Exercises To Prevent ACL Injuries

The nation’s first – and only – program aimed at taking a wide-scale community prevention approach to decrease non-contact anterior cruciate ligament (ACL) tears among female high school athletes is working, and as a result, is being expanded in Rochester, New York. The program, called PEP (Prevent injury, Enhance Performance), targets the prevention of one of the most serious knee injuries that can sideline athletic careers among females, who are at six to nine times greater risk than males to sustain an ACL tear.

Organized by University Sports Medicine (USM), the PEP program is being rolled out to 119 high schools in Section V, an area that covers all Monroe, Ontario, Seneca, Livingston, Allegany, Steuben and Wayne counties in upstate New York. The expansion, made possible by a $161,000 grant from the Greater Rochester Health Foundation (GRHF), will cover junior varsity and varsity female athletes playing soccer, volleyball and basketball – the three main sports with high incidences of ACL tears. USM officials expect to train about 11,180 athletes on nearly 700 teams during the two-year program.

GRHF provided the seed money for USM to introduce the program to Monroe County high school athletes in January 2007. Since that time, USM athletic trainers have worked with 1,137 female athletes on 71 teams, and preliminary results are promising.

“We would typically expect to see about two ACL tears per 100 participants, or about 58 non-contact ACL tears for the 2,900 athletes we have been working with,” Michael Maloney, M.D., director of USM, said. “To date, we’ve seen only 10 non-contact ACL tears, so this data is very promising. I’m grateful that with additional funding from the Greater Rochester Health Foundation, we are able to significantly expand the reach of our program, and help even more female athletes stay in the game and attain their goals, whatever they may be.”

The program has steadily been gaining national attention. In 2008, the NCAA posted an interactive segment on ACL injuries to its website, which included a feature on USM’s PEP program.

Mystery Surrounds Female ACL Tears
The numbers on female ACL tears are astounding. Over 1.4 million women have been afflicted in the past 10 years alone — twice the rate of the previous decade. It is estimated that more than 30,000 high school and college age females will rupture their ACL every year. In the last 15 years, ankle sprains have decreased by 86 percent while knee ligament injuries have increased by 172 percent.

Much speculation exists on the cause of the higher non-contact ACL injury rate in females, with hormones, biomechanics and environment some of the common culprits named. While researchers have been unable to definitively pinpoint the exact cause for the increased incidence in females, they have been able to develop a series of specific stretching, strengthening, flexibility and balance exercises that have been shown to significantly reduce injury rates.

“PEP works by retraining the nervous and muscle system in female athletes to be more efficient, and as a result, reduce the potential for non-contact ACL tears,” said Andy Duncan, P.T., A.T.C., director of sports rehabilitation at USM.

It consists of a specialized warm-up program that must be completed two to three times a week, and includes exercises and training to increase muscle strength, plyometrics (active strengthening like jumps), agility, balance and flexibility. The program takes about 20-25 minutes to complete.

“We stress quality versus quantity with the girls. These exercises are so precise that they must be done properly or they will not receive any benefit at all,” Duncan said. “In effect, we are re-teaching the muscles how to fire and respond to signals from the nervous system. At the end of six weeks, if the program is done correctly and consistently, these athletes will have a much better chance at preventing an ACL tear.”

Beginning in the summer of 2009 USM athletic trainers will use a “train-the-trainer” approach to educate team coaches/representatives on the benefits and components of the PEP program. The sessions will be interactive, including demonstration and participation. Videos detailing each exercise will be given to each team to help guide the athletes through the program.

Sample PEP Exercises
• Warm-ups: Jog, slides, backpedals
• Strengthening: Lunge walk, ball bridge, calf raise
• Plyometrics: Lateral, front/back and single leg hops, rebound jumps, scissor jumps
• Agility: Shuttle and pivot runs
• Stretching Hamstrings, quads, calves, groin and hip flexors