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Avoiding The Worst Injury Of All | Muscle & Body Magazine

Excercising to avoid a torn ACL

Here’s how to protect your knees from career-ending ACL injuries.

Every year, between 250,000 and 300,000 athletes suffer injuries involving the ACL (anterior cruciate ligament, found in the knee). Sometimes it’s a minor tear, other times it’s more complicated damage. You hear about it all the time in sports. Just last year, 11 NFL players saw their season end early due to this devastating injury. More than 75% of all ACL injuries are noncontact based, meaning factors such as the player’s body composition, playing surface and lower-trunk (body) stability contribute to the cause.

As someone who has made a career out of keeping world-class athletes at the top of their respective games, I can tell you firsthand that there is no greater threat to an athletic career than an ACL tear.

Women Are Especially Vulnerable

The statistics are staggering for those who tear their ACL, and it seems the complications that arise are not as easily solved after surgery. In fact, according to the American College of Sports Medicine, “of 400,000 ACL reconstructions, up to 5% risk re-injury, up to 45% fail to return to their pre-injury sport level, and up to 80–90% develop radiographic evidence of osteoarthritis (as early as seven years postsurgery).” Interestingly enough, in more recent years, the amount of female-related ACL injuries have become an epidemic.

East Jefferson General Hospital orthopedic surgeon and team physician for the AAA baseball team the New Orleans Zephyrs, William Sherman, M.D., believes that female athletes in explosive sports are more likely to sustain ACL tears for the following reason: female athletes typically have a more valgus (outward angulations of the joint) alignment than males when landing and pivoting, resulting in a larger moment of stress through the knee during landing and deceleration.

Explosive sports do seem to confer a higher risk of an ACL injury. These sports include football, soccer, volleyball and any sport that involves jumping, cutting, pivoting and changing direction rapidly, and often unexpectedly.

It’s All About The Hips

Why does the ACL so easily succumb to injury? In short: hip extensors (i.e., butt muscles).

Hip extensors are of the upmost importance when it comes to an athlete’s ability to decelerate the center of one’s mass during a landing—meaning, an athlete will benefit with more bend in the knee than absorbing force straight-legged. Since it has been suggested that women have less strength in the hip extensors than men, they’re more likely to overuse their knee extensors, thus resulting in a tendency to exhibit “excessive quadriceps force, increasing anterior shear loads at the knee joint and subsequent strain on the ACL.”

While female athletes may be more vulnerable to injury to the ACL, men should take into consideration that they, too, could experience the same setbacks if they don’t properly strengthen their lower trunk.

According to research published by the National Strength and Conditioning Association, plyometric training, including jumping drills like wall and tuck jumps, can greatly benefit an athlete’s knees, as these drills will prepare the joint to handle the force of a landing or deceleration movement. The findings prove that plyometrics can “modify inadequate muscle activation, decrease valgus movements and knee rotations, and increase hamstring strength.”

Without proper conditioning, an athlete places him/herself at greater risk of ACL-deficient knees. This long-term instability can lead to early meniscal (cartilage shock absorbers in the knee) degeneration, which, in turn, predisposes an athlete to early arthritis.

This leaves no doubt that this type of training is crucial for any athlete.

Training Your Trunk

How do you properly train your lower trunk to avoid such complications? Research suggests that in conjunction with plyometric training, neuromuscular (incorporating both nerves and muscles) training should be implemented during your workout. This training focuses on increasing an athlete’s strength and balance as well as core stability to alleviate the stress on the joint (knee) when enduring blunt force. It has been suggested that “such training can increase knee flexion and decrease maximum knee valgus.”

The following are routines I use with my clients [to] specifically target the lower trunk, as well as overall core stability.

Standing Hip Extension

Keep the band around your upper thigh, while pulling the resistance toward your body. Perform 3 sets of 15–20 repetitions.


Place the band above the knee. Laying on your back with your heels together, move your knees apart to cause external rotation of the hips. Perform 3 sets of 15–20 reps. This exercise is ideal for strengthening the gluteal muscles (butt muscles). Strong glutes leads to less chance of ACL injury.

Recently at the 2013 U.S. Lacrosse Sports Medicine Symposium, Richard Hinton, M.D., urged coaches and athletes to take ACL injury more seriously, stating, “The knee has very complex biomechanics and there are any number of places where the knee joint can fail when it is overstressed.” He encourages athletes to not only evaluate themselves, but also their environment (artificial playing surfaces versus natural grass fields) and the associated risks that come from them. Landing “softly” can reduce the brute force to the knee joint, and Hinton believes that teaching this method should be unyielding during practices.

Perfect Your Form

In my opinion, the key to preventing injury is to be aware of the mechanics that cause injury. Through research, it has been determined that it can take upward of five years after surgery to fully provide insight into an athlete’s long-term recovery process. A little more attention to correct form can make all the difference, as poor form can lead to a future of pain and discomfort, and if severe enough, can often result in some form of mental and physical debilitation.

Be cautious of your environment, know your limits and body composition, strengthen your lower trunk, and always seek medical attention if in pain. Don’t ever push through the pain. Whoever said, “no pain, no gain,” never tore an ACL (otherwise he/she would have reevaluated that sentiment).