ACL injury prevention is becoming a more popular focus in many sports. In the US, approximately 200,000 people per year suffer an ACL injury with about half of these requiring surgery. The recovery process is long and for sports people, it usually means being side-lined for about one year. This is definitely a case where prevention is better than cure.
When thinking about ACL injury prevention, there is no one thing you can do to avoid injury, but by being aware of how ACL injuries occur and by incorporating certain elements into your training structure, you can definitely help reduce the risk of injury. Let's find out how.
ACL injury prevention starts by understanding how the ligament works and
how it tends to get damaged. The ACL (anterior cruciate ligament) is
one of four knee ligaments
that are responsible for controlling stability. It sits between the
thigh and shin bones in the middle of the knee joint and controls the
forwards and twisting movements of the skin bone (tibia). Functionally,
it works for all movements of the leg, but it is especially important
with starting, sudden stopping and twisting movements.
The ACL is flexible and can stretch to a degree, but too much strain through it will cause it to tear. This usually happens in one of two ways:
1) Direct Trauma: Anything that puts too much force through the ligament such as a sports tackle, hard fall or car accident
2) Twisting: Sudden turning and twisting the leg when the foot is stuck to the ground e.g. with studs or cleats
Effective rehab to reduce the risk of ACL injuries should incorporate a number of things:
It’s one of the oldest pieces of advice out there for all
activities but it really does play an important role in injury
prevention. Warm ups usually last about 15 minutes and should be
designed to get your body prepared for activity. Activities such as
jogging, shuttle runs and running in different directions should be
incorporated into warms ups focussing on ACL injury prevention.
Another essential part of ACL injury prevention as they help to improve the flexibility and therefore performance of the knee. Stretches for the quads, hamstrings, calves, hip flexors, inner thigh and glutes should all be done. The most effective way to stretch is to hold the stretch for 30 seconds and repeat it 2-3 times.
Improving the strength of the quadriceps, hamstrings, glutes, calf and
trunk muscles helps the muscles work together to
provide more stability to the knee thus supporting the ACL and reducing the risk of injury.
This is becoming a very popular part of ACL injury prevention programmes, designed to improve dynamic stabilisation of the knee. They also teach individuals how to land from jumps, pivot and change direction without putting too much force through the ACL.
One element of this is plyometric exercises - specialised, high intensity exercises to improve power, strength and speed through various jumping and hopping activities. They work by causing the muscle to first lengthen and then quickly shorten. They should only be done under close supervision as they involve high-risk movements and if done incorrectly, can result in injury.
Having good proprioception is a vital part of preventing ACL knee injuries. Proprioception is the reflex control through small adjustments that provides the stability of the knee. The ACL provides the primary proprioceptive input at the knee.
Balance exercises such as
exercises on one leg, on a wobble board and with your eyes closed
helps improve balance and proprioception and is thus an important part
of ACL injury prevention.
ACL injuries often occur when the foot is stuck to the ground so where possible, avoid shoes with cleats/studs, particularly in contact sports
There is some controversy over whether wearing a knee brace helps with
ACL injury prevention. Wearing a brace can help reduce the risk of over
stretching the ligament but they can also create a false sense of
security. In the general population, there is usually no need for a
knee brace but in high-level athletes participating in high-risk
activities, an ACL knee brace may help. They can be particularly useful
after an ACL reconstruction to reduce the risk of further injury during
the rehab and recovery phase
Effective injury prevention combines some or all of the suggestions
above. Coaches of high risk activities such as basketball, soccer and
football should ensure they are encorporating exercises specifically
targeting ACL injury prevention into their programmes to help reduce the
risk of injury.
You can find out more about ligament injuries, including the causes, symptoms and diagnosis in the ACL knee injury section. Alternatively, if you have already suffered from an injury, visit the ACL knee surgery section to find out more about what surgery entails and the rehab and recovery process.