ACL Prevention Program

1. ACL Prevention Program

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Components of Program • Warm up • Stretching • Agility drills • Practice • Strength exercises • Cool Down

14. 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

15. 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.

16. Stretching Calf Stretch • Correct • Instructions: Stand on your right leg, bend forward and put your hands on the ground in a V-form. Keep your right leg straight and your right foot flat on the 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. • Incorrect • Things to look for: bending the stance leg, leaning forward in the pushup position, arching the back, or raising up on your toes.

17. 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 the front of your left ankle. Bring your heel up to your buttock and keep your left knee pointed towards the ground. Keep your left leg close to your right leg. Hold for 30 seconds and repeat on your right side. Things to look for: bending at the waist, or letting your knee “wing” out to the side.

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

19. 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.

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

21. Agility Drills • Instruction: Stand on one leg and balance while performing soccer kicks with the other or dribbling basketball while balancing. Perform 1-2 minutes each leg. • Things to look for: Do not allow balance knee to fall in towards mid line of body- keep knee in a slightly bent position Single Leg Sport Specific

22. 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 knees straight!! 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 knees straight!! Agility Drills • Instruction: Stand on ground with feet approximately shoulder width-perform a quick squat and then explode into a jump- hold the landing for a 2 count Perform 20 times. • 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 knees straight!! Squat Jump With Hold Correct Landing Incorrect landing

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

24. Agility Drills • Instruction: Stand with feet 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. • Things to look for: 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 Lateral Jumps

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

26. Strength Exercises 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. 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.

27. Strength Exercises Single Leg Calf Raise Correct Incorrect Instruction: Stand on one foot and slowly raise up on to toe and then back down. Repeat 10 times each side. Things to look for: Be sure to move up and not forward (as shown above in picture 2).

28. Strength Exercises Forward Lunge Correct Incorrect Instruction: Take large step forward and slowly lower self towards ground keeping your knee directly over your toes. Repeat 10 times each side. 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.