The following presents a 20-25 minute program that can be done three times per week or as part of daily warm up activities. This program is designed to generally address the above recommendations. However, if an athlete has already sustained an injury or if there are concerns regarding specific deficiencies, it is recommended the athlete first consult a Certified Athletic Trainer or other health care professional for a complete injury assessment and evaluation and to develop a more individualized program.
The benefit of these exercises is that they can be incorporated into everyday practices and also serve to improve overall function and performance.
FIRST TEACH AND TRAIN PROPER LANDING AND CUTTING TECHNIQUES
(click the play button above to start video)
Goals of these Activities:
Avoid “kissing knees” (functional knee valgus) – Maintain hip-knee-foot line
Reduce landing forces
Insure these principles are maintained while executing the activities described below
Activity Descriptions:
When landing from a jump, land softly by flexing the hip and knee upon landing. Keep your body weight forward by landing on the forefoot, then rolling back to the rear foot. Maintain a straight vertical line between the hip, knee and foot. The knee should not extend forward of the toes (The video shows good and bad technique during a depth drop jump)
When cutting, get low into the cut, flexing the hip and knee. Taking a shortened step and keeping the trunk leaning forward into the cut is more protective of the knee than having the trunk upright and fully extending the knee to reach the cut point. Keep hip-knee-foot in line when cutting. (The video shows good and bad technique during a side cut)
ACTIVE WARM UP
Goals:
Ready muscles for activity by increasing blood flow, heart rate and core body temperature.
Enhances functional range of motion
Activities:
General Mobility
Forward Jog – Moderate speed forward jog along court or field sideline
Side shuffle – Shuffle towards the right down the end line, then return by shuffling to the left the same distance.
Backward Jog – Moderate speed backward jog along court or field sideline
Carioca Small Step – Carioca leading with the right down the end line, then return by leading with the left leg.
Repeat above for a total of 3-5 minutes duration
Key Points:
Move continuously at a moderate pace from one activity to the next in order to maximize increase heart rate and blood flow. Remember this is a warm up, so no need to go full speed.
FOUNDATIONAL LOWER EXTREMITY STRENGTH
Goals:
Balanced Strength of the Calf, Thigh and Hip Muscles
Address areas of weakness [these are usually the knee flexor (hamstrings), hip abductor (gluteus medius), and hip extensor (glulteus maximus) muscles]
Keys: Head, trunk, back, hip and thigh should all stay in a straight line. If unable to maintain a straight back, you are progressing too quickly.
Progressions: Start with concentric only (concentric push only), then begin lowering yourself down slowly as your hamstrings get stronger (eccentric-concentric push). Start with 2 set of 5 repetitions, and increase over time to 3 sets of 10 repetitions. You know you are at a good volume if you are barely able to complete the last rep of the last set. (same is true for all strength exercises)
Single Leg Buck (Single leg bridge to isolate hip extensors)
Description – Mark’s narration.
Keys: Push off leg should begin in 90 degrees hip and knee flexion. As you push up, keep knee in line with hip and ankle. Trunk, back, hip, and knee of extended leg should all stay in a straight line. “Draw in” the abdominal muscles during this activity to maintain a straight back. If unable to maintain a straight back, decrease the time and repetitions.
Progressions: Start with 3-5 reps of 10 second holds for each leg, alternating sides between reps. Increase to 5 reps of 20-30 seconds.
Side Wall Pushes (isolated hip abductors)
Description – Mark’s narration.
Keys: Maintain an upright posture, arms at sides, elbows flexed to 90 degrees. Make sure stance leg is not too far in or out, should be in straight vertical line. Non stance leg should be flexed at the knee, with thigh pointing straight down (vertical) Hip should be neutral (i.e. not rotated in or out). Gradually push into the wall, increasing to maximal effort over 3 seconds and hold at maximal effort for 5 seconds, then release. Although this exercise works both left and right hip muscles simultaneously, be sure to perform the exercise on both left and right legs.
Progressions: Start with 3 reps of 5 seconds on each leg, increasing to 10 reps of 5 seconds on each leg. Always try to achieve a maximal effort. Rest for 10 -15 seconds in between reps.
Lunge Matrix with Return to Center Stabilization
Description – Mark’s narration.
Keys: Maintain an upright posture, arms at sides, elbows flexed to 90 degrees. Be sure to keep hips level, and during the lunge limit hip and knee flexion to 90 degrees, and watch to make sure knee does not go forward of the toes during each lunge (i.e. that both hip and knee are flexing, and that they are dropping down not just lunging forward with their knee). The decent phase should be slow and controlled (~2 second count). Be sure to pause and stabilize on the stance leg after each lunge.
Progressions: Start with 2 sets of 3 reps in each direction, increasing to 3 sets of 5-8 reps in each direction. Repeat on the other leg.
BALANCE AND COORDINATION
Goals:
Improve neuromuscular coordination, balance and postural stability
Activities:
Star excursion balance test – 3 reaches towards each diagonal
Description – Mark’s narration. Set up 4 cones or objects approximate 10 feet apart in a square. While keep hands on hips, and head facing forward, stand and balance on a single leg while reaching with the other leg toward each of the 4 cones, returning to the starting position (single leg upright stance) between each reach and holding this position for 2 seconds.
Keys: Maintain hands on hips, and reach as far in each direction without losing balance. Lightly touch the big toe at the furthest point you can reach in each direction (but do no put the foot down), so that you continue to rely on the stance leg for balance.
Progressions: Start with 3 sets of 1 rep in each direction, increasing to 3 sets of 3-5 reps in each direction. Repeat on the other leg.
Single Leg balance with Perturbation / Ball Throw
Description – Mark’s narration.
