ACL Injury Prevention Program

Joseph Consalvo PT ATC CSCS Stephen Cusano ATC Kelly Copperthite ATC Ken Kosior PT ATC Connecticut Orthopaedic Specialists STAR Sports Therapy

ACL Injury Prevention Program

Program Components:
1. 2. 3. 4. Dynamic Warm-up Strength Plyometric / Proprioception Agility

I. Dynamic Warm-up
A. , Mile Jog
1. Jog around the track once / twice. Complete under 2.5 minutes / 5 minutes

B. Shuttle Run
1. 200 yd 2. Jog length of field and back

C. Inch Worm
1. Standing with your feet and hands flat on the floor, walk your hands out until you are in the plank position and then walk your feet in until you are back to the starting position. Repeat 5-10 times.

D. Frankensteins
1. Standing up point your arms straight out. Keeping your knees locked straight try to kick your outreached hand. Travel 10-20 yds while performing this warm-up.

E. Butt Kicks
1. For 20 yards, walk while kicking your heel towards your buttocks at a moderate speed. Alternate legs.

F. Knee Grab w/ Hand to Sky

1. Standing take one step forward, grab your knee and pull it to your chest. Then stick your opposite arm straight up to the sky and bend at the waist backwards. Take next step leading with opposite leg and repeat. Travel 10-20yds.
G.

Leg Swings
1. Stand against wall or holding fence and swing leg out to side back and forth so stretch is felt. Perform 30yds.

H.

Scorpions
1. Lying on stomach with arms spread, kick heel to opposite hand quickly. Repeat on opposite side.

20x each side

I. Strength
A) Single Leg Squats
1) Starting in the athletic position with your knees bent assume a single leg stance. Keeping your weight on your heels, squat down making sure your knee does not go in front of your toes.

B) Forward Lunge w/ Upper Body Rotation

1) Lunge forward with your right leg and drop your left knee down to the ground. With arms out, rotate trunk toward the right. Return to starting position. Repeat with your left leg in front. Try to keep your front knee from bending inward and coming past your toes keeping it in line with the ankle.

C) Lateral Lunge
Consalvo, Cusano, Copperthite, Kosior 2009

1) In the athletic position lunge laterally with your right leg transferring your weight there. Squat down and back up. Return your left leg to the starting position. Repeat in opposite direction leading with your left leg.

D) Backwards Lunge
1) Similar to the forward lunge without the rotation, lunge backward dropping the back knee down to the ground. Remember to maintain knee-ankle alignment in the front leg while preventing inward bending.

E) Partner/Russian Hamstring
1) Kneel down on your knees. Have your partner hold and stabilize your ankles firmly. Keeping your arms at your side and a straight back, slowly start to lean forward activating your hamstrings. Try to maintain shoulder-hip-knee alignment without bending at the waist. Return to starting position.

F) Single Leg Bridges

1) Laying supine on your back, bend your knees and plant your heels in front of your buttocks. Keeping knees level, straighten out one knee. Push off your heel lifting your pelvis off the ground. Hold position for 5-10 seconds and return to starting position. Continue on opposite leg.

G) Band Walks
1) With a Resistance band around ankles assume the athletic position. With your toes pointing straight ahead step laterally. Slowly follow with your left leg and return to the starting position always keeping the band taut. Try to keep your weight on your heels and maintain a shoulder-knee-ankle alignment.

H) Step-Ups/ Bench Ups

1) Begin facing step/bench. Step up and place one foot onto surface. Push up with given foot maintaining hip-knee-ankle alignment and a straight back until both are placed on surface. Step off step/bench and repeat again. Make sure not to push off with trailing foot while performing exercise.

I) Single Leg Superman

1) Stand shoulder width apart. Maintaining a flat back and with arms overhead bend forward at hips at the same time as extending one leg behind until trunk, arms and leg are parallel to ground. Repeat for opposite leg.

