4th Annual Marino Lecture
and Symposium
ACL/ Injury Prevention Program
Phases
Sports and Physical Therapy
Associates
Cincinnati Sports Medicine
1999 Using a combination of Jump
Training/ Plyometrics
Strength Training and Flexibility
6 week preseason program Reduced
ACL injuries in the Trained Women vs.
Untrained women
Hewett 1999 AJSM
PEP Program
USC, Santa Monica California,
from 2000 to 2002 completed 3
studies
Highly specific Training session
Used to replace the
conventional warm up
Dramatic reduction in ACL
injuries from 72% to 88%
compared to the control groups
Mandelbaum AMJS 2005
Training To Reduce ACL
Injuries
Cincinnati Children’ Hospital
Timothy Hewett, Ph.D.
Jump Training
[Link]/sportsmed
Pep Program
Dr. Bert Mandelbaum, MD
[Link]
ACL/General Injury
Prevention Program Phases
Dynamic Warm-
up/Cool down
Plyometrics/ Neuro
Muscular Re-ed
Proprioception/
Balance
Strengthening Lower
Extremities/Core
Flexibility
Agility PEP/Cincinnati Sports Medicine
Dynamic Warm up
Prepares the Body for the
demands of the work out or
practice
Increases heart and respiratory
rate and blood flow to muscles
Increases core body
Temperature
Enhances Muscles elasticity
Athlete Should break a sweat
w/o excessive fatigue
Usually 10-20 minutes
NSCA
Dynamic Warm Up
Progress from low to high
intensity
Include all planes of motion, Multi
directional and Diagonal Patterns
Warm up should include exercises
for both upper and lower
extremities
Warning: May induce fatigue in
deconditioned athlete
NSCA
Dynamic Warm Up
Many Of the Components of The Injury
Prevention Program can be worked on
during this phase
[Link]: Mike Huff and Verne
Gambetta have taken Low intensity
agilities, Plyos and dynamic stretches
to act as warm up
Cool Down
Following Sport or Activity
Cool down consists of moving in same
movement patterns as warm up with
decreasing Intensity
Static Stretching Optimal Time
Rehydrate/ Refuel Carbs
Relax
Ian Jeffreys MS CSCS
NSCA
Plyometrics/Strength
Progressive Leaping and
bounding exercises
This gives Muscle pre stretch
which enhances muscle
contraction Allerheigen 1994
Jump Training/ Neuro
Muscular Control
Develop stability during the
movement patterns that seems to
put knee in most vulnerable
landing or cutting positions
Valgus landing with rotation
Co contraction of Muscles to
Stabilize Joint
Mandelbaum 2000
ACL Injury
Prior to starting Plyos
Instruct Athlete on the
stability/power position
Knees bent 25-30 degrees
Hip and Knee in Neutral
alignment
Control valgus
Greatest level of Ham to
quad co contraction
NSCA
Reps and Sets
Foot Contacts per workout:
Level Low intensity Med Intensity High Intensity
Beginner 40 60 80
Intermediate 60 80 100
Advanced 100 120 140
McNeely NSCA 2008
Criteria for Advancing
Once Athlete has
mastered each jump
for at least 2
consecutive practice
sessions , this means
good form and DOMS
has subsided you may
progress to greater
level of difficulty.
If athlete is in middle
of high volume
jumping season,
basketball, volley ball
etc. watch for signs of
overtraining NSCA
Plyometrics/Jump
Training
Higgins/Duke
Proprioception
The ability to maintain
stability and orientation
during static and dynamic
activities.
Mechano Receptors are
neuro sensory cells that
are responsible for
monitoring joint position
and movement.
6 exteroceptive senses
1 interoceptive sense
Kinetics
Proprioception
A proprioception
program should
stimulate these
mechano receptors.
The ability to know
where you are in
space
NSCA
Strengthening
Strengthening
To increase a muscles
tolerance to physical
stress. This in turn
will increase its
cross sectional area.
Progressive Resistive
means move up!!!
