ACL Prevention Program

Mandy D’Amour
Rebecca Dickinson
Anne Louise McDonald
Emily Preston
John Purdy
 WHY?

• Research shows there will be an estimated

100,000 ACL tears this year
• Several research studies indicate that this
injury is more common in female athletes
• Several risks factors have been pinpointed
for the increase in frequency in female
athletes
 Major Factor For ACL Tear

• Instantaneous loss of motor control while

in combination with landing with knees
and hips straight
• Good news is research is showing that a
dedicated program with the right
components can reduce this risk of injury
 Literature Review

• Our focus group performed a thorough

literature review to find studies that looked
at ACL prevention
• We came up with 24 studies that we
decided to examine closer
• Of those, 10 were Level 1 or 2 studies
• We then further broke those 10 down
 Research

• The evidence shows that neuromuscular training

including plyometrics, balance, and technique
training reduces the risk of serious knee injuries in
female athletes
• All current preventative programs are different but
center on alteration of neuromuscular risk factors
• Training may facilitate NM adaptations to
increase joint stabilization and muscular
preactivation and reactivation patterns which help
protect the ACL
 Research

• Gilchrist, Mandelbaum, Silvers et al

studied 1435 Division 1 Female Soccer
players-Level 1 study
• Program used PEP (Prevent injury and
Enhance Performance) program 3x/wk
during fall season
• Results found ACL injury 1.7x less likely
in intervention group
 Research cont.

• Pollard, Sigward, Powers, et al studied 26

female soccer players between ages 14-17
• Implemented the PEP program with soccer
practice
• Results- Players showed significantly less
hip internal rotation and significantly
greater hip abduction
• Thus, PEP has been shown to alter LE
kinematics
 Research cont.

• Mandelbaum and Silvers et al. In 2000-

1041 intervention group and 1905 in
control group. Results: 88% less ACL
injuries in intervention group
• 2001-844 in intervention group and 1913
in control Results: 74% less ACL injuries
in intervention group
 Research cont.

• Hewett, Ford, and Myer looked at 6 of their

studies that included plyometrics, biomechanics
technique feedback, balance and core stability
training, and strength training
• Results showed training decreased injury in 3 of
the 6 studies and 5 of the 6 demonstrated positive
trends and reduction in odds ratios
• Results of the six studies:
• Balance training alone is not as effective as when
combined with other training
• plyometric training should be included
 Hewett cont.

• Strongest studies incorporated

strengthening but it may not be a
prerequisite for prevention
• Training needs to be performed more than
1 time per week with a minimum duration
of 6 weeks
 Research cont.

• Hewett’s team and Mandelbaum’s team each

came up with their own separate programs
• Hewett’s program was developed by the
Cincinnati Children’s Sports Medicine
Biodynamics Center and the Human Performance
Laboratory
• Mandelbaum’s program is labeled the PEP
program as discussed earlier
• Each program has exercises that pertain to all the
components needed in order to reduce risk of
ACL injuries
 VOI ACL Prevention Program

• Combination of the two programs that would accommadate for the

amount of time available at each practice session to perform the
exercises, to ensure every athlete could perform it with very little
equipment, and to simplify the exercises to allow for ease of
implementation
Components of Program
• Warm up
• Stretching
• Agility drills
• Practice
• Strength exercises
• Cool Down
 Components cont.
• Components are listed in the order that
they should be performed
• Warm up and stretching are to be done at
the beginning of practice followed by the
agility drills
• Then, the athlete would be ready for a
normal practice session
• At the conclusion of practice, a brief
strengthening session followed by the cool
down
 Warm Up

• Warm up is designed to get ready for practice activity and to help prevent injury.

• Set up two markers about 10-20 yards away from each other and have the players perform
the following 3 warm up activities about 2 minutes each:

• Forward jogging- Have each participant jog forward from cone to cone. Hip, knee and ankle
should be in alignment and make sure the knees are not falling in toward each other and
that the feet are not moving out to the sides behind them.

• Side shuffling- Have each participant shuffle sideways between the cones, make sure they
maintain hip and knee in bent position and don’t travel standing straight up.

• Backward jogging- Have each participant jog backwards from cone to cone, again
maintaining hip, knee, and ankle alignment and not allowing knees to fall inward. They
should also stay on their toes and not jog flat footed.
 Stretching
Calf Stretch

• Correct • Incorrect
• Instructions: Stand on your right leg, • Things to look for: bending the stance
bend forward and put your hands on the leg, leaning forward in the pushup
ground in a V-form. Keep your right leg position, arching the back, or raising up
straight and your right foot flat on the on your toes.
ground. Bend your left leg and place
your left ankle across your right calf.
Hold this position for 30 seconds.
Switch legs and repeat on your left side.
 Stretching
Quadriceps Stretch

