Prevent the “pop” with P.E.P! (ACL prevention)

Step. Twist. POP!!! For anyone who has ever injured their anterior cruciate ligament (ACL), they probably know this dreaded ‘pop’ all too well. This ‘pop’ usually means a torn ACL, which equals a long period on the sidelines, months of rehabilitation and plenty of frustration! For a long time it was unclear whether the chances of an ACL injury could be reduced through specific exercises, which was a real bummer for patients and therapists alike. However, over the last few years some really promising research has started to emerge, shedding light on what can be done to prevent ACL injuries. Firstly, here are 5 important points you need to know about the ACL:

  1. It’s one of the four main ligaments of the knee, and is the most important ligament for stabilising the knee. It prevents the tibia (shin bone) from sliding forward on the femur (thigh bone).
  2. Injuries often occur in agility sports such as soccer, AFL, rugby and netball, usually during a rapid change of direction involving twisting of the knee.
  3. Injury also occurs with direct contact (such as a slide tackle in soccer) and these are usually more severe, with other knee structures also damaged.
  4. Most cases require a total knee reconstruction that requires at least 9-months of comprehensive rehabilitation.
  5. Women are at higher risk of injury compared to males – sorry ladies!

As the ACL provides roughly 90% of overall stability to the knee, it’s easy to see why an effective injury prevention program is so important. Prevention is always better than cure, right? That’s where the research done by the Santa Monica Sports Medicine Research Foundation comes in, who developed the Prevent injury and Enhance Performance program (PEP). The PEP program is a highly specific warm up routine that has been shown to reduce both first time ACL injuries and also injury after reconstruction by 70%! The program combines the core elements of stretching, strengthening, plyometrics and agility; needs to be completed 3 times per week; and only takes 15-20 minutes to perform. Here’s the basic structure of the program:

  1. Warm-up (50 metres each):
    1. Jog – forwards
    2. Jog – side to side
    3. Backward running
  2. Strengthening
    1. Walking lunges (2 sets x 20 metres)
    2. Russian hamstring (3 sets x 10 repetitions)
    3. Single toe raises (30 repetitions each side)
  3. Plyometrics (20 repetitions each)
    1. Lateral hops over cone
    2. Forward/backward hops over cone
    3. Single leg hops over cone
    4. Vertical jumps
    5. Scissor jumps
  4. Agility (40 metres each)
    1. Forward run with 3 step deceleration
    2. Lateral diagonal runs
    3. Bounding run
  5. Stretching (done post training – 2 sets x 30 seconds each)
    1. Calf stretch
    2. Quadriceps stretch
    3. Figure 4 hamstring stretch
    4. Inner thigh stretch
    5. Hip flexor stretch

The most important thing to remember about this basic warm up routine is quality, quality, quality!!! Continually performing these basic exercises with perfect technique gradually reinforces new movement patterns in your brain, replacing the old patterns that are putting your knees at risk of injury. This becomes so important in the final 10 minutes of a game when you’re both physically and mentally exhausted. You can rely on your brain to continue to support and control your knee during that awkward landing from taking a mark in AFL because you’ve taught it how to move properly over and over again! Lastly, because the knee is stuck in between your ankle/foot and hip, it’s really important to have full mobility at these joints to allow your knee to do its job properly. Think about it – if you have really tight hips and are trying to twist and turn over and over again when sidestepping playing rugby, where do you think that movement is going to come from? That’s right – your knee. And what movement places your ACL at greatest risk of injury? Right again – twisting. Starting to see the bigger picture? Your physio is able to compare your range to optimal and implement some effective treatment techniques to improve your mobility. Once you’re moving the way your body was designed, it’s time for you to work with an exercise physiologist to develop the strength and control to keep your newly found range of motion. Simple, but so effective! So remember – you can reduce your chances of the dreaded ACL ‘pop’, and it’s not as hard as you may have imagined. The best tip? Movement quality outweighs quantity every time.

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