J) Star Drill w/ Leg

1) Stand on one leg with knee bent and in correct hip-knee-ankle alignment. With opposite leg touch toe as far forward as possible without putting weight down on toe while maintaining correct hipknee-ankle alignment and a flat back and head-up posture. Repeat drill touching toe to right, behind and left using same leg. Repeat then using opposite leg.

III. Plyometric (in order of degree of difficulty)

Plyometric drills should only be performed once the athlete has sufficiently performed the stretching/warm-up phase as in addition to having been properly instructed in the correct form and technique for each specific plyometric drill.1234

A) Squat Jump
1) Begin in a squat position with thighs parallel to ground, feet shoulder-width apart and hands behind head. Jump as high as possible landing softly in the squatting position and immediately repeat jump.

B) Standing Jumps
1) Vertical jump (a) Double leg cone jump (i) Begin jump with knees slightly bent, feet shoulder-width apart (ready position). Swing arms back then reach arms up while explosively jumping over a cone/barrier. (b) Single leg cone jump
Consalvo, Cusano, Copperthite, Kosior 2009

(i) Technique same as double leg. 2) Single leg twist jump (a) Begin with knees slightly bent with the body in hip-knee-ankle straight alignment. Jump vertically and turn body and leg 90 degrees while in mid-air landing in starting hip-knee-ankle alignment.

C) Hops
1) Zig-Zag Hop (a) Place 10 cones/barriers approx 2 ft from each other in a staggered pattern. Begin in ready position between the line of cones. Keeping the chest facing the line throughout the exercise jump diagonally over first cone followed by immediately jumping diagonally over 2nd cone and so on. 2) Single leg Hop (a) Can be performed in forward-straight pattern, laterally or diagonally. Begin in single-leg stance with hip-knee-ankle in straight alignment. Using arms for momentum explosively jump forward and immediately repeat the hop. 3) Lateral Barrier Hop (a) Begin in ready position with the barrier to one side. Using arms for momentum jump over the barrier landing with both feet at same time in the ready position. Immediately repeat jump to return to opposite side of barrier.

D) Box Jump
1) Jump to (a) Begin in ready position with knee slightly bent and feet shoulder-width apart. Using arms for momentum, jump up landing softly on box with both feet at same time and completely on surface in a mini-squat position. Step off and repeat. 2) Jump from (a) Begin in ready position. Step off box and land with both feet at same time on floor. 3) Lateral jump (a) Stand to side of box in ready position Using arms for momentum, explosively jump up landing both feet on box. Step off the other side and repeat jump once again.

E) Depth Jumps
1) Double (a) Begin standing on box. Step down landing with both feet followed by an immediate explosive vertical jump using arms for momentum and reaching up. Land with both feet once again in the ready position. 2) Single (a) Performed with the same starting technique as the double leg depth jump. Step from box landing on floor with one foot and immediately jump as high as possible. 3) Depth Jump w/ Lateral Movement (a) Step from box. Land on floor with both feet and immediately sprint in the direction determined by partner.

IV. Agility
A) Ladder Drills
1) Forward a) Quickly step with two feet in each box minimizing foot contact time. 2) Backward a) Quickly step backwards with two feet in each box minimizing foot contact time.
Consalvo, Cusano, Copperthite, Kosior 2009

3) Lateral a) Step laterally through ladder with two feet in each box minimizing foot contact time. Perform while leading with each leg. 4) Diagonal (a) Repeat activity as stated above in a diagonal pattern

B) T-Dill
1) Place 4 markers in T formation a) 3 markers are set five yards apart on a straight line. b) A fourth marker is placed 10 yards from the middle marker to form a 'T' c) Athlete sprints to the middle marker, side steps 5 yards to the left marker then 10 yards right to the right marker. He/she then side steps back to middle marker and back-pedals to starting marker.

