Anterior Cruciate Ligament Injury Prevention

Perhaps one of the most dreaded injuries in young athletes, anterior cruciate ligament injury (ACL) occurs at a rate of approximately 80,000 per year in the United States. Young athletes ages 15-25 are the most susceptible to this devastating injury, and within that group, females are four to eight times more likely to tear their ACL. As a coach or parent of young athletes, understanding ACL injury and working to prevent them is one key to safe and happy sports participation.

The ACL is one of the primary ligaments that provides stability to the knee joint. In addition to connecting the upper and lower leg bones, it also functions as a feedback mechanism, sending information about the position of the knee joint to the brain. This communication is vital during athletic activities, not only for performance, but also to keep the knee out of positions that may cause injury.

An anterior cruciate ligament injury can occur both through contact and non-contact mechanisms. In females, non-contact injuries are more common, and often occur when young athletes pivot or cut during their sport. Most sports involve some type of pivoting or cutting, and ACL tears can occur in softball, basketball, soccer, volleyball, and other sports. Many times they come without warning, and may even be brushed off at first as a simple sprain.

While there are many factors that can contribute to anterior cruciate ligament injury, one recognized risk is a lack of neuromuscular control. This is the ability of the ACL to provide feedback to the central nervous system about the body's position, as well as the ability of the muscles to adequately control the body's movements. Of all of the potential factors that may increase risk for ACL injury, neuromuscular control is one area that can be readily improved upon through simple warm up and conditioning exercises.

You can have a direct impact on your young athlete's risk for ACL injury through neuromuscular training. Neuromuscular training programs have been shown to reduce the incidence of anterior cruciate ligament injury by as much as 10 fold. These programs are not time intensive, nor complicated, and usually consist of a warm-up, stretching, plyometric / agility drills, and balance exercises.

While anterior cruciate ligament injury isn't a career ending injury in most cases, it does forever alter the life of an athlete. Usually requiring surgery, it can take up to 9-12 months to fully recover, and the life changes to the knee include earlier onset osteoarthritis and knee replacements. Not to mention the fact that the cost for surgery and rehabilitation for ACL reconstruction ranges from $20,000 - $35,000.

You don't have to look very far to find a young girl who has suffered an ACL tear - just visit a competitive club soccer, basketball, volleyball or softball team practice and you will likely find one, or more. A recent count of a local high school soccer team had 5 players with ACL tears, one of which had torn both. On a team of 20 players, that's 25% - a number that is way too high!

With a few simple additions to your team or athletes routine, you can significantly decrease the risk for anterior cruciate ligament injury. While not every injury can be prevented, many can be with a few simple exercises.

Example ACL Prevention Program

Warm Up (50 yards each)

light jog
• back peddal
• lateral shuffle
• carioca (cross left foot front then right foot front as you shuffle side to side)
• high knee skips

Alternate Warm Up

• jump rope (2 minutes each)
  • single jumps
  • double jumps
  • alternating right left hops

Stretching

• figure 4 hamstring stretch
• kneeling hip flexor stretch
• supine piriformis stretch
• trunk cross over stretch

Agility / Plyometrics

• lateral ball jumps (2 feet)
• forward/backward ball jumps (2 feet)
• tuck jumps

Balance

• single leg balance
• single leg balance with ball toss/catch
• single leg balance with leg reaches
• single leg balance with arm reaches

About the Author:

Barton Anderson is a certified athletic trainer in Phoenix Arizona. Over the last 12 years, he has worked with hundreds of athletes with ACL tears, helping them recover and prevent re-injury. His website, Sports Injury Info, is dedicated to providing information on prevention, treatment, and rehabilitation of sports related injuries.

For more on ACL injury prevention from Bart, please see his e-book on preventing the ACL injury. Bart also has an e-book on knee pain (Patella Femoral Solutions) that is also relevant to this topic.

You can find additional information on ACL injuries and how you can prevent them on this site.

Further Reading / Resources

The Torn ACL

Sports Injury Info Santa Monica Sports Medicine Foundation Prevent Injury and Enhance Performance - PEP Program

References:

Caraffa A, Cerulli G, Projetti M, et al: Prevention of anterior cruciate ligament injuries in soccer: a prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthros 1996;4(1):19-21

Hewett TE, Stroupe AL, Nance TA, et al: Plyometric training in female athletes: decreased impact forces and increased hamstring torques. Am J Sports Med 1996;24(6):765-773

Hewett TE, Lindenfeld TN, Riccobene JV, et al: The effect of neuromuscular training on the incidence of knee injury in female athletAm J Sports Med 1999;27(6):699-706

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