HOW TO PREVENT ACL INJURIES OR RE-RUPTURE?
Welcome to our last blog of the ACL injury blog series! In this blog, we hope you will be able to take away some good tips to help you stay fit and injury-free during your season. This blog primarily discusses ACL injury prevention, but you can definitely use the programs mentioned below to prevent many other leg injuries such as hamstring tears or ankle sprains.
To give you a little bit of an insight, there has been a ton of research on injury prevention done by large sporting organisations. Based on results of those research they are able to implement specific programs that clubs or teams can use to reduce risk of injuries of their players. One such organisation is FIFA. In 2010 during South Africa FIFA World Cup, FIFA rolled out a “FIFA 11+” warm-up program across the world. And very recently, Football Australia rolled out “Football Australia PERFORM+” program, where they modified the “FIFA 11+” program to become more practical. Other organisations such as AFL has their own program called “FootyFirst”, and Netball Australia has “The KNEE Program”. These programs can reduce risk of lower limb injuries by about 35% compared to your “normal” warm up program. That’s 1 out of 3 injuries prevented!
All these programs have 5 components in common:
1. Warm up (pre- training & games)
I’m sure you already have your own warm up routine before training or game. A good warm up routine should be gradually loading up your cardiovascular system and focused on moving the muscles and joints into end of ranges. Warm ups should last for about 10mins and include running and dynamic stretches. Agility work during warm up is also crucial to prepare you for cutting and changing of direction movements (which are movements that can cause ACL rupture).
2. Strengthening (2x/week)
FIFA11+ program included strengthening component in their warm up program, but PERFORM+ lets you do the strengthening work outside of game and training days to prevent gameday fatigue. Strengthening not just your lower limb but also core muscles will massively build the foundation you need to be able to perform on the field with bloody good technique while running, jumping, landing and changing of direction. Weakness is a main ingredient for ACL injuries during landing and cutting movements. This part of your prevention program should be performed at least 2x/week, with rest days in between for recovery. Make sure you add in single legged exercises (eg. single legged squats, deadlifts, calf raises) into your program. PERFORM+ have specific strength exercises for your quads, hamstrings, and groin to prevent strains/tears to those muscles.
3. Balance / Landings (2x/week)
Once you get your strengthening component right, start improving your balance. You can start by standing on 1 leg, make it harder by turning your head side to side / up & down. This should be followed by hopping (eg. jumping on the ground, jumping/dropping from a box, jump & turn, etc.) and make sure you stick your landing properly. Especially for ACL injury prevention, look at your knee alignment in particular as you land (shown below). If you want to know why, click here for our first blog where we explained how ACL injuries occur.
4. Agility / Changing of Directions (2x/week)
ACL injuries happen frequently during cutting movements. Make sure you practice your agility and changing of directions. Again, pay particular attention to your knee position as you are changing direction. Start with a jog, then cut to the left/right. Increasing your speed each time. Or you can jump, and as you land, cut to the left/right. Perform these exercises together with your balance/landing practice.
5. Flexibility (pre-/post- training & games)
Don’t forget to stretch. Although stretching doesn’t really lengthen muscles (unless done at a high volume and frequency), it can improve flexibility as you can tolerate the stretching sensation and relax into further ranges. Make it a routine to perform your stretches on training/game days.
Before we forget, our physios Zac and Karina have covered the topic of FIFA11+ program extensively, along with videos on how to perform the exercises. Click here to check it out. These injury prevention programs are all based on research, and all of them have shown significant reduction in risk of lower limb injuries. There is no reason not to follow them. You can pick and choose which program suits you best, but if you are unsure on what to pick, and how to perform them, you can always ask your PT/EP/Physios. The physios and EP here at INSYNC Physio can help tailoring the program that suits your physical demands of your sport. We love to see our patients perform well on the field all season long.
This blog concludes our ACL Blog Series. It’s been a pleasure to be on this journey with you. We really hope that you can take away some points from our spiel to protect yourself or your players (if you are a coach) against an ACL injury. The series did cover a lot of things, from how ACL injuries happen, and how to rehab it. However, if you have injured your ACL, it is highly recommended that you see physios who know the step by step process to get you back on the field safely. We have made sure that every ACL patient that comes in gets the best care.
Thank you so much for tuning in. Stay safe!
Warm regards,
The Insync Team.
Click here for the other parts:
ACL INJURY BLOG SERIES:
Part 1: What is an ACL injury?
Part 2: Surgery or No Surgery?
Part 4: Prevention
References for pictures