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An Update on ACL Injury Prevention Programs

15 Oct 2018
Mick Hughes
If you caught my last blog, you’d remember that I said how important it was to strengthen the quads during ACL reconstruction rehabilitation, and how doing so leads to better knee function and quality of life, and less chance of knee re-injury. At the time I was writing that blog I was thinking to myself, how nice it would be write a positive proactive blog for once discussing ways to reduce the risk of ACL injury, rather than continually writing reactive blogs suggesting ways to help ACL injury outcomes and ACL reconstruction outcomes. Well I decided to do something about it, and here is that blog...

You may not be surprised by this, but a lot of research is published on ACL injury. But what may surprise you is that a large percentage of this body of research is actually aimed around trying to find out ways to prevent ACL injuries from occurring in the first place. The reason being that an ACL injury can significantly impact on a person’s function and quality of life in both short & long terms. 

What the research consistently shows is that ACL injury prevention programs (also referred to in research as neuromuscular training programs) can’t eliminate the risk of all ACL injuries; but can significantly reduce the risk of ACL injuries, with one very recent high quality paper showing that 50% of all types of ACL injuries (contact & non-contact mechanisms, males and females) and 67% of non-contact ACL injuries in females can be reduced with the regular implementation of ACL injury prevention programs (Webster & Hewett, 2018).

As an added benefit, neuromuscular training programs have a flow on effect to lower the risk of other types of lower limb injuries  - ankle sprains (40% reduced risk) and all lower limb injuries (22% reduced risk) (Finch et al, 2016, Grimm et al, 2016).

What’s even more impressive is that neuromuscular training has the ability to make players run faster and jump higher! Research into the The 11+ injury prevention program in young soccer players has shown that doing the program significantly improved balance, jumping and sprint performance measures (Ayala et al, 2017).

However, despite the ability for injury prevention programs/neuromuscular training to decrease a range of lower limb injuries and improve performance measures, research also shows that there are issues with overall understanding and awareness of these programs. More concerning is that in those that actually know that these injury prevention programs exist, program adoption and adherence in some populations is low (mostly young amateur athletes & recreational athletes). Anecdotally, a common reason for lack of adoption is “lack of time”.

Well, in my very humble opinion, “lack of time” is simply not good enough.

Maybe it’s a lack of understanding in these coaches and players of the powerful effects of what these programs can achieve; less injuries and faster players. Maybe it’s a misunderstanding of what the programs are designed to do – simply “warm-up” and prepare the players of the demands of the training session or game that they’re about to participate in. By simply replacing the current 1970s style warm-up that most amateur/recreational clubs still perform (a slow jog around the park followed by a few static stretches) with a program like The 11+, coaches and players will have the SAME amount of time that they have for their current training session, not less time…



Image: Warming up for sport has changed significantly in recent years

Whatever the reason, it’s up to us to make a change and keep pushing the agenda of changing the way all athletes prepare for sport to lower the risk of significant injuries such as ACL.

Maybe we have to start calling injury prevention programs “Performance Enhancing Programs”?

Whatever we do, the simplest thing we can all do so is add these injury prevention programs into the regular training schedule of each and every athlete and team that plays sport.

Now I understand that not all sports have their version of the The 11+. In saying that, Netball has done a fantastic job with the Netball KNEE program; as has the AFL with the AFL Footy First program. And I can’t forget the original injury prevention program the PEP program, which was originally designed for sports like basketball and volleyball in mind.

But, if you find that you are involved in sports not listed above, never fear. I’ve got you. Simply follow this checklist by Petushek et al (2018) who published a high-quality paper of the key components of an injury prevention program that significantly reduces the risk of ACL injury. What you’ll need to do is make some sport specific tweaks to the program to match the movement patterns to your sport, especially the jumping and landing drills.

To summarise this paper, a score of >10 gives you the largest benefit for ACL injury risk reduction. The program should be instructed by an appropriate health professional, and be performed for at least 15mins before every training session and game from the start of pre-season through to the end of the competition.

Image: Petushek et al (2018) checklist

So there it is, ACL injury prevention programs in a nutshell. They significantly reduce the risk of all types of lower limb injuries, not just ACLs. They improve some key sporting performance measures. And as you can see, they actually take very little time to complete. We just need more coaches, parents, players and administrators to be on board with this information, so please share this blog far and wide!

 

To keep up to date with great articles like this one, please consider joining Our Community where we'll send one (yes, just one) email a week with a link to all new articles and the odd special offer from Premax.

 

You can also check out my ACL Masterclass with Randall Cooper at Learn.Physio, or download your copy of the Melbourne ACL Rehabilitation Guide 2.0 here.




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