can expect to lead."

Respect is critical in building an effective motivated project team. As project manager, you should have the same respect for the skills and knowledge of your most junior member as you do for the project executives.

"In maneuvers you will frequently see, when an emergency arises, certain men calmly give instant orders which later, on analysis, prove to be, if not exactly the right thing, very nearly the right thing to have done. You will see other men in emergency become badly rattled; their brains refuse to work, or they give a hasty order, revoke it; give another, revoke that; in short, show every indication of being in a blue funk.

Regarding the first man you may say: "That man is a genius. He hasn't had time to reason this thing out. He acts intuitively." Forget it! Genius is merely the capacity for taking infinite pains. The man who was ready is the man who has prepared himself.

He must also have the decision to order the execution and stick to his orders.

Any reasonable order in an emergency is better than no order. The situation is there. Meet it. It is better to do something and do the wrong thing than to hesitate, hunt around for the right thing to do and wind up by doing nothing at all. And, having decided on a line of action, stick to it. Don't vacillate. Men have no confidence in an officer who doesn't know his own mind."

Being able to react coolly in a crisis is a hallmark of an effective project manager, and the one area where I see most people fail. No project will ever run entirely smoothly, it is the crises that make the manager.

"You must frequently act without orders from higher authority. Time will not permit you to wait for them. Here again enters the importance of studying the work of officers above you. If you have a comprehensive grasp of the entire situation and can form an idea of the general plan of your superiors, that and your previous emergency training will enable you to determine that the responsibility is yours and to issue the necessary orders without delay.

And then I would mention courage. Moral courage you need as well as mental courage - that kind of moral courage which enables you to adhere without faltering to a determined course of action, which your judgment has indicated is the one best suited to secure the desired results.

You will find many times, especially in action, that, after having issued your orders to do a certain thing, you will be beset by misgivings and doubts; you will see, or think you see, other and better means for accomplishing the object sought. You will be strongly tempted to change your orders. Don't do it ..... every time you change your orders without obvious reason you weaken your authority and impair the confidence of your men. Have the moral courage to stand by your order and see it through."

And this all boils down to self-confidence, and knowing your job.

"Moral courage further demands that you assume the responsibility for your own acts. If your subordinates have loyally carried out your orders and the movement you directed is a failure the failure is yours, not theirs. Yours would have been the honor had it been successful. Take the blame if it results in disaster. Don't try to shift it to a subordinate and make him the goat. That is a cowardly act. "

Accountability, both personal and for the overall project, is critical. Even when a failure on the project is caused by a member of the team, the Project Manager is accountable, as they are in control of the team.

"Furthermore, you will need moral courage to determine the fate of those under you. You will frequently be called upon for recommendations for promotion or demotion of officers and non-commissioned officers in your immediate command.

Courage is more than bravery. Bravery is fearlessness - the absence of fear. The merest dolt may be brave, because he lacks the mentality to appreciate his danger; he doesn't know enough to be afraid.

Courage, however, is that firmness of spirit, that moral backbone which, while fully appreciating the danger involved, nevertheless goes on with the undertaking. Bravery is physical; courage is mental and moral. You may be cold all over; your hands may tremble; your legs may quake; your knees be ready to give way - that is fear. If, nevertheless, you go forward; if, in spite of this physical defection you continue to lead your men against the enemy, you have courage.

The physical manifestations of fear will pass away. .... You must not give way to them."

Whilst we are extremely unlikely, as Project Managers, to ever face the kind of fear these student officers were about to face, there can be times on a project where courage is required to recommend or follow a particular course of action.

"Use judgment in calling on your men for displays of physical courage or bravery. Don't ask any man to go where you would not go yourself. If your common sense tells you that the place is too dangerous for you to venture into, then it is too dangerous for him. You know his life is as valuable to him as yours is to you."

In today's work environment, I draw the parallel with working long hours. We all aspire to a reasonable work life balance; however there will be times on some projects where additional, and sometimes extraordinary, effort is need to meet a particular milestone. Just make sure that your request is not unreasonable, is not something you would not do yourself, and that the project team members are rewarded later for their additional efforts.

"And, lastly, if you aspire to leadership, I would urge you to study men.

Get under their skins and find out what is inside.

Some men are quite different from what they appear to be on the surface. Determine the workings of their mind.

You cannot know your opponent ........ But you can know your own men. You can study each to determine wherein lies his strength and his weakness; which man can be relied upon to the last gasp and which cannot.

Know your men, know your business, know yourself!"

These fundamentals of leadership are as relevant in today's business as they were in the 1920's when written. I'll leave you with a last quote from Napoleon Hill on the link between leadership and initiative.