NSCA
Isolation Exercises
Isolates Muscle groups to address
Imbalance
post injury or surgery
+Less chance of injury during training
- Costly
- Doesn’t strengthen stabilizing
muscles
NATA
Multi Muscle Group
Training
Sports Specific
Training
– Training muscle
groups to work
together in concert.
Training the body to
work per the
required needs to
the specific
demands of a sport.
NATA
Multi Muscle Group
Examples
Field exercises
Squats
Diagonal Patterns
NATA
Open Chain Exercises
Open Chain : Foot is
free to move
– SLR, SAQ, LAQ
– Leg Extension machines
– Leg Curl machines
Hamstring /Quad Ratio
+great for isolating muscle
groups
Closed Chain Exercises
Closed chain: Foot is Fixed
– Wall slides, squats, lunges
– Leg Press Machine
– Hack Squat Machine
+ co-contraction of leg and hip muscles
- don’t isolate muscles as well
Which is Better??
Open Chain vs. Closed Chain
Studies show long term no
greater results in strengthening
and no greater result in injury.
PFS or ACL
– Use them appropriately
Erik Witrvrouw, AJSM 2004
Hooper & Morrisey AJSM 2001
Repetitions How Many?
Science of Repetitions
– Physiologically higher
repetitions give the joints and
tendons better blood flow
– Used better for post-season or
rehabilitating an injury 15-20
reps
– Lower reps better for
strength/power, used better
during power cycles and pre-
season
Grimsby
Frequency of Training?
How often to train the
same
movements/muscles?
– It depends on similar
variables
In-season, pre-season,
off-season, age and
sport of the athlete
– Typically the same
muscle group no more
than 2 x/week
NSCA
Periodization
The science of cycling
reps and intensities
during different
parts of the
training cycle.
NSCA
Flexibility:Improving a
Joints Range of Motion
Types of Stretching
– Active- Hold 2-3 sec
repeat 20 times
– Static – hold 30
seconds repeat 2
times
– Dynamic -Active
Movements through
exaggerated ranges NSCA
ACL Injuries/
Patellofemoral Pain
The age group that
ACL injuries occur 13-
17:
Also age group
marked decrease in
flexibility which can
lead to Patellar
Tendinitis and or PFS
Witvrouw AJSM 2001
Stretches to decrease
Patella Tendinitis Witvrouw AJSM 2001
Stretches
– Rectus/Quadriceps
- Hamstring
Time to stretch?
Optimal time to stretch
– After warm-up
– At end of Cool
Down
Ian Jeffreys, MS CSCS
NSCA
Agilities
Most Sports are in
themselves agility
movements
However practicing
cutting movements that
tend to cause stress to
the athlete’s knee can
create improved
coordination and
strength through sports
specific movements NSCA
Pick Agilities to Fit Sport
Agility Patterns that
mimic sports
movements
– Grapevines
Side to side
– Run ,plant and cut
NSCA
ACL Prevention Today
Although the Pep program and
Cincinnati prevention
programs reduced ACL
injuries significantly.
Both groups readily admit it is
unclear which aspect of their
programs were responsible
for the reduction in injuries
USC/Cincinnati Sports Medicine
ACL Project Prevent
USC ACL Project
Prevent
A 3 year Study
Funded By the NIH
Identify Gender
Specific Movement
Patterns
That may predispose
Female Athletes to
ACL Injuries
As Athletic Trainers and
Physical Therapists
Utilize evidence based
Medicine as the backbone of
your rehab!
Develop a program that
works for your coaches,
teams and patients !
Achieve participation with
resources and time available !
One Size doesn’t Fit All
FIELD DRILL FOR Injury
PREVENTION
Run Back Peddle Run Back Peddle
Plyometrics,
Cut
Squats, Side
and
to Side, etc.
Run
30 yards x 30 yards
Raise level
of difficulty
as season
progresses
Side to Side, Carioca, etc
If Budget is really Bad
1 piece of Chalk
1 pebble
4 single Leg Jumps
2 Double leg Jumps
1 180 Degree Jump
1 Single Leg Squat
Make the Squares
Bigger
Start Again