Stay in the Game: Proactive Strategies to Prevent ACL Injuries

Anterior Cruciate Ligament (ACL) injuries are one of the most common and severe injuries experienced by youth and adult athletes as well as physically active individuals. This type of injury often requires surgery to return to pre-injury level of performance and can significantly affect an athlete’s mobility, athletic performance, and overall quality of life. While we can’t completely eliminate the risk of sustaining an ACL injury, taking a proactive approach to ACL injury prevention can significantly reduce the risk of having a setback take you out of the game. 

In this blog, we’ll dive into effective prevention strategies for not only reducing your ACL injury risk but also aiding in recovery and keeping you at peak performance all season long. 

What is the ACL?

Before we talk about how to prevent an ACL injury, it’s important to review what it is, what it does, and recognize who is at greatest risk. The ACL is one of the four main ligaments in your knee that helps to stabilize the knee joint. It runs diagonally in the center of the knee and connects the thigh bone (femur) to the shin bone (tibia). The ACL plays a pivotal role in maintaining the knee’s stability by doing two main things:

1. Preventing forward movement – it prevents the shin bone from sliding too far forward relative to the thigh bone, especially during sports that require a lot of cutting, accelerating and decelerating.

2. Controlling rotation – it also helps control the knee’s rotational stability, specifically during motions that involve pivoting, turning, or twisting. 

Common Causes of ACL Injuries

ACL tears most commonly occur due to sudden changes of direction, awkward landings from a jump, or sudden stops. These movements place excessive strain on the ligaments in the knee (particularly the ACL), leading to partial tears or complete ruptures. Some scenarios where these injuries might occur include:

Sports involving a lot of cutting, jumping, change of direction: Higher risk sports include football, soccer, basketball, and lacrosse – specifically because all of these sports involve rapid changes of direction, pivoting, and jumping.

Physical Contact: While most ACL tears are non-contact (meaning you don’t have contact with another player when it happens), some do occur from direct blows to the knee. These types of injuries usually occur during higher contact sports such as football and soccer.

Weakness and muscle imbalances: Muscular imbalances or poor biomechanics during sports can place excessive stress on the knee joint. For example, having poor landing mechanics from a jump or having weak hip and hamstring muscles can increase your risk of injury.

Who is most susceptible?

Some individuals might be more prone to ACL injuries due to a variety of factors. Some of these groups include:

Athletes: Due to the nature of high-intensity sports, those participating in sports that involve frequent cutting, pivoting, and jumping are at a higher risk. As noted previously – soccer, basketball, football and lacrosse are all sports that typically see higher ACL injury rates.

Youth athletes: Youth athletes specifically are more susceptible to ACL injuries due to the fact that their bones, muscles, and coordination are still developing. Proper training and conditioning are vital during these years where they are still growing.

Females: Female athletes have a higher incidence of ACL tears compared to males for a variety of reasons including anatomical differences, hormonal influence, and variations in muscle strength and coordination.

Best Prevention Strategies

As kids increasingly specialize in one sport year-round at younger ages, it becomes even more important to incorporate an injury prevention approach that includes strength training, flexibility/mobility exercises, technique training, and jump training. Below are some of the best training tips to prevent injury: 

Strength and Conditioning

1. Strengthening exercises: It’s important to focus on exercises that help stabilize the knee – particularly the quadriceps, hamstrings, and glutes. 

   Exercises: Squats, lunges, hamstring curls, knee extensions

2. Core stability: Having a strong core helps to enhance overall strength and coordination, reducing strain on the knees when you’re playing sports. 

   Exercises: Planks, deadbugs, medicine ball twists

Stretching and Mobility

1. Stretching: Regular stretching of key muscle groups like the quadriceps, hamstrings, calves, glutes, and hip flexors improves flexibility and reduces risk for injury. Make sure you are including dynamic stretching (stretching with movement) BEFORE a game, lift or practice and save static stretching (holding a stretch for 30+ seconds) for AFTER you are done.

2. Foam rolling: Foam rolling can help release muscle tension and improve tissue mobility, reducing your injury risk. 

   *Some other advanced recovery techniques we use at the clinic include massage, trigger point release, muscle scraping, cupping, and dry needling – all achieving similar effects 

Technique

1. Proper landing techniques: Practicing correct landing mechanics, such as landing softly with your knees slightly bent and in line with your toes, can help reduce the impact on the knee joint when you are doing the same movements during a practice or game. 

2. Cutting and pivoting: Practicing good form with cutting and pivoting movements can help to minimize risk of ACL injuries. To train these movements well, seek out guidance from a trained performance coach or physical therapist. 

Neuromuscular Training

1. Plyometrics: Incorporate jumping exercises to improve power, explosive strength and landing mechanics. Focus on proper technique when training to avoid putting excessive stress on the knees.

2. Balance Training: Improving single leg stability with exercises like balancing on one leg, single leg squats, and single leg deadlifts can help to enhance the body’s ability to control the knee joint position and movement. 

How can Physical Therapy help?

Individual Assessment – Your physical therapist can help to assess your strength, movement mechanics, and flexibility to identify areas of improvement and design a custom exercise program to help minimize injury risk. 

Neuromuscular Training – Physical Therapists can also provide training to improve agility, landing and cutting mechanics, joint stability, and overall coordination. This training will also reduce the likelihood of injury.

Rehabilitation – If an ACL injury does occur, physical therapy can guide you throughout the rehabilitation process to restore strength, mobility, and function and get you back on the field. Programs that are designed for ACL rehabilitation are individualized to the athlete’s specific needs and progress gradually.

Manual Therapy – Techniques such as joint mobilizations, massage, trigger point release, muscle scraping, and dry needling can help to reduce pain, improve mobility, and promote healing. These techniques are important both from a preventative standpoint as well as throughout rehabilitation. 

Preventing ACL injuries requires a proactive approach that includes strength training, flexibility exercises, and proper technique – all of which can be improved with physical therapy. Our goal for every client at Bridge is to help them enjoy their favorite activities and sports to their fullest potential. To learn more about how we might be able to help, don’t hesitate to reach out to schedule a consultation appointment!