The Anterior Cruciate Ligament (ACL) sits deep in the knee joint running from the back, outer of the femur(thigh bone) to the front inner of the tibia(shin bone). It acts to control excessive forward movement of the tibia on the femur, and control rotation movements. The hamstring muscles also help to control forward shear of the tibia, particularly when the knee is flexed > 20 degrees.
Rupturing the ACL occurs in sports involving cutting and weaving such as football, basketball, touch football. One study indicated that the frequency rate for injury in soccer players is approx. 1 in 60. It usually is injured during non-contact mechanisms involving change of direction, landing, or decelerating.
If injured, surgery to reconstruct the ligament occurs, and return to sport takes 6 to 12 months. There may also be long term consequences to the knee such as early development of arthritis, particularly if other structures (e.g. menisci) are injured as well.
Neuromuscular training to minimise risk of ACL injury
The goals of specific exercises are:
1. Train correct landing techniques with good knee alignment and adequate hip and knee bend.
2. Strengthen hamstring, gluteal, and core musculature.
3. Increase the speed of neuromuscular firing.
4. Improve proprioception.
1. 2 legged Squats
2. 2 legged box jump and hold
3. Single leg squats
4. Hamstring curls
5. Russian hamstring curls
6. Bridging. 2 legged progressing to single leg.
8. Hip extension drills in 4 point (i.e hands and knees)
9. Single leg balance with eyes closed. +- unstable platforms (e.g. wobble boards, BOSU ball)
10. Single leg balance throwing and catching
11. Side leaps
12. Single leg cross-over hop and hold.
15. Swiss ball hamstring curls
16. Swiss ball stability drills (many and various)
17. Various abdominal strengthening drills (ensure pelvic floor and transversus abdominis activation and good spinal position).
18. Single leg box jumps. Forward and back – side to side – diagonals. (NB More advanced – ensure adequate strength and knee position control).