C) Whistle Drill
1) 2) 3) 4) 5) At sound of whistle athlete jogs approximately 20 yards 2nd whistle sounds and athlete sprints approximately 30 yards 3rd whistle sounds and athlete jogs 20 yards 4th whistle sounds and athletes sprints the last 30 yards of field Repeat 2-3x

D) Zig-Zag
1) Place 10 cones in two lines each 5 yards apart from the other in a staggered pattern. Sprint to each cone in a zig-zag pattern.

E) Quick Steps
1) Quickly step over line on toes minimizing contact time as fast as possible while moving feet.

Consalvo, Cusano, Copperthite, Kosior 2009

Program Worksheet
Stretching /Warm-up should be performed at the beginning of each workout and prior to plyometric exercise in order to decrease risk of and prevent injury. Stretching /Warm-up phase should be approximately 5-10 minutes in length. ACL Prevention Program performed 3x/ week with at least 1 day rest in between sessions. Perform 4 week program 2x/season successively followed by repeating 4th weeks session 1-2x/ week throughout remainder of season.

STAGE I
Week 1: A. Dynamic Warm-Up
1) Butt Kicks (x 30 yards) 2) Knee Grabs (x 30 yards) 3) 200 yd Shuttle

Elapsed Time 3.5 minutes

30 sec 1 min 2 min

B. Plyometrics
1) Jumping Jacks (30 sec.) 2) Squat Jumps (10 x 2) 3) Double Leg Cone Jump (10 yards x 3) 4) Single Leg Twist Jump (6 x)

5 minutes
30 sec 1 min 1.5 min 2 min

C. Agility
1) Quick Steps (3x30) 2) Forward Ladder (approx 10yds 3x) 3) Lateral Ladder (approx 10yds 3x)

4.5 minutes
1.5min 1.5min 1.5min

D. Strength
1) Single-Leg Squat (10 x 2 each leg) 2) Lunges w/ Rotation (10 yards x 3) 3) Single Leg Bridges (10 x 2 each leg) 4) Lateral / Backward Lunges (15 yards x 2 each way)

6.5 minutes
1.5 min 1.5 min 1.5 min 2 min

Total Session Time 19.5 minutes

Consalvo, Cusano, Copperthite, Kosior 2009

Week 2: A) Dynamic Warm-Up

1) Leg Swings 2) Scorpions (x 20 each leg) 3) mile jog

Elapsed Time 4 minutes

1 min 1 min 2 min

B) Plyometrics
1) 2) 3) 4) 5) Jumping Jacks (30 sec.) Double Leg Vertical Jump (10 x) Single Leg Vertical Jump (10 x 2) Forward Hop (10 yards x 3) Lateral Barrier Hop - 12 (10 yards x 3)

4 minutes
30 sec 30 sec 1 min 1 min 1 min

C) Agility
1) Diagonal Ladder (approx. 10 yards x 3) 2) T-drill x 3

4 minutes
1.5 min 2.5 min

D) Strength
1) 2) 3) 4) Step-Ups/ Bench-Ups 18 inch (10 x 2) Single Leg Superman Single Leg Bridges Lateral Band Walks ( 10 yards x 4)

6 minutes
1 min 1.5 min 1.5 min 2 min

Total Session Time 18 minutes

Consalvo, Cusano, Copperthite, Kosior 2009

STAGE II
Week 3: A) Dynamic Warm-Up
1) Inch Worms (10 x) 2) Frankensteins (20 yards) 3) Mile Jog

Elapsed Time 3.5 minutes

1 min 30 sec 2 min

B) Plyometrics
1) 2) 3) 4) 5) Double Leg Vertical Jump x 10 Single Leg Vertical Jump (10 x 2) Zig-Zag Hop ( 10 yards x 4) Jump to Box/Bench - 18-24 (8 x 2) Jump from Box/Bench - 18-24 (10 x )

