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ACL Injury Prevention Programs

BOSU Ball used to train balance and help reduce ACL tears

BOSU Ball squats and balancing can help reduce ACL injuries by training joints and muscles to react appropriately.

A tear to the ACL (anterior cruciate ligament) in the knee can be one of the most detrimental injuries to an athlete. In order to decrease the chance of such an injury occurring, preventative programs should be performed by athletic populations. These programs can be done at home or during the beginning of a practice. ACL prevention programs can also be incorporated into a warm up, prior to exercise. The programs focus on plyometrics, balance, stretching, and strengthening exercises.

Plyometrics are described as rapid and powerful movements. These movements first cause a muscle to lengthen, then shorten. The combination of lengthening and shortening the muscle at a fast pace increases the power of a muscle. Plyometrics aid in the prevention of ACL injuries by training the muscles to react at a faster rate preventing the knee from shifting. Examples of plyometrics are single leg cone jumps, squat jumps, single leg bounding, and ladder drills. The goal when performing these drills is to jump immediately again after making contact with the ground. The exercises are generally performed for about 30 seconds, however when first starting the drills, a shorter time may be required to begin and then gradually increased with practice.

Balance and stretching are also key factors to preventing ACL injuries. It is important to thoroughly stretch the calf, quadriceps, and hamstring muscles. Stretching these muscles will ensure that the muscles are not too tight which could cause a muscular imbalance and increase your chance of injury. Balance or proprioception is also a goal in ACL prevention as it can allow muscles to work together to stabilize the body on various surfaces. If the body and knee cannot quickly react to surface changes, an ACL injury could occur. Balancing exercises can be performed on one leg, on uneven surfaces such as a BOSU Ball, and can incorporate throwing a ball while balancing to increase muscular stability and neurologic reaction time.

Strengthening is the final aspect of an ACL prevention program. It is essential to strengthen not only the hip and thigh musculature, but also the core. Strengthening the musculature of the legs allows for a more stable knee joint which decreases the risk of ACL injury. Core and leg strengthening can be done using the body’s weight through exercises such as walking lunges, squats, sit ups, and planks. Exercises such as walking lunges are also an adequate exercise to warm up and loosen the muscles before activity.

While performing ACL prevention programs, it is imperative to focus on technique more than the number of repetitions completed in the allotted time. When jumping during plyometrics, the proper landing technique is to bend at the knees and hips to absorb the force rather than keeping the knees and hips straight causing the force to compress the joints. The phrase ‘light as a feather’ is used to describe how to land, meaning land as softly and quietly as possible to absorb the shock. The toes are to remain pointing forward at all times, and the knees are to stay in line with the toes. This ensures that the muscles are functioning together providing the best stability for the ACL. Poor technique can lead to a muscle imbalance, decreasing the stability of the knee.

ACL prevention programs can be done in 15 minutes and research has found them to be beneficial to help prevent injury. These programs are recommended to be performed at least 2-3 times per week with at least 1-day rest between each session. A minimum of 6 weeks is needed to provide the best results. Although it appears to be a hassle, these programs only take a few minutes to perform and can be done using simply the body’s weight, while providing a decreased risk of a serious ACL knee injury.

Should I use Static or Dynamic Stretching in my Workouts?

     One of the most critical aspects of injury prevention is the maintenance of complete and non-restricted joint range of motion through stretching.  Stretching not only improves flexibility, but also can reduce the risk of injury.  The question of whether static or dynamic stretching is the most beneficial prior to exercise has been debated.  Recent evidence has determined that dynamic stretching is most effective prior to exercise, while static stretching is most beneficial following activity.  Dynamic stretches resemble the movements produced during activity, while static stretches allow a relaxation period for the muscles of the body to recover.  So what is static and dynamic stretching?

Static Stretching

            Static stretches are utilized to increase the flexibility of a joint or multiple joints while

the body is at rest.  During a static stretch, the muscle is placed at the maximal stretch, which is generally determined as the point at which a firm, yet bearable resistance is felt. 

