How to Prevent ACL Injuries for Athletes
By Robert Rogacki, PT, DPT, CERT. MDT
If you play soccer — or have played on a team in the past — chances are you know someone who has torn their anterior cruciate ligament, or ACL. It’s just a matter of probability, really; female soccer players are 4-8 times more likely to suffer an ACL injury compared to the normal person, and the injury rate is higher than average for males as well. While surgical interventions have come a long way in helping athletes recover from these injuries, wouldn’t we be better off preventing them in the first place?
What is the anterior cruciate ligament?
The ACL is a ligament within the knee that is essential for stabilization during running, jumping, cutting, and twisting; basically, everything that soccer players are doing on the field. Most ACL tears are non-contact injuries, and occur while cutting or changing direction.
Why do ACL injuries occur and how can we prevent them?
Most ACL injuries occur as a result of valgus forces at the knee, or an inward movement of the knee when jumping, landing, or cutting. Avoiding these movements is not easy. It takes concentration and practice to learn correct movement patterns that avoid putting excessive stress on the knee and the ACL.
Here are a few easy exercises that will help soccer players (and other athletes!) decrease their risk of ACL injuries.
Side-lying Hip Abduction
Lie on your side with your bottom knee bent for support. The top knee should remain straight, and in a straight line with your torso. It may be helpful to lie with your back against a wall at first to get a sense of the proper hip position. Once in position, keep your top knee straight and toe pointed forward, and lift your leg straight up into the air (think about lifting with your heel). Stop when you start to feel your pelvis rotate. It may be helpful to keep your top hand on your hip during the exercise.
Why it’s important: Knee and leg strength are important for injury prevention, but so is hip strength. Strengthening the hip abductors (or the outside of the hip) can keep the hip in a more neutral position, which will in turn help knee the knee more neutral as well.
Standing Squats (With Proper Form!)
Squatting is a normal functional movement, but people have a lot of trouble with correct form when squatting for exercise. There are two key points to note here: (1) keep your knees from bending inward when squatting. The kneecap should stay even with or slightly outside of the toes.
Also (2), it is important to keep the knees from moving too far forward relative to the foot and toes when squatting. Many people have trouble activating their gluteal muscles when squatting, leading to a forward position that puts excessive force on the front of the knee, including the patellar tendon.
Why it’s important: Proper squat form is a precursor to proper knee bending form when running, jumping, and other high-impact movements. By learning how to activate your glutes and “sit back” into a squat, you will avoid putting excessive stress on the knee joint.
Standing Reach and Row
Stand on one leg with your knee slightly bent and either a weight or a band in front of you. While maintaining a slight knee bend and level trunk, lean forward to grab the weight or band. Allow the opposite leg to come up, ensuring you are hinging at the hip. Prior to rising back up, focus on elevating your glutes (on your stance leg) to help you return to a vertical position.
Why it’s important: Maintaining proper form when running, jumping, and cutting isn’t just about strength; balance and stability are important too! This exercise is a nice catch-all for many of the things PTs focus on when rehabbing patients with ACL injuries, and is beneficial for those looking to avoid injury as well. It helps improve standing balance, forces the athlete to focus on maintaining proper knee position, and strengthens the hip and glute muscles all at once!
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