We all know just how big of an issue ACL tears and other knee injuries are. However it is an alarming trend that very few athletes or strength programs spend time focusing on ACL injury prevention.

With such a high occurrence of this injury, and taking into account the severity, shouldn’t there be more time be dedicated to prevention?

The anterior cruciate ligament (ACL) is one of the four major ligaments that connect the bones of the knee joint. The ACL ligament helps to hold the bones in proper alignment and help control the way your knee moves. The ACL provides stability to the knee and prevents excessive  anterior (forward) movement of the tibia in relation to the femur as well as hyperextension of the knee. A common misconception is that an ACL injury is caused by contact during competition.  In fact, over 70% of ACL injuries occur during non-contact activities.

My goal with all of my athletes is to train them to perform at a high level on a consistent basis.  In my opinion, the best ability an athlete can have is availability.  With that in mind, every program that a coach designs should have a strong emphasis on muscular control and the stability components needed to help in the prevention of ACL injuries.

When Assessing an Athletes Risk for ACL Injury a Coach Should Focus on Three Contributing Factors: 

Does The Athlete Have Functional Stability in the Foot, Ankle and Knee?

The great majority of youth athletes typically lack neuromuscular control in their lower leg (foot, ankle, and knee).  This causes the knee to buckle and assume a valgus position during athletic movements, especially when jumping and during the deceleration phase.  In order to correct this, an athlete should spend a portion of their warm up performing simple stability and activation exercises.  That is the primary reason our prep level athletes warm-up barefoot and complete banded movements prior to the start of their training session.  These exercises will provide stability in the foot, ankle, and knee as well as activating the gluteal muscles which provide stability for lower body athletic movements.

Can The Athlete Decelerate Properly?  

According to SportsMD.com – “A torn ACL can be grouped into two categories: contact and non-contact. An example of non-contact injuries can be when an athlete rapidly decelerates, followed by a sharp or sudden change in direction. Non-contact ACL injuries have also been linked to heavy or stiff-legged landing as well as twisting or turning the knee during the landing phase, especially when the knee is in the valgus position.”

By teaching an athlete to decelerate properly they will have the ability to absorb the force of their motion and transition to their next motion safely and effectively.

I approach this in a number of ways:

• 1^st – directly following the Dynamic Warm Up we always have some variation of a deceleration drill such as a single leg lateral bound, depth jump, or deceleration sprint.
• 2^nd – with strength training I have a focus on eccentric and isometric training. The use of these techniques teaches the body to control its deceleration and transition phases of movement.
• 3^rd – build a ‘hard deceleration’ into our speed training. This simulates the forces an athlete may face during competition and allows them train their body to absorb the force safely and with proper muscular control.

Is the Athlete Quad Dominate?

Most athletes have stronger quads because of the abundance of activation they receive during athletic movements.  Research shows that increased quadriceps activation and less hamstring activation resulted in increased ACL loading during the landing phase and therefore increased the risk of injury. With this in mind, greater hamstring strength and glutes activation should be a priority for all athletes. The hamstrings and glutes, however, are often overlooked during training.

When designing an effective program for athletes, the trainer or coach must put a strong emphasis on hamstring strength and glute activation.  We approach each athlete with the goal to build symmetry between the posterior and anterior sides.  To do this the ‘pull’ movements need to be about 2:1 when compared to ‘push’ movements.  This will help build a functionally strong athlete who has the strength to control their body through any movement.

It is important to know that regardless of how prepared an athlete is there is always a potential for injury.  With that said, proper training will decrease the likelihood of a knee injury.