ACL Injuries... Prevention or Reduction?

A-C-L: The three letters that make every athlete cringe when mentioned together. Although there has been extensive research done on this specific topic, the fact of the matter is if you are an athlete who competes in a sport that involves jumping, pivoting or rapid deceleration, you are at significantly higher risk for this devastating injury. With 150,000 – 200,000 reported ACL injuries per year; to think that we are able to prevent these injuries is a bit foolish. The only preventative measure would be to avoid all sports and activities that include running, jumping, cutting, stopping, starting, etc… and we all can agree that sounds like a life of misery! Although most ACL injuries occur in sports, it is important to remember that this type of injury has the potential to occur in other aspects of life. It just so happens that physical activity naturally lends itself to an increased risk of ACL injury. Instead of prevention, we need to shift our way of thought to reduction. So the question is, what can we do as trainers or strength coaches to reduce the possibility of an ACL injury to our athletes? We will discuss that and more in this post.

What is the ACL and What Causes an ACL Injury?

The ACL or anterior cruciate ligament, attaches the front top portion of the tibia to the back bottom portion of the femur. This stops the tibia from sliding forward.

Cutting, pivoting, jumping and sudden stopping are all mechanisms of an ACL Injury. The injury to the ACL often occurs due to the following:

• Hyperextension

• Sudden deceleration

• Jumping (Landing)

• Too much rotation of the shin bone relative to the thigh bone

How do we reduce the incidence of ACL injury amongst our athletes?

As I mentioned before, to think that we are able to prevent ACL injuries, or any injuries for that matter, is completely unrealistic. We are however, able to reduce the incidences of ACL injury to our athletes by incorporating a few things into their training programs. At Elite Performance Training Systems, the program that we use for ACL injury reduction for our athletes is the same program that we use for with all of our clients. Because ACL injuries are not exclusive to athletes alone, we feel as if every client could benefit from some of the exercises prescribed in an ACL reduction program.

ACL Injury Reduction Protocols

Our ACL injury reduction protocol takes a 6 phase approach. Each phase is a building block for the next, so it is imperative that the protocols are completed in the order listed. They are as follows:

• Dynamic Warm-up: A good dynamic warm-up sets the tone for any training session. In the case of an ACL Injury Reduction program, the dynamic warm-up helps increase single leg strength, flexibility and improves proprioception. Some examples are:

• Walking Knee Hugs

• Walking Cradle

• Walking Hamstring Stretch

• Walking Quad Stretch

• Dynamic Lunge (Multidirectional)

• Inchworms

• Activation: Simple exercises that will “activate” smaller muscles that play a major role in movements such as running, jumping, cutting. These smaller muscles are often critical role players in stabilization of the hip and/or pelvis. Some activation exercises include:

• Monster Walks (Linear and Lateral)

• Clamshells

• Side Planks

• Stability / Eccentric Strength (Deceleration and Landing Skills): Eccentric strength is the single most important protocol in ACL Injury Reduction. Many ACL “prevention” programs put a huge emphasis on jumping but neglect landing concepts. Exercises to improve eccentric strength and stability include:

• Eccentric Squats

• Jumps, Hops, Drops

• Double legs (Jump)

• Single leg

• Medial

• Lateral

• Bounds

• Linear

• Lateral

• Skaters

• Double Skaters

• Depth Drops

• Single Leg

• Double Leg

• Plyometrics

• Box Jumps

• Hurdle Jumps

• Single Leg Power/Strength Development: Single leg power/strength is the second most important component of our ACL Injury Reduction Protocol. Strength exercises are functional and focus more on single leg progression. Exercises include:

• Single leg bodyweight progression

• Functional strength development exercises

• Single leg strength development

• Implementation of hip dominant and knee dominant single leg exercises

• Change of Direction Instructional Concepts (Teaching the athlete how to stop and restart): The majority of ACL injuries are non-contact and often occur during some form of deceleration, which includes landing and/or changing direction. This component of our ACL Injury Reduction Protocol focuses on teaching the athlete how to safely and efficiently slow his/her body down and then reaccelerate. It is a progression from the Eccentric Strength portion of the protocol that uses simple drills to teach the athlete. Some drills may include the following:

• Shuffle and stick

• Crossover to stick

• Linear sprint to deceleration

• Change of Direction Application of Concepts (Athlete displaying mastery of concepts): In this phase, the athlete will demonstrate mastery of the concepts learned in the previous phase. All drills will have planned incorporation of stops and restarts to mimic movements executed in various sports.

Conclusion

The reality is that we will never be able to prevent injuries, but we are always able to reduce the likelihood of the occurrence. Remember, a good strength and conditioning program is the best form of injury reduction! Whether its shoulder injuries, hip injuries or knee injuries, the incidents of occurrence can be reduced by ensuring that our athletes are doing the right things to prepare their bodies.

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