What is an ACL injury?

The anterior cruciate ligament (ACL) is one of four ligaments that provide stability to the knee joint. These fibrous bands attach bone to bone and help control excessive motion of the knee joint and keeps the lower leg from sliding too far forward. Of the four major ligaments of the knee, the ACL injury is the one most commonly injured. The majority of ACL repairs that occur each year are done on young athletes (under age 25) and female athletes.

ACL injuries are common in sports that involve sudden changes of direction, such as football, and soccer. Most are non-contact injuries that occur during sudden twisting motion (for example, when the feet are planted one way and the knees are turned another way) or when landing from a jump.

Are Women At Higher Risk of ACL Injury?

The causes of ACL injury have recently been the focus of research. Factors contributing to ACL injuries include ground hardness, grass type and cleat type. But one of the other major findings is that women are nearly three times more likely to have ACL injuries than men. And some statistics says that a female soccer player is eight times more likely to injury her ACL than a male soccer player. Researchers believe this may be due to differences in hormone levels on ligament strength and stiffness, neuromuscular control, lower limb biomechanics, ligament strength and fatigue. Findings have show a difference in neuromuscular control in women when landing jumps (women appear to have less hip and knee flexion than men).

How Do I Prevent an ACL Injury?

Athletes can reduce their risk of ACL injuries by performing training drills that require balance, power and agility. Adding plyometric exercises, such as jumping, and balance drills helps improve neuromuscular conditioning and muscular reactions and ultimately shows a decrease in the risk of ACL injury. Many team physicians now routinely recommend an ACL conditioning program. Phases of the ACL Injury Prevention Program should be performed at least 2-3 times per week during the season and includes: This program should take approximately 15 minutes to complete. Alongside each exercise you will notice a box with the approximate amount of time that should be spent on each activity. This will serve as a guideline to you in order to conduct your warm-up in a time-efficient manner.

Warm-up:

Warming up and cooling down are a crucial part of a training program. The purpose of the warm-up section is to allow the athlete to prepare for activity. By warming up your muscles first, you greatly reduce the risk of injury.

Jog line to line (cone to cone): Elapsed Time: 0 - .5 minute

Purpose: Allows the athletes to slowly prepare themselves for the training session while minimizing the risk for injury. Educate athletes on good running technique; keep the hip/knee/ankle in straight alignment without the knee caving in or the feet whipping out to the side.

Instruction: Complete a slow jog from near to far sideline.

Shuttle Run (side to side): Elapsed Time: .5 to 1 minute

Purpose: engage hip muscles (inner and outer thigh). This exercise will promote increased speed. Discourage inward caving of the knee joint.

Instruction: Start is an athletic stance with a slight bend at the knee. Leading with the right foot, sidestep pushing off with the left foot (back leg). When you drive off with the back leg, be sure the hip/knee/ankle are in a straight line. Switch sides at half field.

Backward Running: Elapsed Time: 1-1.5 minutes

Purpose: continued warm-up; engage hip extensors/hamstrings. Make sure the athlete lands on her toes. Be sure to watch for locking of the knee joint. As the athlete brings her foot back, make sure she maintains a slight bend to the knee.

Instruction: Run backwards from sideline to sideline. Land on your toes without snapping the knee back. Stay on your toes and keep the knees slightly bent at all times.

Stretching:

Warm up before stretching is very important to decreasing risk of injury. The following exercises help improve range of motion, reduce stiffness, reduce post-exercise soreness, reduce the risk of injury and improve overall mobility and performance.

Don't bounce or jerk but gently stretch to a point of tension and hold. Hold the stretch for 30 seconds, Breathe normally (don't hold your breath).

Calf stretch (30 seconds x 2 reps)

Elapsed Time: 1.5 to 2.5 minutes
Purpose: Stretch the calf muscle of the lower leg.
Stand leading with your right leg.
Bend forward at the waist and place your hands on the ground (V-formation).
Keep your right knee slightly bent and your left leg straight.
Make sure your left foot is flat on the ground.
Do not bounce during the stretch.
Hold for 30 seconds.
Switch sides and repeat.

Quadricep stretch (30 seconds x 2 reps)

Elapsed Time: 2.5 to 3.5 minutes
Purpose: Stretch the quadricep muscle of the front of the thigh.
Place your left hand on your partner's left shoulder.
Reach back with your right hand and grab the front of your right ankle.
Bring your heel to buttock.
Make sure your knee is pointed down toward the ground.
Keep your right leg close to your left.
Do not allow knee to wing out to the side and do not bend at the waist.
Hold for 30 seconds and switch sides.