Static Stretching

Perform static stretches after workouts.

The position is then held for 10 to

20 seconds and repeated from 3 to 5 times.  Static stretching can be as simple as the common hamstring stretch.  While sitting on the floor with legs extended straight out in front of you, slowly lean forward to touch your fingers to your toes and hold this position.  When performing the stretch do not bounce or rock, hold a controlled stretch the entire time.  This is an example of static stretching.  Resistance bands and stretch straps are two common pieces of equipment used by athletes to assist them in performing static stretches.      

Dynamic Stretching

           Dynamic stretching is a series of controlled movements with slight resistance which are intended to improve range of motion, or flexibility, as well as prepare the

Dynamic Stretch

Athlete warming up on the track performing dynamic lunge stretches.

muscles for a more intense activity.  A dynamic stretch is generally repeated about 10 times per stretch.  During the repetitions, the dynamic stretch is accelerated from small, slow movements to bigger and faster movements.  Unless physically fit, it is recommended that dynamic stretching is slowly incorporated into a fitness routine to prevent soreness or injury.  Walking lunges are an example of dynamic stretching in which a typical lunge is performed while walking forward for a designated distance.  Other examples include arm circles and half squats.  Dynamic stretches can also be performed using resistance bands and stretch straps.

 

            While both static and dynamic stretching have been proven effective in increasing the range of motion of a joint, dynamic stretching can also prepare and ‘warm-up’ the muscles for further activity by mimicking physical activity patterns.  Since sports and other activities are dynamic in nature, the best way to prepare for exercise is with dynamic stretching that incorporates full body stretching with your sports movement patterns.  Static stretching should be utilized following activity to allow muscles and joints to increase flexibility and aid in the prevention of soreness.  For those who are just beginning an exercise regimen, it is recommended that dynamic stretching is slowly incorporated into the warm up routine to prevent soreness or injury.

Flexibility: An Important Component in Your Fitness Regimen

Woman working on flexibility

Flexibility is an important part of a fitness program for athletes of any age

Flexibility, the ability of a joint to move freely through a full range of motion, is a key contributor in injury prevention and should be an important part of any fitness program. When performed regularly and correctly, flexibility can decrease the likelihood of injury and increase overall performance. Stretching is the best way to increase flexibility and should be performed daily to increase the range of motion of joints, decrease the probability of delayed-onset muscle soreness (soreness that appears 1-2 days after an intense workout), and enhance quality of life and graceful movement. Furthermore stretching can also assist in the development of motor skills, improve body positioning and strength for sports, and relieve aches and pains from stress or being in a stagnant position for a long period of time. Stretching is also a very important component of general fitness and wellness as we age.

Factors Affecting Flexibility

Flexibility varies from person to person. Everyone has a specific predetermined range of motion and degree of flexibility. From this range, gains can either be made if stretching is performed correctly or lost if it is not maintained. Flexibility is joint specific. This means that a person can be flexible in one joint and at the same time lack flexibility in another. This makes determining or scoring an individual’s overall range of motion very difficult. Some joints allow motion in only one plane such as flexion and extension, as the hinge joints perform in the fingers. On the other hand, ball and socket joints located in the shoulder and hip allow movement in many different directions, such as flexion, extension, adduction, abduction, internal rotation, and external rotation. The following factors can also affect flexibility:

Heredity; Some people are born with joints, muscles, and tissues that are looser or tighter than the average individual

Level of physical activity; Usually with activity and training flexibility can be improved

Joint structure; The type of joint, and position of bones and tissues to one another, can affect the pull of muscles and your ability to stretch and gain flexibility

Tendons, cartilage, and ligaments; A torn or stretched ligament or tendon can make a joint more flexible and even unstable

Lifestyle; A sedentary lifestyle or jobs that require long periods of sitting can decrease flexibility and lead to tightness over time

Skin; Skin thickness and scars can impede stretching

Previous or current tissue or joint injury; Scar tissue, swelling, and previous surgeries can reduce the extensibility and movement of tissues and joints

