July 13

ACL Injury Prevention Protocol


This is a huge buzzword in the athletic training world because unfortunately it happens all the time in sport. The ACL stands for anterior (front) cruciate ligament and is one of for ligaments responsible for maintaining proper function at the patella-femoral (knee) joint.


As you can see below the rates are particularly higher in females as opposed to males predominantly due to their wider hip carriage and the ensuing compensations that occur accordingly. If you coach or train female or male soccer, football, basketball, or lacrosse in particular then this is a post you won’t want to toss aside lightly.


Before I embark on the protocol the first thing I want to address is what can be prevented and what cannot. First off, I will say that no protocol is 100% because even the best conditioned athletes at the highest level of sport fall victim to injury, however we take ownership over our athletes and take every precaution we can to keep them playing for as long as they so desire. There are 2 main categories of injury: 1-contact and 2-non contact. We are only dealing with the latter because if Ray Lewis dives into the side of your knee with your foot planted then no dynamic warm-up or strength training regimen will help you (morphine is a viable option there however). Under the canopy of non-contact there is both acute (one time excessive stress) and chronic (overuse). What we will be talking about today can benefit both categories.

The protocol has 4 distinct parts:

1) Assessment and interpretation

2) Proper corrective exercises (we like using the movement prep portion of the workout)

3) Teach and reinforce proper movement mechanics (particularly while cutting)

4) Use proper strength and plyometric training progressions


Phase 1 – Assessment and interpretation

If you don’t look at the quality of your athletes’ movement it is very difficult to know who your higher risk population is. If fundamental movement patterns are compromised then all I am doing as a trainer is pouring fitness on top of dysfunction, not the best idea. We use the FMS or Functional Movement Screen. It is a series of 7 basic functional movement patterns that is proven to predict which subjects are at a higher chance for injury. You can find out more about it here or I happen to be certified in it and love talking about this stuff so feel free to contact me. A good indicator is watching the athlete in an overhead squat which I depict in the video below.

As far as interpretation goes you usually have two major suspects that contribute to instability of the knee and that valgus pattern that I depicted above. Most likely it is an underactive gluteus medius (the side of your butt) and overactive muscles in the adductor (inner thigh) complex. This leaves us with activating, or more correctly causing more activity and strength in the glutes and inhibiting and stretching the overactive adductors.

Phase 2 – Proper corrective exercises

Now it’s time to begin actually fixing the problem. If you are like I am then you have tons to accomplish and limited time to do so. We like to whenever possible incorporate corrective solutions into the movement preparation portion of our workouts (some of you call this as a warm-up but we shy away from that term due to the much more comprehensive nature of what we accomplish in the beginning of our sessions). For us movement prep breaks into 4 parts 1) glute activation 2) dynamic stretching 3) movement skills integration (linear or multi directional depending on the training focus) and 4) Neural activation. For the purpose of this post I will just be hitting on points 1 and 2. Please enjoy the next video:

Phase 3 – Use proper strength and plyometric training progressions

Here’s the deal, Injuries are much more common to occur in the frontal (lateral) or transverse (rotational) planes of motion, so if I only train my athletes the way most people do with regular squats and lunges then I am not preparing them for the field of play where their movements will be much more random and chaotic. One of the easiest ways to train in all 3 planes of motion is to have the athlete train on one leg. Although they may not be moving laterally or rotationally the element of instability now causes the musculature to counteract forces from all three planes motion. I chose 3 exercises that can be done with minimal equipment for maximum results. One falls in our basic balance category, one is resistance based and the third is plyometric.

Phase 4 – Teach and reinforce proper movement mechanics

Since most ACL injuries do occur in the frontal or transverse planes of movement we put a high emphasis on correct movement skills in drills that work in these planes. When I met Mark Verstegen at Athletes’ Performance he said many things that resonated deeply with me, one of which was that they “do simple things savagely well.” That’s a credo that we have adopted and are constantly striving for here at Raw Fitness. In the next video I will cover a drill we call lateral push to base to shuffle viagra sur internet. The main coaching cues are not optional. The reason I say “not optional” is because perfect practice makes perfect. I don’t need my athletes to get every drill right the first time, there is a learning curve, but I need to know what perfection is and constantly and patiently be leading them there.

From the base position, slightly internally rotate left hip causing a more positive angle at the knee and ankle.
Avoid the problematic knee valgus.
Move to right by pushing off left foot and stepping with right foot.
Return left foot to base position and repeat until behind second cone.
Keep knees behind toes and tension in glutes.
Do not let feet come together.
Keep back flat.


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Mike Montefusco

About the author

Michael's mission is to bring clarity those who have fitness goals but lack clarity on how to achieve them. He got certified through the prestigious National Academy of Sports Medicine and is a Precision Nutrition Level 1 Nutrition Coach. He started Raw Fitness 10 years ago and has 15 years of experience of helping thousands of clients to look and feel their best.

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