Exercises and Warm Up Techniques to Prevent ACL Injuries

Written by Drew Morcos of Motus Specialists


About 250,000 individuals experience an anterior cruciate ligament – ACL – tear every year.

Usually, the ACL prevents the shin bone from sliding forward, stops hyperextension of the knee, and keeps the knee from collapsing inward. However, sports that involve frequent cutting, pivoting, or jumping movements come with a high risk of an ACL injury.

As more information and evidence emerges on ACL injury risk factors and prevention, coaches and athletes continue to become better equipped to reduce the frequency of this type of injury. Yet, a consensus amongst experts has not fully been reached for combating ACL injuries.

On the other hand, various predispositions set one up for a higher risk of an ACL injury, such as specific knee movement and muscle activation patterns. Such patterns increase the potential for injury via excessive strain placed on the ACL. From this information, we can infer a general warm-up guideline and ACL injury prevention exercises that can help protect the area and reduce the risk of an injury occurring.

Warming Up to Protect the ACL and Reduce Risk of an Injury

The warm-up preps the body for action. It’s a necessary step when it comes to general injury prevention, and it is an important factor when it comes to protecting the ACL. A proper warm-up for ACL injury prevention should involve mobility exercises, certain movement patterns, and muscle activation and strengthening exercises.


ACL Mobility Exercises for Injury Prevention

Interestingly, evidence indicates that static stretches may increase the forward position of the shin bone, which causes laxity. This laxity increases the risk of an ACL injury.

In addition, static stretches may cause a decline in an athlete’s performance. This is thought to occur due to the inhibitory effect that static stretching has on muscle activation.

Thus, dynamic stretches prove to be the best mobility exercises to prevent an ACL tear. These types of ACL injury prevention exercises have even shown to improve an athlete’s performance, rather than reduce it. They also allow the athlete to move their joints, limbs, and muscles through their full range of motion.

Dynamic mobility exercises to reduce the ACL injury risk factors include ankle dorsiflexion (the toes pointing up), hip internal rotation (the toes pointing out), and hip external rotation (the toes pointing in).

Why is this the case? When there is a decreased range of motion at the ankle and hip joints, the knee may take on a more valgus position. This places direct stress on the ACL, increasing one’s risk of injury. Thus, these are essential mobility components to include in an ACL injury prevention and warm-up routine.

Movement Patterns

If retraining certain movement patterns are necessary, more time may have to be put aside outside of the warm-up time. Yet either way, these movement patterns should also be regularly included in an individual’s warm-up who aims to reduce their ACL injury risk.

Movement patterns should target the hip joint and should include lunges, jumping, and landing techniques. A proper “hip strategy” is essential for the protection of the ACL in these movements. This involves increased hip flexion, and a forward trunk lean when loading or landing. By doing so, hip flexion is increased, and the hamstrings become stretched. This reduces the load placed on the ACL. The glutes further become engaged, which aid in supporting and stabilizing the hip and knee.

These movements should further occur in a controlled manner for optimal ACL injury prevention. The knee should also slightly flex in conjunction with increased quadriceps activation. Evidence suggests that this may further decrease ACL injury risk factors. Generally, this strategy places more stress and demand on the muscles as opposed to the ligaments and other connective tissue.


Muscle Activation for Reducing the Risk of an ACL Injury

In a warm-up, ACL injury prevention and strengthening exercises should be fairly light. You don’t want to push the muscles to the point of fatigue since this will reduce performance later on. And when it comes to reducing one’s risk of an ACL injury, the main targets of muscle activation should be the glutes and the hamstrings.

The hamstrings and the ACL work together to prevent the shin bone from moving forward, which often causes ACL injuries. The stronger your hamstrings are, the better equipped you are to prevent an ACL tear. The glutes’ ability to generate power also matters. Increased power of the glutes may prevent knee valgus, which is a major predecessor to ACL tears.

Additional Notes for ACL Injury Prevention

In addition to these exercises and components outlined above, a proper warm-up should also get one’s heart rate up as the body prepares for more intense activity. Include the above guidelines in your warm-up, and you’ll reduce your ACL injury risk that much further.

Have you already experienced an ACL injury or looking for specific suggestions for ACL injury prevention for yourself, your child or your  athletes? Use the BetterPT website or mobile app to find a physical therapist that specializes in ACL injuries near you. BetterPT helps you schedule appointments with top-quality clinics like Motus Specialists and more without requiring a prescription from your medical doctor.  You can be proactive with physical therapy and prevent injuries before they occur. Be the best athlete you can be with PT!

Drew Morcos is the founder of MOTUS, a functional movement approach to clinical rehabilitation for amateur and professional athletes. He has experience as an athletic trainer and physical therapist in Division 1 Athletics, NFL, NBA, USA Indoor Volleyball, USA/AVP Beach Volleyball and the World’s Strongest Man Competition.

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