"And what is Initiative? It is that exceedingly rare quality that prompts -nay, impels - a person to do that which ought to be done without being told to do it. One of the peculiarities of Leadership is the fact that it is never found in those who have not acquired the habit of taking the initiative. Leadership is something that you must invite yourself into; it will never thrust itself upon you." - Napoleon Hill 1928

If you wish to read the Major's speech in full, I have reprinted the speech on ManageThatProject.com.

Knee Fractures and Dislocations - How a Patella Knee Brace Can Help

The Knee Joint

The knee is the largest joint in the human body, and it's used on a daily basis. Most of us take our knees for granted, and it's not until something goes wrong with them that we take a moment, pause and realize just how much we actually need our knees.

1.) Knee Fractures

Knee fractures are rare. It is far more common to suffer a sprained or dislocated knee than it is to break it. In most cases, a knee fracture is caused by falling, extreme pressure being applied to the knee or a severe twisting of the knee.

Your knee is made up of three major bones: the knee cap or patella, lower thigh bone or distal femur and the leg bone (tibia). If you suffer a fracture, it is to one of these bones and it can be extremely painful. It generally takes a lot of force to break your knee. Usually, a knee fracture is caused by a sporting injury, a fall or extreme force, such as a car accident that causes your knee to be smashed against the dashboard.

2.) Symptoms

Symptoms of a dislocated knee or fractured knee are similar, and painful. Once you have dislocated your knee once, it is easier to dislocate it a second time, especially if the same forces that dislocated your knee the first time are reproduced a second time.

Symptoms include:

Pain

Swelling

Bruising

Unstable knee joint that makes it either impossible or difficult to walk

Unable to bend your knee

Kneecap is pushed to the side of the leg

If you suffer a fractured or dislocated knee, you will have to have the bone set or the knee placed back in the socket. Elevating the injured knee and applying cold packs are a good way to reduce swelling. You may also have to have your leg and knee splinted in order to immobilize it. Like many things, rest is imperative to the healing process.

3.) Knee Brace For Support

You could also consider using a knee brace to help add support to the knee. This is especially true if you have dislocated your knee. As mentioned above, your knee is more likely to get dislocated a second time, and the use of a brace can help prevent this from happening.

Protect your knee from injury by using a knee brace when engaging in sporting activities is a great way to prevent injury in the future. Do not take your knees for granted. Protect them whenever you can.

Putting the Freeze on Knee Arthritis Pain

Millions of people across the globe suffer from some type of knee related pain. Whether it is arthritis, meniscus tears, ligament injuries, contusions, instability, tendonitis or overuse, the treatment pattern is often similar. Regardless of the situation, reducing inflammation is paramount to resolving pain.

Most people know to use the acronym R.I.C.E. (Rest, Ice, Compression and Elevation) when they experience an acute injury. While rest seems fairly obvious, many people forgo ice after the first day or so. This is a big mistake. I generally recommend ice for prolonged periods of time as I find it effective in reducing chronic pain related to arthritis as well as more acute injuries.

Your knees will ultimately tell you when to ice. Swelling is most common inside the knee joint itself as well as around the kneecap. In some cases, the swelling will travel down the leg and into the foot and ankle as well since gravity tends to pull it there when you sit or stand for prolonged periods. This is where the elevation part becomes necessary if you are limited with weight bearing or unable to walk based on pain or the doctor's orders.

Aside from just icing, using a cold pack or wrap that provides compression is also beneficial in accelerating the reduction of swelling and fluid on the knee. Applying a cold wrap immediately following exercise or after a period of increased activity will reduce post activity soreness and swelling. I recommend applying the ice treatment for 15-20 minutes and then removing for one hour before repeating as needed.

As pain and swelling subside, it becomes easier to restore range of motion and strength with a properly directed exercise program. Using appropriate quadriceps, hamstrings and hip exercises will eliminate muscle imbalances and restore function. Typical knee rehab programs last anywhere from 4-8 weeks for non-operative conditions and from 1 to 6 months for most post-operative conditions.

The maximum protection phase for healing tissue ranges between 3 days and 6 weeks depending upon the injury in the knee. During this phase, icing the knee routinely is critical for controlling pain and inflammation. Too much swelling will inhibit the quadriceps muscle thereby reducing strength and mobility, while also making walking more painful and difficult.

So, if you are plagued by chronic knee pain or have recently suffered a knee injury, begin maximizing your health and recovery by using cold therapy. Invest in a good cold compression wrap today, avoid abusive stress on the knee joint, and consult a qualified medical professional to advise you on safe and effective knee rehab exercises.