Hamstring stretch (30 seconds x 2 reps)

Elapsed Time: 3.5 - 4.5 min
Purpose: To stretch the hamstring muscles of the back of the thigh.
Sit on the ground with your right leg extended out in front of you.
Bend your left knee and rest the bottom of your foot on your right inner thigh.
With a straight back, try to bring your chest toward your knee. Do not round your back.
If you can, reach down toward your toes and pull them up toward your head.
Do not bounce.
Hold for 30 seconds and repeat with the other leg.

Inner Thigh Stretch (20 seconds x 3 reps)

Elapsed Time: 4.5 - 5.5 min
Purpose: Elongate the muscles of the inner thigh (adductor group).
Remain seated on the ground.
Spread you legs evenly apart.
Slowly lower yourself to the center with a straight back.
You want to feel a stretch in the inner thigh.
Now reach toward the right with the right arm.
Bring your left arm overhead the stretch over to the right.
Hold the stretch and repeat on the opposite side.

Hip Flexor Stretch (20 seconds x 2 reps)

Elapsed Time: 5.5 - 6.5 min
Purpose: Elongate the hip flexors of the front of the thigh.
Lunge forward leading with your right leg.
Drop your left knee down to the ground.
Placing your hands on top of your right thigh, lean forward with your hips.
The hips should be square with your shoulders.
If possible, maintain your balance and lift back for the left ankle and pull your heel to your buttocks.
Hold for 30 seconds and repeat on the other side.

Strengthening:

The strengthening phase of the program focuses on increasing leg strength. This will lead to increased leg strength and a more stable knee joint. Technique is everything; close attention must be paid to the performance of these exercises in order to avoid injury.

Walking Lunges (3 sets x 10 reps)

Elapsed Time: 6.5 - 7.5 min
Purpose: Strengthen the thigh (quadriceps) muscle.
Lunge forward leading with your right leg.
Push off with your right leg and lunge forward with your left leg.
Drop the back knee straight down.
Make sure that your keep your front knee over your ankle.
Control the motion and try to avoid your front knee from caving inward. If you cannot see your toes on your leading leg, you are doing the exercise incorrectly.

Hamstrings (3 sets x 10 reps)

Elapsed Time: 7.5 - 8.5 min
Purpose: Strengthen hamstrings muscles.
Kneel on the ground with hands at your side.
Have a partner hold firmly at your ankles.
With a straight back, lean forward leading with your hips.
Your knee, hip and shoulder should be in a straight line as you lean toward the ground.
Do not bend at the waist.
You should feel the hamstrings in the back of your thigh working.
Repeat the exercise for 3 sets of 10, or a total of 30 reps.

Single Toe Raises (30 reps x 2 reps)

Elapsed Time: 8.5 - 9.5 min
Purpose: This exercise strengthens the calf muscle and increases balance.
Stand up with your arms at your side.
Bend the left knee up and maintain your balance.
Slowly rise up on your right toes with good balance.
You may hold your arms out ahead of you in order to help.
Slowly repeat 30 times and switch to the other side.
As you get stronger, you may need to add additional repetitions to this exercise to continue the strengthening effect of the exercise

Plyometrics:

Plyometrics exercises are explosive and help to build, power, strength and speed. The most important element when considering performance technique is the landing. It must be soft. When you land from a jump, you want to softly accept your weight on the balls of your feet slowly rolling back to the heel with a bent knee and a straight hip. These exercises are basic, however, it is critical to perform them correctly. Please take the time to ensure safe and correct completion of these exercises.

Lateral Hops over Cone (20 reps)

Elapsed Time: 9.5 - 10 min
Purpose: Increase power/strength emphasizing neuromuscular control.
Stand with a 6" cone to your left.
Hop to the left over the cone softly landing on the balls of your feet land bending at the knee.
Repeat this exercise hopping to the right.

Forward/Backward Hops over cone (20 reps)

Elapsed Time: 10 - 10.5 min
Purpose: Increase power/strength emphasizing neuromuscular control.
Hop over the cone/ball softly landing on the balls of your feet and bending at the knee.
Now, hop backwards over the ball using the same landing technique.
Be careful not to snap your knee back to straighten it.
You want to maintain a slight bend to the knee.
Repeat for 20 reps.

Single Leg hops over cone (20 reps)

Elapsed Time: 10.5 - 11 min
Purpose: Increase power/strength emphasizing neuromuscular control.
Hop over the cone/ball landing on the ball of your foot bending at the knee.
Now, hop backwards over the ball using the same landing technique.
Be careful not to snap your knee back to straighten it.
You want to maintain a slight bend to the knee.
Repeat for 20 reps.
Now, stand on the left leg and repeat the exercise.
Increase the number of repetitions as needed.

