How to Prevent an ACL Injury

How to Prevent an ACL Injury

By Allan Roth

How To Prevent An ACL Injury

Athletes, both professional and amateur, are prone to numerous injuries during their careers. The body takes a beating while engaging in sports. Many of the injuries athletes sustain can be prevented, allowing the individual to avoid uncomfortable procedures and medical devices as well as keeping them 'in the game'. One of the most preventable injuries in sports today is an injury revolving around the ACL.

What is the ACL?

The ACL - anterior cruciate ligament - is a major ligament that is found in the knee. It is responsible for keeping the knee from moving too much, limiting the joint's range of motion and stabilizing leg movement. The ACL is attached to the front and top of the tibia and stretches diagonally up to attach to the back and bottom of the femur. People who complain of their knee 'giving out' or 'popping' usually have some form of ACL injury.

How does an ACL injury occur?

ACL injuries can occur during sports related activities as well as during regular day to day activities. Most of them are due to sports but the ACL can tear during a motor vehicle accident, a fall, a work related accident, rough play or during other activities that causes the knee to move in a direction it is not supposed to naturally go in. The majority of ACL injuries fall under the heading of 'non-contact' injuries. This means that the injury happens without another person being involved. For example, an athlete can turn on their foot the wrong way during a pivot or land improperly from a jump and tear the ACL. A good sign that the ACL is injured is the knee giving out from under the person when the ligament is torn.

A torn ACL that is due to non-contact usually occurs when there is a rapid deceleration of the body and the knee joint. If the body is not properly placed during a sport or physical activity, the ACL can be stressed and overloaded. When this happens, the ACL will tear. The knee is not stable and the pressure from the hips and ankles place it in a state of weakness. The muscles in the shins and thighs attempt to control the deceleration of the body and this causes the aforementioned stress and overload to the ACL

How can you tell if you have an ACL tear?

A person can have ACL problems without a tear being present but if the ligament is not checked prolonged injury could ultimately cause a tear. A good sign that a person has an ACL injury is the popping of the knee or the knee simply giving out and causing the person to fall. ACL tears usually come with swelling and pain, but a minor injury may not be painful. Going to the doctor and having the knee tested for instability and other stressors are used to diagnose the problem. Additionally, an MRI of the knee may be ordered to verify the injury and possibly any other injuries that could be associated with an ACL tear.

What is done heal an ACL injury?

Depending on the severity of the ACL injury will determine what type of treatment may be used by the physician who diagnoses the tear in the ligament. People who suffer ACL tears that do not participate in sports or who are suffering from a partial ACL tear may be required to wear a special knee brace for a few weeks to allow the ligament to heal on its own. If the tear is severe and the person is an athlete who relies on the range of motion provided by the knee, reconstructive ACL surgery may be recommended.

It should be noted that many athletes who suffer from an ACL injury such as a tear may never regain total mobility in the ligament like they had prior to the injury. Therefore, it is better to work towards preventing ACL injuries than dealing with them after they occur.

How do you prevent an ACL injury?

It takes more than just strengthening the legs to prevent an ACL injury. Everything from weak hips to the internal rotation of the knee itself can add to an ACL injury. In order to prevent this injury, core body muscles, external hip rotators, the gluteus medius muscle, lower abs and obliques all must be stretched and strengthened in order to help prevent an ACL injury. Quadriceps and hamstrings should also be strengthened in an even ratio to help in ACL tear prevention, especially in women who are not as muscular as men. Finally, good calf and ankle muscles are also required as they help control knee deceleration and provide the body with stability.

Athletes should engage in coordination drills and training in order to learn how to properly move during sports activities. Cutting - the quick side to side movements seen in many sports - as well as landing must be done so that the center of gravity in the body is lowered and the knee flexes more. The torso should remain upright at all times if possible and where it is feasible, additional movement after the cut or land is encouraged as it helps with the deceleration process in the knee.

Finally, the proper footwear for the activity is required. Shoes are important in that they provide stability for the body. They should have a good drip on the playing surface and prevent the person from slipping.