Keys: Progress as balance improves and as each progression becomes easy (i.e. no wobbles during the 20 second rep). Maintain hands on hips, eyes forward, and opposite knee flexed to 90 degrees. If you lose your balance, return to the starting position and continue with the trial (no need to start over).
Progressions: 3 reps of 20 second on each leg. Progress activities in the following order as the previous activity become easy.
Firm surface, eyes open
Firm surface, eyes closed
Firm surface, eyes open, catching ball thrown directly to you
Firm surface, eyes open, catching ball thrown in various directions causing you to reach
Firm surface, eyes closed, with the command to open the eyes just before the ball is thrown.
Firm surface, eyes open, with perturbation
Firm surface, eyes closed, with perturbation
Make each of the above more challenging by progressing to an unstable surface (airex pad, bosu ball, pillow, cushion, sand, etc)
LEG POWER AND AGILITY
Goals:
Improve leg speed, reaction time and explosive leg power
Activities:
Agility and Power Progression
Front Rapid Response Drill:
Description – Mark’s narration
Progressions: - 3-7sec x 1-3 sets (move as fast as possible while staying under control and maintaining good technique.
Lateral Rapid Response Drill:
Description – Mark’s narration
Progressions: - 3-7sec x 1-3 sets (move as fast as possible while staying under control and maintaining good technique.
Rotational Rapid Response Drill:
Description – Mark’s narration
Progressions: - 3-7sec x 1-3 sets (move as fast as possible while staying under control and maintaining good technique.
Plyometric Progression
Split Squat Jump: 4-8reps (each leg) x 2-4 sets
Description – Mark’s narration
Progressions: 2-4 sets of 4-8 repetitions (each leg).
Depth Drop Bound-Vertical:
Description – Mark’s narration
Progressions: 2-4 sets of 2-5 repetitions. Goal is to do a maximal jump with each repetition so emphasis on quality not quantity
Depth Drop Bound-Horizontal:
Description – Mark’s narration
Progressions: 2-4 sets of 2-5 repetitions. Goal is to do a maximal jump with each repetition so emphasis on quality not quantity
Key Points for all of the above agility and power activities:
It is critical that you maintain good alignment of the knee and hip during these exercises. If you are not able to maintain good knee alignment and the knees begin to fall inward, this means you do not have sufficient foundational strength and need to drop back to the previous progression of activity. Continue strengthening and other exercises, working on good alignment and technique and return to the activity when you can maintain a good technique. Avoid being overly tired when doing these activities. They should be done before, not after practice, to insure maximal power is achieved, and that proper technique can be maintained. Allow plenty of rest time between each set.
These agility and power exercises only need to be done 2-3 days per week, and can be reduced to one time / week if in season.
GENERAL FLEXIBILITY (POST ACTIVITY, COOL DOWN STRETCHING EXERCISES)
Goals:
Address areas of inflexibility (usually hamstrings, hip flexors, calf muscles)
Complete at the end of all activity to elongate and relax muscles (i.e. complete these after the above program if done apart from practice, or complete after practice if practice immediately follows the program)
Activities:
Stride Stretch for hip flexors and quadriceps muscles
Description – Mark’s narration.
Keys: Keep hips level, foot forward of knee on stride leg. Should feel a mild, comfortable stretch of the targeted muscle – stretching too hard will cause the muscle to tense rather than relax.
Progressions: 2-3 reps of 15-20 seconds – as the muscles relax during the held time, extend the muscle farther to maintain the same mild stretch.
Butterfly stretch for hip abductors and back
Description – Mark’s narration.
Keys: Keep back straight, use elbows to slowly push knees down. Can push knees against elbows using very light resistance, then relax into the stretch for greater gains. Should feel a mild, comfortable stretch of the targeted muscle – stretching too hard will cause the muscle to tense rather than relax.
Progressions: 2-3 reps of 15-20 seconds
Figure-4 Hamstring stretch
Description – Mark’s narration.
Keys: Back straight, hips square, and extended leg should be straight ahead of the body and in line with the hip. Be sure to bend at the hip, and not the waist, reaching as far down the leg as possible while keeping the knee straight to achieve a mild stretch. Should feel a mild, comfortable stretch of the targeted muscle – stretching too hard will cause the muscle to tense rather than relax.
Progressions: 2-3 reps of 15-20 seconds
Calf Stretch
Description – Mark’s narration.
Keys: Keep knees straight, heels in contact with the ground.
Progressions: 2-3 reps of 15-20 seconds
For More information, contact:
Sandra J Shultz PhD, ATC, CSCS (Co-Director)
Randy J Schmitz PhD, ATC (Co-Director)
Yum Nguyen PhD, ATC (Post Doctoral Research Associate)
Email: sjshultz@uncg.edu (my personal email address, which you are welcome to post)
Based on current scientific evidence, recent consensus statements recommend that the following components be included in an ACL prevention program:
1) Teach and Train Proper Landing and Cutting Techniques
2) Foundational Lower Extremity Strength and Flexibility
3) Balance and Coordination
4) Leg Power and Agility
Sources: (Griffin, Albohm et al. 2006; Renstrom, Ljungqvist et al. 2008; Shultz, Schmitz et al. In Press)
Griffin, L. Y., M. J. Albohm, et al. (2006). "Update on ACL Prevention: Theoretical and Practical Guidelines." American Journal of Sports Medicine 34(9): 1512-1532.
Renstrom, P., A. Ljungqvist, et al. (2008). "Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement." British Journal of Sports Medicine 42(6): 394-412.
Shultz, S. J., R. J. Schmitz, et al. (In Press). "ACL Injuries: The Gender Bias: Research Retreat IV April 3 to 5, 2008 Greensboro, NC." Journal of Athletic Training
