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Exercises
Strength
Exercises should be completed in 2-3 sets of repetitions of 10-12
Lower Quarter Exercise Examples:
Squats, Single Leg Squat, Single Leg RDL, Nordic Hamstring Curls, Side Lying Lateral Leg Raise, Fire Hydrants
Core Exercise Examples:
Russian Twist, Plank, Side Plank, Bicycle Crunches
What to Avoid: Make sure the knee does not move inward or past the toes during lower quarter exercises. With core strength, pull your belly button to your spine and tuck your hips in to limit compensations.
Neuromuscular Retraining
Exercises can be completed in 2-3 sets and use a time component of 30-45 seconds for repetitions
Cone Drills:
Set up cones in a triangle and have athletes either sprint, lateral slide, back pedal, or a combination of the 3 to each cone. Cue for deceleration before reaching each cone, not crossing feet, and which foot to plant with vs step with when going to the next cone.
Shuffle Drills:
Athletes can diagonally slide forward or backward about 30 feet. Important to cue athletes to sit low instead of standing straight up. They should also not cross their feet while sliding or planting to change directions.
Balance Drills:
While balance is a part of neuromuscular retraining and can be added to prevention programs; it should not be what the majority of your time is spent on. Prevention programs that spent increased time on balance saw decreased effects at prevention ACL injury.1
Plyometrics
Exercises should be completed in 2-3 sets of repetitions of 8
Double Leg Exercise Examples:
Box Jumps, Tuck Jumps, Long Jumps, Vertical Jumps, Lateral Line Jumps, Jump from a box and land in a squat
Single Leg Exercise Examples:
Single Leg Bounding, Single Leg Box Jump, Skiers, Single Leg Vertical Jump
What to Avoid: Make sure athletes are not landing with flat feet and instead are landing on their toes, then making contact on their heels. Ensure the knee does not move too far forward or towards the middle of the body. Weight should be equally distributed between both legs in double leg activities and trunk should be bent forward.
Good vs Bad Form
Bad
Good
Knee Position
In the first picture, the knees move inward. This places a greater load on the knee. In the second picture the knees go out and are more neutral.
Hip Alignment
In the first picture, the swing limb hip drops below the level of the stance limb. The second picture demonstrates good hip position as the hips are in equal aligment.
Bad
Good
Good
Bad
Trunk Placement
In the first picture there is less forward lean. This causes the athlete to compensate, and her knees come further forward. In the second picture there is more trunk lean, and the athlete can appropriately sit back to perform the squat.
Structure
Elements from each component should be incorporated into a prevention program
- Dynamic Warm Up
- Strength Exercises
- Neuromuscular Retraining Exercises
- Plyometrics
Prevention Programs should be completed before practice or competition 2
Prevention Programs should be completed multiple times a week in both pre-season and during season (3x/week) 2
Can take about 20-30 minutes, but as athletes become more comfortable they will complete the program quicker 2
References
1. Söderman, K., Werner, S., Pietilä, T., Engström, B., & Alfredson, H. (2000). Balance board training: Prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA, 8(6), 356–363. https://doi.org/10.1007/s001670000147
2. Arundale, A., Bizzini, M., Giordano, A., Hewett, T. E., Logerstedt, D. S., Mandelbaum, B., Scalzitti, D. A., Silvers-Granelli, H., & Snyder-Mackler, L. (2018). Exercise-based knee and anterior cruciate ligament injury prevention. The Journal of Orthopaedic and Sports Physical Therapy, 48(9), A1–A42. https://doi.org/10.2519/jospt.2018.0303
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