Exercises to help prevent ACL injuries

About one month prior to any sports season starting, athletes should add stability strengthening exercises to their routine. Cross training with a stair climber or elliptical should be included in the cardiovascular routine to help the muscles warm up and stretch. Here are some strengthening exercises that can be included in the workout to help prevent painful ACL injuries. These exercises should be continued through and after the sports season.

Warm up

Because it is dangerous to stretch a cold muscle, warm ups should be done in order to prepare the body for the exercise and physical activity to follow. Warm ups should include:
o Line to line jog - slowly jog from one line or cone to another while keeping the hips, knees and ankles in a straight line. Knees should not cave in and the feet should not whip out to the sides while jogging.
o Side to side shuttle run - moving from side to side, the hips, knees and ankles remain in a straight line. The exercise should start in an athletic stance with the knees slightly bent. The participant pushes off with the back leg and sidesteps in one direction to a predetermined point and then reverses.
o Backward run - this warm up helps to prevent knee locking. The participant runs backwards from one line to another, landing on the toes lightly. The knees should remain bent at all times.

Stretches

Anyone who exercises should always stretch after warm up to limber up the muscles and ligaments in the body. Stretches allow the range of motion to be maintained and helps reduce joint stiffness, soreness after activity and injury. Never bounce or jerk the muscles during stretches. Instead, the stretch should be done to the point of tension in the muscle and held for 30 seconds. Breathing should be normal and the stretch should be muscle lengthening.
o Calf stretch - starting from a standing position, bend forward from the waist and lay the palms on the ground. The right knee should be bent slightly while the left leg remains straight with the heel of the foot on the ground. Hold for 30 seconds and then switch sides. This should be done two times for each leg.
o Quadricep stretch - this exercise is done with a partner. Lay the left hand on the partner's left shoulder and then grab the front of the right ankle with the right hand from behind. Bring the heel of the foot to the buttock with the knee pointing to the ground. The legs should remain close together and the knee should not go out to the side. Remain in an upright position and hold for 30 seconds before switching sides. This should be done two times for each leg.
o Hamstring stretch - sitting on the ground, stretch the right leg out in a straight line with the left leg bent and the left foot against the inside of the right thigh. Keeping the back straight, lean forward to touch the chest to the knee. If able, reach towards the toes and bring them back towards the head. Hold for 30 seconds and then switch sides. This should be done two times for each leg.
o Inner thigh stretch - while sitting, spread the legs apart and lower the upper body down while keeping the back straight. The muscles in the inner thigh will stretch. Sit up and reach over the right leg with the right arm while extending the left arm overhead to the right. Hold for 20 seconds and then switch sides. This should be done three times for each leg.

Strengthening

In order to build up stability in the knees and legs, strengthening exercises should follow the warm up and stretching exercises. It is important that the technique is followed closely and that the performance of the exercises is adhered to in order to get the proper results.
o Walking lunges - starting with the right leg, lunge forward keeping the front knee over the ankle. Push off with the right leg and lunge forward with the left, dropping the right knee down. The motion needs to be controlled with keep the knees from caving inwards. The toes should be visible on the leading leg. If they are not, the exercise is not being performed properly and the stance needs to be adjusted. This exercise should be done in three sets of 10 reps.
o Russian hamstring - with a partner, kneel on the ground with hands at the side while the partner holding the ankles. Lean forward from the hips with knees, hips and shoulders in a straight line and the back straight. Do not bend at the waist. The hamstrings in the thigh will be working. This exercise should be done in three sets of 10 reps.
o Single toe raise - standing with arms at sides, bend the left knee upwards and balance on one foot. Stretch the arms to the sides to help maintain balance and rise up on the toes of the right foot slowly. Hold and then lower. Repeat this exercise 30 times and then switch sides.

