The Ultimate Guide to ACL Injury Prevention

I came down funny on my leg, felt a pop in my knee, and it buckled on me…

Anterior cruciate ligament (ACL) injuries are common in sports and can often devastate an athlete. ACL injuries can sideline players for the entire season or end their careers. While there is no way to completely prevent ACL injuries from happening, there are ways that trainers and coaches can help minimize the risk of them occurring.

ACL injuries are one of the most commonly known sports-related injuries. They are becoming more prevalent in our young athletes, particularly in girls. Over 120,000 ACL injuries occur annually, and nearly 80% are in girls ages 15-19. In fact, girls are 4-8x more likely to tear an ACL than boys.

The most concerning statistic is that 2/3 of all ACL injuries are from noncontact resulting from one-step/stop deceleration, cutting movements, sudden changes in direction, landing from a jump with inadequate knee and hip flexion or at full extension, or lapse of concentration.

Straight-ahead sports like jogging, swimming, and biking place minimal stress on the ACL. Sports such as football, soccer, basketball, and volleyball involving cutting, planting, and changing direction, in which the ACL plays its most important role, put all athletes, particularly girls, at the highest risk for injury.

But there is some good news. Because most of these are non-contact injuries, a majority of them can be prevented.

Conditioning for Injury Prevention

One of the most important things trainers and coaches can do is to ensure that athletes are properly conditioned. This means that athletes need to have a well-rounded training regimen that includes strength, flexibility, and conditioning exercises. Drills targeting the knee muscles can also help reduce the risk of ACL injuries.

Another key factor in preventing ACL injuries is proper technique. Athletes need to be taught how to execute movements properly so that they are not putting unnecessary stress on their knees. This includes proper landing techniques when jumping and proper cutting and pivoting techniques.

Training for Female Athletes

The female athlete may be more at risk for noncontact ACL injuries due to anatomical and hormonal differences that occur in girls versus boys, but these factors are probably minimal. There are modifiable risk factors that we, as therapists and trainers, can impact.

There are differences in strength and muscle recruitment patterns in females. Girls tend to have an imbalance between quadriceps and hamstring strength, where they are more quadricep dominant and rely less on the hamstrings and posterior chain to balance out the power of the quadriceps. Proper leg muscle strength training and core training should include a focus on the posterior chain: the glutes, the hamstrings, and the calves.

Specific exercises to address the posterior chain include:

  • Hip thrusts/bridging (including both legs and single leg and progressing from body weight to weighted)
  • Deadlifts
  • Cable leg extension
  • GHRs
  • Side-lying clam shells
  • Banded walks in all directions
  • Reverse lunges.

When performing squats, it is imperative to properly cue the athlete, as females tend to be more quad dominant with this activity. Emphasize bracing with the core, maintaining an appropriate stance for that individual, not allowing knees to cave in, and pushing through the heels.

Take Care with Jumping and Landing

The jumping and landing technique of the athlete needs to be closely observed. What needs to be prevented is the “position of no return”. This is the position where upon landing from a jump, the athlete caves in the leg(s), the hip and ankle rotate in, trunk control is poor, and the knee is at near or full extension. This position is most taxing on the ACL and is the typical position that occurs when an ACL is injured. We often see athletes with poor neuromuscular control displaying this position. It can be a difficult position to retrain the athlete, but it is critical that the coach/trainer makes every attempt to do so.

While there is no guarantee following these suggestions will prevent an ACL injury, they may help lower the risk.

Training Deficits Lead to Injury

Strength and neuromuscular deficits are the principal culprits in injuries. Strengthening alone doesn’t work. Proprioceptive training (balance and awareness) alone doesn’t work. What works and has been proven by research to reduce injury risk is the combination of strength, stability, and movement…what we call dynamic neuromuscular training.

In short, this means that you are training your brain and muscles to perform physical activities more effectively. This can be handy for movements such as squatting, jumping, or even starting and stopping abruptly. Research suggests that by implementing a simple 15-minute dynamic warm-up into sports programs, there is a significant reduction in ACL tears.

The evidence is there; the knowledge is there. The problem is in the implementation of athletic programs.

A basic dynamic warm-up is 10-15 minutes and combines warm-up, stretching, plyometrics, and sport-specific agility drills while emphasizing correct posture and straight up-and-down jumps to minimize side-to-side movement and soft landings. It requires monitoring of your athletes to ensure proper form and observe for lower extremity asymmetries.

While a wide variety of programs exist, some movements that should be included are:

  • Toy soldiers
  • Inchworms
  • Grunges (walking lunge with trunk rotation)
  • Walking knee hugs
  • Over the gait/under the fence (side-to-side stepping with exaggerated hip rotation into squatting)
  • Skipping forward and backward.

Many variables are involved in ACL injuries, but there are methods to reduce the risks of injury and put everyone on a level playing field. Proper communication between athletes, coaches, therapists, trainers, and parents will keep our kids in the game.

At Darkside Athletics, we pride ourselves on providing the most comprehensive and effective training available. Our coaches are experts in strength, stability, and movement and work with each athlete to ensure they perform at their best. We know that a dynamic warm-up is critical for reducing the risk of injury, and our programs are designed to prevent deficits from leading to an ACL tear. Contact us today for a free consultation if you’re concerned about your child’s safety while playing sports. We’ll help get them on the right track to preventing a devastating injury.

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