ACL Prevention Program
(PEP Program: Prevent injury and Enhance Performance)
Research
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Several research studies indicate that this injury is more common in female athletes
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Instantaneous loss of motor control while in combination with landing with knees and
hips straight as been highlighted to increase incidence of knee and ACL injury.
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The evidence shows that neuromuscular training including plyometrics, balance, and
technique training reduces the risk of serious knee injuries in athletes
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All current preventative programs are different but centre on alteration of
neuromuscular risk factors; they must focus on the sports specific demands.
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Training may facilitate NM adaptations to increase joint stabilization and muscular
preactivation and reactivation patterns which help protect the ACL and knee joint.
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There is good evidence to support the use balance/proprioceptive training in ACL
and knee injury prevention.
•
There is good evidence to support the use of plyometric training in combination with
other training components injury prevention of ACL and knee injury.
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PEP has been shown to alter lower limb kinematics
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Each program has exercises that pertain to all the components needed in order to
reduce risk of ACL and knee injuries.
Overview
Female are more likely to have an ACL injury due to neuromuscular imbalances
Four neuromuscular imbalances are observed more often in female than male athletes.
The first observed neuromuscular imbalance is the tendency for females to be ligament
dominant. Females demonstrate a tendency to allow stress on ligaments prior to muscular
activation to absorb ground reaction forces. Typically during single-leg landing, pivoting, or
deceleration, as often occurs during ACL injury, the female athlete allows the ground
reaction force to control the direction of motion of the lower extremity joints, especially the
knee joint. The lack of dynamic muscular control of the joint leads to increased valgus
motion, increased force, and high torque at the knee and ACL.
The second imbalance is termed quadriceps dominance. With quadriceps dominance,
female athletes activate their knee extensors preferentially over their knee flexors during
sports movements to stabilize their knee joint, which accentuates and perpetuates strength
and coordination imbalances between these muscles.
The third imbalance is leg dominance. Leg dominance is the imbalance between muscular
strength and coordination on opposite limbs, with 1 limb often demonstrating greater
strength and coordination. Limb dominance may place both the weaker, less-coordinated
limb and the stronger limb at increased risk of ACL injury. The weaker limb is compromised
in its ability to dissipate forces and torques, while the stronger limb may be subject to high
forces and torques due to increased dependence and increased loading on that side in highforce situations.
The fourth imbalance often observed in female athletes is trunk dominance. Trunk
dominance is characterized by increased motion of the body’s centre of mass due to the
absence of neuromuscular control of approximately two-thirds of the body mass during
single-leg landing, pivoting, or deceleration.
Any injury prevention strategy must incorporate corrections to the observed imbalances
through post warm up drills ideally these need to be conducted on a daily basis to alter
neuromuscular control. The evidence suggests that a phenomenon called central fatigued
has been linked to poor control and proprioception. These variables have a relationship to
higher incidence of injury.
Further individual functional control issues and imbalances must be addressed in their own
strength and conditioning sessions and Strength and conditioning input united with the
patterning type work from the Physiotherapy team.
ACL Prevention Program
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Plyometeric squat jump
Lateral jumps.
Nordic Hamstrings
Single leg dynamic lunge
X hops
Single leg bosu balance
Wall jumps (minimum knee flexion)
Plyometeric squat jump
Correct Landing
Instruction: Stand on ground with feet approximately shoulder width-perform a quick squat
and then explode into a jump- hold the landing for a 2 count Perform 20 times.
Incorrect landing
Things to look for: When landing make sure to land softly on balls of feet keeping knees
slightly bent and pointing straight forward.
Lateral jumps
.
Instruction: Stand with feet slightly apart- Push off ground with plant leg while moving in a
sideways direction landing on opposite foot- hold 2 seconds- repeat with other leg Perform
10 times each leg.
Things to look for: Explosion at take off with plant leg making sure knee does not fall in to
midline of body and on landing make sure knee stays in a forward direction with a slight
bend.
Nordic Hamstrings
Instruction: Start on knees with arms crossed resting on chest and your partner holding
your feet. Keeping your body straight, slowly lower self towards floor and return to upright
position. Repeat 20 times.
Things to look for: Be sure to tighten your stomach while moving forward and back. Make
sure not to arch back when returning to start position.
Single leg dynamic lunge
Correct
Instruction: Take large step forward and slowly lower self towards ground keeping your
knee directly over your toes. Repeat 10 times each side.
X hops
X hops. The athlete faces a quadrant pattern and stands
on a single limb with the support knee slightly bent. She hops
diagonally, lands in the opposite quadrant, maintains forward
stance, and holds the deep knee-flexion landing for 3 seconds. She
then hops laterally into the side quadrant and again holds the landing.
Next she hops diagonally backward and holds the jump. Finally,
she hops laterally into the initial quadrant and holds the landing.
repeats this pattern for 2 x 15 reps. Encourage the athlete to maintain balance during each
landing, Keeping her eyes up and the visual focus away from her feet.
Single leg bosu balance
Single-leg balance. The balance drills are performed on a bosu
The athlete begins on the bosu with a 2-legged stance with feet shoulder width
apart, in a single-leg position. Maintain deep knee flexion.
Wall Jumps (Minimum knee flexion)
Wall jumps. The athlete stands erect with the arms semi extended overhead. This vertical
jump requires minimal knee flexion.
The gastrocnemius muscles should create the vertical height, and the arms should extend
fully at the top of the jump. 3 x 15 reps
.
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