Correct Incorrect
Instructions: Stand tall with your weight
evenly distributed. Bend your left knee,
reach behind with your left hand and grab Things to look for: bending
the front of your left ankle. Bring your heel at the waist, or letting your
up to your buttock and keep your left knee knee “wing” out to the side.
pointed towards the ground. Keep your left
leg close to your right leg. Hold for 30
seconds and repeat on your right side.
 Stretching
Hamstring Stretch Inner Thigh Stretch

Instructions: Sit on the ground with your left

Instructions: Sit on the ground, and
leg extended out in front. Bend your right knee
spread your legs evenly apart. Keeping
and place the sole of your shoe on your left
your back straight, reach overhead with
inner thigh. Keep your back straight and try to
both hands. Then, slowly reach towards
bring your chest to your left knee. Reach
your right foot with both hands. Hold the
towards your left toes and pull them towards
stretch for 30 seconds and then repeat
your head. Hold for 30 seconds and repeat
the stretch on the left side.
with the right leg.
Things to look for: rounding your
Things to look for: rounding your back or
back, leaning forward too fast or
bouncing.
bouncing
 Stretching
Hip Flexor Stretch

Instructions: Lunge forward leading with your left leg and kneel on your right knee.
Rest your left arm on your left thigh, and lean forward with your hips. Keep your
balance, reach back for your right ankle and pull your heel to your buttocks. Hold the
stretch for 30 seconds and repeat the stretch leading with your right leg forward.
Things to look for: maintaining your balance and keeping your hips square with your
shoulders.
 Agility Drills
Single Leg Touches

• Instructions: While standing on

• Instruction: Stand on one leg and
one leg with ball on the ground in front
balance while performing soccer kicks
of you, slowly reach down with one
with the other or dribbling basketball
hand and touch the ball, then perform
while balancing. Perform 1-2 minutes
using other hand. Repeat 10 times on
each leg.
each side.
• Things to look for: Do not allow
• Things to look for: Do not allow
balance knee to fall in towards mid line
balance knee to fall in towards mid line
of body- keep knee in a slightly bent
of body- keep knee in a slightly bent
position
position
 Agility Drills
Single Leg Sport Specific

• Instruction: Stand on one leg

• Things to look for: Do not allow
and balance while performing balance knee to fall in towards mid
soccer kicks with the other or line of body- keep knee in a
dribbling basketball while slightly bent position
balancing. Perform 1-2 minutes
each leg.
Things to look for: When landing make sure to land softly on balls of feet keeping knees slightly bent and pointing straight forward- No landing on heels with knee

Agility Drills
Squat Jump With Hold

Correct Landing Incorrect landing

• Instruction: Stand on ground • Things to look for: When landing
with feet approximately shoulder
make sure to land softly on balls of
width-perform a quick squat and then
explode into a jump- hold the landing
feet keeping knees slightly bent and
for a 2 count Perform 20 times. pointing straight forward- No
landing on heels with knees
straight!!
 Agility Drills
Single Tuck Jump

• Instruction: Stand on ground

with feet approximately shoulder • Things to look for: Off balance
width apart- jump into air while landings- should land on balls of
bringing knees up toward chest and feet with knees slightly bent and
hitting knees with hands- Be sure to pointing forward
land softly on balls of feet with knees
slightly bent- try to bring thighs
parallel to ground. Perform 10 times.
 Agility Drills
Lateral Jumps

• Instruction: Stand with feet • Things to look for:

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.
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
 Strength Exercises
Front Plank Side Plank

Instruction: Position yourself in a

Instruction: Lie on either side, legs
“push-up” start position, with your
outstretched, lower elbow on floor in
elbows on the floor in line with
line with shoulder. Tighten your
shoulders. Tighten your stomach, lift
stomach muscles, lift your hips off
your hips off floor till your legs and
floor until your legs and upper body
upper body are in line with shoulders
are in line.
over elbows.
Things to look for: Make sure
Things to look for: Make sure to
shoulder is positioned over elbow on
keep legs and torso straight. Make
the floor. Keep legs and torso straight
sure back is not arched or curved
and place upper arm against side.
downward. Hold 20 seconds, Repeat 2
Hold 20 seconds, repeat 2 times each
times.
side.

Assisted Russian Hamstring Curl
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.
Strength Exercises
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.
 Strength Exercises
Single Leg Calf Raise

Correct
Instruction: Stand on
one foot and slowly raise
up on to toe and then
back down. Repeat 10
times each side.
Incorrect
Things to look for: Be
sure to move up and not
forward (as shown above
in picture 2).

Forward 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.
Strength Exercises
Incorrect
Things to look for: Make
sure to keep your knee
over your toes when
performing lunge.
Make sure to keep your
torso straight when
lowering self.
 Conclusion

• It is our hope that adapting this routine at

practice will help reduce the incidence of
ACL injuries and allow for successful
participation all year for each athlete

• Next year-Video??