In Part 1 of this blog, I wrote about the risk factors associated with Anterior Cruciate Ligament (ACL) injuries. It is very important that any person involved in regular physical activity, regardless of whether they are a weekend warrior or an elite athlete, needs to be engaged in comprehensive exercise program. Below are components every exercise program should contain to reduce the risk of injuries.
Pillar Strength: I do not like the word core because people think of six pack abs. Rather, I use the term pillar, because I want to broaden the scope of thinking to include not just the abdominals, but the deep stabilizers of the trunk and spine, the obliques, hip flexors, and glutes. All of the aforementioned muscles are responsible for lumbopelvic stability, which is key to power transfer through the kinetic chain. Include activation exercises like hip bridges, plank variations, and mini band drills to properly recruit all of these areas prior to training or activity.
Mobility/Stability: Maintaining healthy, mobile, and stabile joints, along with good posture is the key to reducing all injuries. There is a strong correlation between poor function of the ankles and hips as it relates to ACL injuries. Foam rolling, dynamic mobility drills, corrective exercise, static stretching, and yoga are several tools that can be used to help improve muscle tissue quality, joint range of motion, and overall movement quality and posture. Include single leg balance drills to engage the stabilizer muscles of the lower extremities and improve proprioception.
Functional Strength Training: Functional is a word that gets over used in the fitness and sports performance industry. I define functional strength as the ability to stabilize while under load, or stabilizing while producing force on an external load. Opt for free weight exercises instead of machines when possible. Very rarely in sports are our feet shoulder width apart and parallel, so make sure you incorporate many different foot positons while strength training. It is important to incorporate single leg exercises that require movement and stabilization in all planes of motion (frontal, sagittal, and transverse).
Repetition Tempo: Most ACL injuries occur during deceleration and change of direction. It is critical that the body is trained to both produce force and resist force. There are three types of muscle contractions that take place during movement: concentric, isometric, and eccentric. When a muscle is under load, concentric is shorting of the muscle, isometric is no change in muscle length, and eccentric is muscle lengthening. Most resistance training programs are too heavy on concentric contraction and do not incorporate enough isometric and eccentric training. Changing repetition tempo to emphasis the isometric and eccentric is a great way to prepare the body to decelerate and change direction. Eccentric and isometric training is critical to incorporate in hamstring training since lack of hamstring strength during deceleration is a risk factor for ACL injuries.
Plyometrics and Agility Training: Plyometric and agility training is a great way to prepare the body for the rigors of physical activities. When doing plyometrics, start first with learning proper landing mechanics to reduce the potential for knee injuries. Practice landing on the balls of the feet and midfoot, not allowing the knees to come past the end of your toes, and not letting the knees go in (knee valgus) or out (knee varus). Once this has been mastered, depth jumps can be added to better train deceleration. The same goes for agility training, master proper deceleration first before working on speed. To decelerate properly, sink the hips and don’t let the knees come past the end of the toes. Practice slowly stopping and changing direction in all planes of motion (frontal, sagittal, and transverse), then add speed to the mix once proper mechanics have been established.
Thank you for reading! Please leave a comment below if you have a question.
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