Vertical Jumps with headers (20 reps)

Elapsed Time: 11 - 11.5 min
Purpose: Increase height of vertical jump.
Stand forward with hands at your side.
Slightly bend the knees and push off jumping straight up.
Remember the proper landing technique; accept the weight on the ball of your foot with a slight bend to the knee.
Repeat 20 times and switch sides.

Scissors Jump (20 reps)

Elapsed Time: 11.5 - 12 min
Purpose: Increase power and strength of vertical jump.
Lunge forward leading with your right leg.
Keep your knee over your ankle.
Now, push off with your right foot and propel your left leg forward into a lunge position.
Be sure your knee does not cave in or out.
It should be stable and directly over the ankle.
Remember the proper landing technique; accept the weight on the ball of your foot with a slight bend to the knee. Repeat 20 times.

Agility

Agility skill exercises are designed to improve the power and strength in the muscles.

Shuttle run with forward/backward running

Elapsed Time: 12 - 13 min
Purpose: Increase dynamic stability of the ankle/knee/hip complex.
Starting at the first cone
sprint forward to the second cone
run backward to the third cone
sprint forward to the fourth cone (etc.).

Diagonal runs (3 passes)

Elapsed Time: 13 - 14 min
Purpose: To encourage proper technique/stabilization of the outside planted foot to deter the position from occurring.
Face forward and run to the first cone on the left.
Pivot off the left foot and run to the second cone.
Now pivot off the right leg and continue onto the third cone.
Make sure that the outside leg does not cave in.
Keep a slight bend to the knee and make sure the knee stays over the ankle joint.

Bounding run (44 yds)

Elapsed Time: 14 - 15 min
Purpose: To increase hip flexion strength/increase power/speed.
Starting on the near sideline, run to the far side with knees up toward chest.
Bring your knees up high.
Land on the ball of your foot with a slight bend at the knee and a straight hip. Increase the distance as this exercise gets easier.

Cool Down

Cooling down is essential to the program and shouldn't be skipped. It allows the muscles that have been working hard throughout the training session to elongate and deters the onset of muscle soreness. It is helpful to drink water during the cool down. The cool down takes about 10 minutes. It includes light strength training and stretching exercises.

Bridging with Alternating Hip Flexion (30 reps)

Purpose: Strengthen outer hip muscles (Hip abductors, flexors) and buttocks
Lie on the ground with your knees bent with feet on the ground.
Raise your buttocks up off the ground and squeeze. Now, lift your right foot off the ground and make sure that your right hip does not dip down.
Lower your right foot and now lift your left foot making sure your left hip does not dip down.
Repeat 30 times on each side. As you get stronger, you will place your feet on top of a ball and repeat the exercise.

Abdominal Crunches (30 reps x 2 reps)

Purpose: Strengthen the abdominals (rectus abdominus, obliques)
Lie on the ground with you knees bent.
Place your hands behind your head with your elbows out wide.
Support your neck lightly with your fingers.
Take a deep breath in and slowly contract your abdominal muscles as you exhale.
Repeat 30 times.
Drop your legs off to the right side.
Slowly crunch up with your elbows out wide.
You should feel your oblique muscles working on the side of your waist.
Repeat 30 times and switch to the other side.

Single and Double Knee to Chest (30 sec x 2 reps)

Purpose: Elongate the low back muscles.
Lie on your back.
Bring your right knee toward your chest and hug firmly.
Keep your left leg out straight in front of you.
You should feel a stretch along your low back and into your buttocks.
Hold the stretch for 30 seconds and switch sides.
Now bring both knees to chest.
If you feel any pain in the low back, discontinue the stretch and inform your coach/trainer.

Piriformis stretch- supine (30 sec x 2 reps)

Purpose: Elongate the rotators of the hip.
Lie on your back and bend both of your knees.
Fold your left ankle over your right knee.
Place your hands behind your right thigh and pull your right knee to chest.
You should feel a good stretch in the left gluteals region and the side of the thigh.
Hold for 30 seconds and repeat on the other side.
If you experience and low back pain with this stretch, slowly lower your legs down and let your coach/trainer know.

Seated Butterfly stretch - seated (30 sec x 2 reps)

Purpose: Elongate the inner thigh muscles (adductors).
Sit up bringing your feet in so that the soles of your feet are touching.
Gently place your elbows on your knees and slowly push down.
You should feel a good stretch of the inner thigh. Hold this for 30 seconds and repeat 2 to 3 times.

What is an ACL injury?