ACL injury prevention

how do you prevent ACL injurys?

my girlfriend tore her ACL a while back and was wondering if there was any cause of it?

strength training?
warming up?


Not an expert on this, but I know girls are more prone to them due to structural differences. One thing is to make sure you don’t have muscle imbalances like weak hamstrings and an underdeveloped VMO.

All will help if done correctly. Tell her to go and have some gymnastic lessons. How to land correctly etc.

I guess my first question would be how did she tear it? Was it sports related? Knowing the exact mechanism of injury makes the difference b/w re-injury and staying injury free, to ensure it doesn’t happen again.

Also, Delldell nailed it right on, women have larger Q angles compared to males, due to natural anatomical differences for child bearing.

Lastly, are you sure she tore it or or severly strain it? In any case, after injuries such as those including joint dislocations due to shallow sockets (ie, shoulder, knee usually) as opposed to deeper sockets which rarely get dislocated (ie, hip) usually are treated with resistance training. The analogy is that you need to strengthen the muscles surrounding the joint to compensate for the laxity of the ligament. Basically the muscle is now serving as the role of the ligament.

Tons of research is available looking at ACL injuries. Identifying the “exact” cause of any injury is very hard to determine, unless it’s an impact injury such as in football. Even then it’s hard to know for sure. Overall training factors need to be taken into consideration, not just what was going on at the time of injury.

If she is not doing so already, focus on increasing hamstring and Vmo strength. The Vmo is the “tear drop” muscle on the front of your leg.

One quick observation regarding the Q-angle, among other factors involved, most women who do well in running sports have Q-angles that more closely resemble those that men have, so this may not be as much of an issue in her case.

Even if there is a greater than 18 degrees in Q angle, that doesn’t neccessarily mean the girl will tear her ACL. I’ve had girls with ACL tears that had big hips and girls that were built like boys. I’ve seen more patella/femoral problems in big Q angles with genu valgum.
Q angle can’t be changed. Some of underlying problems with non contact ACL tears and girls are:

  1. Weak or non-firing glutes. Maximus, medius and minimus.
  2. Non existant VMO.
  3. Lack of sport skill.
  4. Playing a high level sport without enough experience at a high level. Meaning the athlete doesn’t have the starting and stopping experience.
  5. Has poor visual feedback/cues to decelerate with proper body mechanics.
  6. Body and brain cannot match speed of the game.
  7. Unable to control upper body when decelerating.

How to prevent tears?

  1. Increase the time spent playing the sport. Learn the skill.
  2. Learn how to land. Someone mentioned this before.
  3. Learn to accelerate and decelerate with heels slightly off ground. Play a modified game of tennis or handball
  4. Strengthen the entire lower body as a whole.
  5. Strengthen the abdominals.

To summerize, expose the athlete to the demands and skills of the sport. Start at low levels and very gradually increase the speed. Although there are no guarentees, you can better the odds.

Excellent post Thomas.

thanks thomas that hepled clear some things

“2. Learn how to land. Someone mentioned this before.”

this was probably the cause as the impact injured her more than anything.

thx for the help

I remember Tim Grover stating this was in his experience one of the most common reasons for female ACL injury.
He also focuses alot on H/S strengthening for prevention.

Watch how a girl who doesn’t fire her glutes lands on one foot even from a 6" or "8 step. If the the knee buckles in toward her midline the glutes aren’t firing and absorbing her body weight. Her foot may also overpronate, abduct and her tibia may externaly rotate. This is the classic situation for a non-contact ACL tear. The same mechanism can also be seen when decelerating.

Another big technical contributor to ACL and Meniscal tears is “stop (plant) & turn”. This is when an athlete immediately stops running and twists to turn into another direction (almost seems like they don’t stop) abosorbing torsion forces being put on the knee and other joints.

Many athletes, as Thomas indicated, get this while decelerating or in agility sports (ie, football and indoor soccer). From experience, I have seen many athletes tear or strain their knees in indoor soccer b/c of the “turf” surface they are playing on, including indoor football. The turf creates strong grip on the shoe when the foot plants, leaving almost no mercy on the joints and increases the risk of injury.

I did a program 2 summers ago run by a university which was specifically geared towards preventing ACL injuries- it included plyos and lots of emphasis on jumping up and down on boxes with correct landing. we also did things like ladder agility and low hurdle hops, as well as general lower leg stability and strengthening… and core as well. fairly all-encompassing. :slight_smile:

Some of the preventive programs are good but too short in length. I’ve found teaching or “polishing up” older athletes that have played a particular sport for many years, that they need a longer period of time to correct the old habits. As always the more athletic they are the shorter the time period may be and the less correcting and teaching has to be done. Take a group of 10-12 year old girls with average athletic ability and you can teach them how to land, cut and decelerate in 6-8 sessions or less.

I’ve found it particulary interesting how these ACL tears have surfaced in the last 10-15 years and little mention of them previously. There seems to be multiple factors. In no particular order:

  1. MRI
  2. Arthoscope
  3. More girls in sports
  4. More unfit, unskilled girls in sports
  5. Synthetic grass. Increased friction between foot and turf requires the muscles to decelerate the body much quicker because the feet are sticking to the ground more. Grass has more give. This creates odd joint angles in the ankle, knee and hip. Eccentric forces are greater on turf and if the leg and trunk strength or co-contraction is not there, injuries occur.