8 minutes
30 sec 1.5 min 2 min 2 min 1.5 min

C) Agility
1) Zig Zag Drill x 3 2) Whistle Drill x 3

3.5 minutes
1.5 min 2.5 min

D) Strength
1) 2) 3) 4) Step-Ups/ Bench-Ups - 24 inch (10 x 2) Star Drill w/ leg (20 sec. x 3) Russian Hamstring (10 x 2) Single Leg Bridges (10 x 2 each leg)

5 minutes
1 min 1 min 1.5 min 1.5 min

Total Session Time 20 minutes

Consalvo, Cusano, Copperthite, Kosior 2009

Week 4: A) Dynamic Warm-up

1) Knee Grabs (x 30 yards) 2) Butt Kicks (x 30 yards) 3) Mile Jog

Elapsed Time 5.5 minutes

30 sec 1 min 4 min

B) Plyometrics
1) 2) 3) 4) 5) 6) Double Leg Vertical Jump x 10 Single Leg Vertical Jump (10 x 2) Lateral Jump - 18-24 (10 x each leg) Double Leg Depth Jumps - 18 (10 x 2) Depth Jump w/ Lateral Movement 10 x Single Leg Twist Jump - *eyes closed* ( 6x)

10 minutes
30 sec 1.5 min 1.5 min 2 min 2 min 2.5 min

B) Agility
1) Whistle Drill x 2 2) Backward Ladder x 3

2 minutes
1 min 1 min

C) Strength
1) Star Drill w/ Leg (20 sec. x 3) 2) Russian Hamstring (10 x 3)

2.5 minutes
1 min 1.5 min

Total Session Time 20 minutes

Consalvo, Cusano, Copperthite, Kosior 2009

Cool Down /Alternative Stretching

A) Stretching- Hold each stretch for at least 30sec and repeat 3x 1) Hamstring Stretch
(a) While lying on your back supine with your hands grasping your knee, straighten out your leg pull your knee to your chest. Keep your knee straight and the opposing leg flat on the ground. Repeat on the opposite side.

2) Adductor (Butterfly) Stretch

(a) Keeping your back straight while seated put the bottoms of your feet together and draw them towards you. Push your knees to the ground stretching your adductor muscle group.

3) Quadriceps/ Hip Flexor Stretch

(a) Standing up with your feet shoulder width apart, grasp one ankle and pull your heel to your buttocks while keeping your knee bent. Repeat on opposite side.

4) Calf Stretch
(a) Standing in front of a wall with your legs staggered, lean forward to feel a stretch in your calf. Place your hands on the wall to help stabilize yourself.

5) Piriformis (Pretzel) Stretch

(a) While lying supine on your back, bend your knees up. Cross one leg over the other so that your ankle is resting atop your opposite legs knee. Reach one hand between your knees and the other around the leg that is bent. Pull that knee towards your chest. If done correctly a stretch in the buttocks will be felt. Repeat on opposite side.

Consalvo, Cusano, Copperthite, Kosior 2009

Consalvo, Cusano, Copperthite, Kosior 2009

Consalvo, Cusano, Copperthite, Kosior 2009

Consalvo, Cusano, Copperthite, Kosior 2009

Consalvo, Cusano, Copperthite, Kosior 2009

Consalvo, Cusano, Copperthite, Kosior 2009

Consalvo, Cusano, Copperthite, Kosior 2009

References

1. Lim et. al. Effects of Sports Injury Prevention Training on Biomechanical Risk Factors of Anterior Cruciate Ligament Injury in High School Female Basketball Players. American Journal of Sports Medicine. 2009 2. Padua DA, Marshall SW. Evidence Supporting ACL-Injury-Prevention Exercise Programs: A Review of the Literature. Athletic Therapy Today. March 2006
3.

Pettineo S, Jestes k, Lehr M. Female ACL Injury Prevention with a Functional Integration Exercise Model. Strength and Conditioning Journal. February 2004. Baechle TR, Earle RW. Essential of Strength Training and Conditioning 2nd ed. National Strength and Conditioning Association.2000

4.

Consalvo, Cusano, Copperthite, Kosior 2009