“I tore my ACL, 1st game of the year”
Those dreaded, season ending, words are spoken too often in the world of sports. It may come in the form of a pop or a silent slash, nevertheless, the ACL injury is the kryptonite of many athletes spanning all ages. The Anterior Cruciate Ligament (ACL) is part of the inner knee connection attaching the tibia (shin bone) to the femur (thigh bone). Its primary function is to prevent the tibia from translating in front of and rotating on the femur as our body moves in space. Due to the configuration of its attachment, this ligament is often placed under stress through contact and noncontact events that lead to sprains or tears of its fibers. Sports such as soccer, football, basketball and lacrosse require frequent cutting and stopping lending increased tension on the ACL. Without the proper support around the knee, it becomes more susceptible to sprains and tears. To this end, extensive research has been conducted in effort to learn how these injuries can be reduced.
A noncontact ACL injury is most often a result of cutting, stopping or landing from a jump incorrectly. Research suggests that a proper ACL prevention program preformed prior to a season can decrease the incidence of ACL injuries. According to a meta-analysis published in the journal of orthopedic research, 50% reduction in risk of noncontact ACL tears for male and female athletes. For females’ athletes alone, up to 67% reduction in rick of ACL tear. In order to best prepare one’s body to withstand the forces that accompany many of these sports, a comprehensive program is necessary. This should be a multifactorial design that encompasses many aspects of fitness including: strengthening, plyometrics, flexibility, agility, balance and technique. This can be implemented through a dynamic warm up routine, strengthening period and plyometric sequences. The program should be progressive over a 6-week period beginning with strengthening and technique and ending with sports specific plyometric exercises. The plan should begin well in advance of the season and should include maintenance as the season proceeds. Form is paramount, especially when performing plyometric exercises; which entails soft landing with knees shoulder width apart and slightly bent with chest up.
A thorough program will contain not only the physical aspects necessary for injury prevention, but the positional and cognitive components as well. Specifically, such a program will include common stance that one will be in during a sport and challenge the athlete in that position. The cognitive aspect can be utilized through adding sports specific situations such as defense or passing while undergoing compromised positions. The ultimate goal of a ACL prevention program is to prepare the athlete to withstand the inevitable forces experienced on the field of play and normalizing their body to prevent disadvantageous positions of the knee.
Dynamic Warm up
*This is not a comprehensive program, rather examples of some exercises that may be included.
1 Anterior Cruciate Ligament (ACL) Injuries - OrthoInfo - AAOS. Clavicle Fracture (Broken Collarbone) - OrthoInfo - AAOS. https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/
2 Benjaminse A, Gokeler A, Dowling AV, et al. Optimization of the anterior cruciate ligament injury prevention paradigm: novel feedback techniques to enhance motor learning and reduce injury risk. The Journal of orthopaedic and sports physical therapy. 2015 Mar;45(3):170-82.
3. Geary M. MD; ACL Prevention Program. https://www.southshorehospital.org/Workfiles/Medical_Services/Orthopedics/ACL_prevention_program.pdf.
4 Gokeler A, Seil R, Kerkhoffs G, Verhagen E. A novel approach to enhance ACL injury prevention programs. Journal of experimental orthopaedics. 2018 Jun 18;5(1):22.
5 Padua DA, DiStefano LJ, Hewett TE, et al. National Athletic Trainers' Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. Journal of athletic training. 2018 Jan;53(1):5-19.
6 Webster KE, Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 2018 May 7.