Overview of ACL Injury Prevention Training 

Overview of ACL Injury Prevention Training

Injury prevention training integrates strength training, proprioception (sensing your knee’s orientation in space relative to other body parts), joint stability, flexibility, and producing controlled neuromuscular patterns for jumping, landing, and cutting. Naturally, the preseason approach for an NFL lineman will be different than that of a recreational skier or soccer player. Addressing the biomecahnics involved, individual sports, or individual techniques could be the subject of a 300 page book. The thrust of this entry, however, is to present an overview of some strategies and their application on preventing some ACL injuries.

Those wonderful knees

New England Patriots fans are too familiar with complete ACL tears. Both Tom Brady and Wes Welker succumbed to this injury in consecutive seasons. Traumatic knee injuries involving flying bodies are difficult to avoid, no thanks to the Kansas City Chiefs. The mechanism of non-contact ACL injury, according to “A Comprehensive Review of Partial Anterior Cruciate Ligament Tears” published in the January 2009 Journal of Bone and Joint Surgery, “involves the femur being externally rotated on a fixed lower extremity or the tibia being internally rotated relative to the femur as a valgus moment is applied to the knee joint.” Accordingly, some non-contact ACL injuries can be reduced by focusing on enhancing the neuromuscular system; by training the hips, knees, and ankles to be more balanced and centered beneath the hips when cutting and absorbing forces; and by training the hip complex to be more explosive and reactive. As athletic as Welker is as a receiver, when he planted forcefully on muddy turf, outside of the frame of his hips, while his torso moved forward and in the opposite direction, the resultant forces of this valgus moment and tibial internal rotation were too great for his ACL to bear. The following lists some of an ever-evolving paradigm of ACL injury prevention movements:

• Proprioception: This training utilizes the sensorimotor system to provide information on joint position and limb movement, and then subsequent muscular contractions to stabilize the joint (your knee, for instance). The end goal is to become more keenly aware of a joint relative to other parts of your body. Establish correct squatting technique by pressing the hips back, aligning the knees with the mid-foot, retracting the scapulas, and tightening the abdominal muscles. Shift weight to balance on one foot and then move a medicine ball through a series of “X” motions. The athlete should focus on recruitment of the calves, hamstrings, and quads as the prime stabilizers for the knee. Perform 3 x 15 “X” motions. Increase difficulty by closing eyes or standing on a balance pad.
• Reactive Jumps and Stability: This type of training has direct application among skiers, since their legs are constantly eccentrically loaded (when absorbing a bump, for instance) and encountering changing surface conditions. Hold a physioball and assume correct squatting position. Close your eyes and jump either laterally or at an angle. Cushion the landing by ensuring the hips, knees, and ankles lightly absorb, and have a partner immediately push or pull the physioball. Be sure that the knees do not drift in an anterior fashion. The hips, knees, core muscles, and upper body muscles must instantly react to this changing movement to prevent loss of stability. Perform 2 x 10 jumps.
• The mechanics of cutting: ACL injury mechanics are well researched and complex. For the purposes of this entry, and in a super generalized sense, we can say some non-contact ACL injuries often result when the ligaments of the knee absorb the forces of a cutting and pivoting motion, rather than the musculoskeletal system. Other mechanisms of injury can include a cutting motion involving a planted foot, coupled with an excessive internally/externally rotated knee and excessive forward torso flexion. In February 2010, The Journal of Orthopaedic and Sports Physical Therapy reported that impaired hip mechanics can influence loading at the knee, and thus contribute to injury. From the perspective of an athlete, a great deal of neuromuscular control is necessary to perform a cut. A trained professional can provide verbal cues, as well as direct the strengthening of oft neglected muscles, such as the glute medius. In a very general sense, cutting movements should always begin with a stable torso, an aligned knee relative to the midfoot, good eccentric control from the glutes, and quadriceps and hamstrings co-contractions.
• Hamstring and hip complex strength: An athlete can be at a greater injury risk when quads are over-developed and tight, and if impaired hip, pelvis, and trunk control produces greater stress at the ACL. To address these deficiencies perform the following, 3 x 10, 2 times per week:
  • Supine physioball hamstring bridges and curls
  • Supine floor bridges
  • Romanian deadlifts
  • Physioball hip extensions
• Flexibility training: Stretches that target the quads, particularly the rectus femoris and hip flexors, can help reduce tension around the knees, and diminish quad dominant control. 1 x 60 seconds each leg.

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About The Author

Eric Minkwitz

Since 2002, Eric Minkwitz has operated Mink Training Systems, a sports performance, workplace wellness, and nutritional consulting business geared towards student-athletes, active individuals, and busy professionals. Minkwitz works with people of all levels, to educate and empower his clients to reach their potential in team sports, personal endeavors, and physical competitions of all types.