Plyometrics

Plyometric exercises are designed to help build up the power, speed and strength of the body. The key to performing these exercises properly is to remember to land softly when jumping. Always land with the weight on the ball of the feet and then distributing it back to the heel with the knees bent and the hips straight. It is important that the technique is followed closely and that the performance of the exercises is adhered to in order to get the proper results.
o Lateral hop over a cone - using a 6 inch high cone to the left of the body, hop sideways over the cone landing on the balls of the feet with the knees bent. Straighten the knee slowly. Hop back to the right to complete a rep. Do this exercise for 20 reps.
o Forward and backward hop over a cone - using the same 6 inch high cone, hope over the cone forwards landing on the balls of the feel with the knees bent. Straighten the knee slowly. Hop backwards over the cone to complete a rep. Do this exercise for 20 reps.
o Single leg hop over a cone - using the same technique found in the forward and backward hop over a cone, start with the right leg and complete a forward and backward hop for one rep. Do this exercise for 20 reps, switch legs and repeat.
o Single leg vertical jump with headers - stand straight with arms at side and knees slightly bent. Push off with the right foot and jump straight up, landing on the ball of the foot with the knee slightly bent. Do this exercise for 20 reps, switch legs and repeat.
o Scissors jump - using the same knee over ankle technique in the walking lunge, lunge forward with the right leg. Push off with the right foot and bring the left leg forward into a lunge position, maintain the knee and not allowing it to cave in or out. Land on the balls of the feet. Do this exercise for 20 reps.

Agilities

Agilities will help build up the range of motion in the ankle, knee and hip combination, allowing the participant to move more smoothly during exercise and physical activity. This will help stabilize the ACL and keep it flexible.
o Shuttle run forward and backward - using as many cones as desired, sprint from the starting line to the first cone and stop. Sprint to the next cone and stop. Continue this to the end and then reverse running backwards.
o Diagonal run - set the cones in a zigzag formation. Start at the line and run to the first cone to the left, pivot on the left foot, and run to the next cone on the right. Pivot off the right foot and run to the third cone. Continue to the end keeping the knee slightly bent and over the ankle. Repeat 3 times.
o Bounding run - run from one line to the other bringing the knees up high towards the chest. Land on the balls of the feet with the knees slightly bent and the hips straight.

Cool Down

The cooling down phase of any exercise routine or physical activity is important and should never be skipped. There should always be water at hand through this phase and it should take about 10 minutes. Jog slowly until the heart rate comes down and then stretch the hamstrings, calves, inner thighs, quadriceps and lower back with the exercises listed above and the following exercises.
o Alternate hip flex bridging - while lying on the ground, bend the knees and place the feet flat. Raise the buttocks off of the ground and squeeze, holding this as the right foot is lifted off the ground. Do not allow the hip to dip towards the ground. Lower the right foot and repeat the motion with the left foot. Repeat 30 times for each side.
o Abdominal crunches - while lying on the ground, bend the knees and place the feet flat. Lace the fingers behind the head with the elbows out. Breathe in and contract the abdominal muscles while exhaling. Do this 30 times. Drop the legs to the right to the ground and repeat the crunching of the muscles to work the obliques. Repeat 30 times and then switch sides.
o Knee to chest - while lying on the ground, bend the knees and place the feet flat. Bring the right knee into the chest while extending the left leg to the ground. Hug the right knee for 30 seconds, feeling the muscles of the lower back and buttocks stretching. Switch sides and then bring both knees to the chest. Repeat all three motions as a rep and do two times. If there is any pain in the lower back, discontinue the stretch.
o Figure four piriformis stretch - while lying on the ground, bend the knees and place the feet flat. Place the left ankle over the right knee. Holding this position, take hold of the right thigh and pull the right knee into the chest. Hold for 30 seconds and switch sides. This will stretch the gluteals and the sides of the thighs. Repeat the two motions as a rep and do two times. If there is any pain in the lower back, discontinue the stretch.
o Seated butterfly stretch - while sitting, bring the feet into the body so that the soles are touching. Place the elbows on the knees and slowly push the knees down to the ground. This stretches the inner thigh. Hold for 30 seconds and repeat two to three times.

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