ACL Injury Prevention

As we all know, contact sports can be dangerous and put athletes at a risk for injury.  Of these potential injuries, an ACL rupture is one of the more severe possibilities an athlete can suffer as they can cause them to be out of the game for quite a while depending  on how well the rehabilitation process goes for the individual. However, these are not something we just have to accept as part of the game. Approximately 80% of ACL injuries are non-contact thus can likely be prevented by implementing proper programming.
 
Injury prevention seems to have a boring connotation and isn’t typically something that athletes get particularly excited about including in their workouts; yet it is critical to increasing the longevity of athletic careers. When qualified coaches run athletes through movement assessments there are various warning signs that may put certain athletes at a higher risk for an ACL injury.  The main red flag is an athlete that presents serious  knee valgus (or when the knees fall inward). Imbalances in the kinetic chain along with coordination deficits can lead to compensations which, when left uncorrected, often turn into injuries. When these movements are noticed it’s crucial that the athlete begin a corrective exercise program prior to progressing to more complex and explosive movements. In these instances, a personalized corrective plan would be best so that the exercises can be specific towards the compensations seen in that individuals assessment.
 
Even when there are no serious warning signs presented in the individual assessments, ACL prevention can and should be implemented into workouts for groups of athletes or teams. There are many ways to incorporate these preventative exercises into a standard training plan, as long as coaches have an understanding of the basic aim of an ACL prevention plan. One important aspect to include is core strengthening since having a strong core can assist with balance and body control. Working on stability and mobility of the ankles and stability in knees can help to insure proper landings. Instilling ideal landing techniques is a big injury prevention step, as this can train athletes to have good muscle memory and good proprioception. These habits of keeping the knees, hips, and ankles in line and controlling their center of gravity are key to athletes when focusing on injury prevention.  

Plyometrics with proper landing mechanics are proven to decrease incidence of ACL injuries. When implementing plyometric work it’s critical to understand that upon impact, athletes are generating an extremely high amount of force that will be reverberated through their tendons, ligaments, and joints during the landing phase. Being able to control this force is key. Keep in mind when programming for your athletes, that landing isn’t always on two feet and coming straight down. Most sports we train for are played on one leg or foot. Work every plane of motion with one limb and two.  

Strengthening the major muscles evenly is also important. One huge mistake we see frequently is neglecting to train the glutes properly, as they are a prime mover that assist in every plane. Lastly, teaching athletes the proper way to cut and react to a stimulus is a big step to keeping them from hurting themselves even when there is no contact involved.  Often this is where ACL ruptures occur. Reacting in a game-like speed often creates sloppy movements with less body control which makes proprioception extremely critical. This is where the proprioception preparation in training plays a huge role. 
 
Some of my personally favorite drills for this reaction adaption are cutting drills that proceed various plyometrics. Whether it’s a depth drop, squat jump, or hurdle hops; getting the athlete to focus on landing in a position where they are able to quickly and efficiently redirect their momentum into a sprint or cut really emphasizes good body control. This also trains quick twitch muscle fibers and reaction time, as these drills can be progressed by using various cues from the coach to direct the athletes next move. Whether by sound, touch, or sight; learning to react not only quickly but safely and efficiently can improve sports performance while simultaneously implementing injury prevention techniques.
 
-Erin Bratcher BS, MS, CPT
​Exercise Specialist 

List of Articles Used
Cruz, D., Penney, S., Comana, F., Lecovin, G., Rebelle, T., Kristof, E., . . . National Academy of Sports Medicine. (2017, September 18). How to Prevent ACL Injuries and Keep Your Clients on the Court Through Corrective Exercise Programming. Retrieved from http://blog.nasm.org/fitness/how-to-prevent-acl-injuries-and-keep-your-clients-on-the-court-through-corrective-exercise-programming/