Amount of adipose tissue (fat); Extra body fat will limit flexibility

Body temperature; Warmer bodies and muscles tend to be more flexible

Age; Children are usually more flexible than adults

Gender; Women are often more flexible than men

When designing a flexibility program you must take all these factors as well as the type of joint, the individual’s goals, and lifestyle into account. Attempting to over stretch or increase range of motion in muscles or a joint that has an obstruction or barrier will only result in injury or damage to the individual. Additionally, stretching a joint that is damaged or has a large degree of laxity already will only harm the individual and predispose them to further injury. Hyperflexibility is the term given to flexibility beyond a joint’s normal range of motion, and may predispose these individuals to subluxation and dislocation injuries.

Approaches to Stretching

There are six main approaches to stretching: static, active, ballistic, dynamic, passive, and PNF stretching. All six are great contributors to increasing flexibility and can be effective when implemented in the correct situation and workout program. A solid routine will use an effective combination of stretching techniques to ensure appropriate maintenance and gains in lifelong flexibility.

Static stretching involves a technique in which a muscle is stretched while the body is at rest. This stretch involves the individual slowly and gently taking the muscle to a point of resistance and discomfort and holding that position. For the best results static stretches should consist of 3 to 5 sets of 10 to 20 second holds. This method is probably the most popular and effective stretching method for increasing flexibility.

Active stretching is a method in which you put yourself in a stretched position and hold it there with no assistance other than using the strength of your agonist (opposite) muscles. This method is based on the fact that when a muscle contracts the opposite muscle relaxes. An example would be contracting your toes and foot upward toward your head, allowing the muscles in the back of your leg and calf to relax and stretch.

Ballistic stretching is a technique in which muscles are stretched by an extreme force generated as the body part is repeatedly bounced, swung, or jerked. This type of stretching can be effective, but also dangerous as it can create injury. Because of the injury risk involved with ballistic stretching most fitness individuals do not recommend its use in a workout routine.

Dynamic stretching is similar to ballistic stretching, except it is more controlled, gentle, and rhythmic. In dynamic stretching the body is warmed up gradually and flexibility is slowly gained and increased using a series of controlled reaches, bends, and swings through a full range of motion. A lunge is a good example of a dynamic stretch that when performed correctly can stretch multiple muscles in your legs and hips in one motion.

Passive stretching is a technique in which muscles are stretched using an outside source or person. Having your body stretched by an outside force may occur during rehabilitative therapy when someone helps you stretch, when using devices designed to help athletes stretch, or by using your opposite hand to hold the body part in a stretched position.

PNF (proprioceptive neuromuscular facilitation) stretching involves muscles being stretched by the use of combinations of alternating contractions and stretches. This method is more complex and usually involves guidance and training from fitness professionals prior to performing. One of the most common PNF stretching techniques is the contract-relax-stretch method. This routine consists of stretching a muscle passively, then performing an isometric contraction of the same muscle while in a stretched position, relaxing the muscle, and then finally passively stretching the muscle again to a new length.

Flexibility Tidbits

  • Muscle tissue is the key to developing flexibility since it can be lengthened with regular stretching
  • A warm muscle may be as much as 20% more flexible than a cold one.  Think of your muscle as a noodle.  It is hard to stretch and bend an uncooked (cold) noodle, but once cooked (warmed up) it is able to bend and move more freely.
  • During athletic participation it is best to stretch after a light warm-up, and then again following an after workout cool down
  • Avoid severe painful stretching and breath holding during stretches
  • Stretching multiple times per day is the best method to maintain and gain flexibility
  • In the United States, approximately 80% of all low back problems stem from improper alignment of the vertebral column and pelvic girdle due to poor flexibility

By: Douglas R. Curnes MS, CPT and Bryan S. Bentz MS, ATC

Douglas R. Curnes MS, CPT is a National Endurance Sports Trainers Association (NESTA) Certified Personal Trainer, and is a contributor of articles to the www.Hat-Trick-Sports.com website. He routinely designs individualized workout programs and provides sports specific training advice to top caliber athletes.

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