ACL – How We Can Help Prevent Injury!

Published: 23 Feb 2018

ACL – How We Can Help Prevent Injury!

The dreaded ACL injury! It’s notorious for its debilitating impact on knee stability and the long stint of rehabilitation required for return back to activity and sports. Knowing how to help prevent an ACL injury at the beginning of any sport season is a great start.

What is the ACL?

The knee joint comprises of 3 bones:

  • the thigh bone (femur)
  • the shin bone (tibia)
  • the knee cap (patella)

The femur and tibia are held together by a number of muscles and ligaments, including the anterior cruciate ligament (ACL). The ACL acts to prevent the shin moving forward in relation to the thigh, as well as prevent rotational movement through the knee. The majority of ACLs are ruptured in a non-contact situations such as poor technique in landing from a jump, or pivoting or deceleration.

ACLYou can read more about the ACL and its function in our previous blog post, ACL – What is that?

Did you know…

Poor landing techniques and body alignment are some main risk factors for ACL tears. Other predisposing factors include:

  • Increased knee valgus (“knock-knees”).
  • Shallow intercondylar notch (a deep notch in the middle of the knee end of your femur).
  • Knee laxity (meaning loose ligaments).
  • Greater risk in females (thought due to increased width of pelvis which affects knee alignment, greater joint flexibility, less strength of surrounding muscles than males and a possible hormonal link).

Injury Prevention Programs

Having good proprioception (the sense of knowing where your body parts are) and dynamic balance ability throughout the lower limbs can greatly reduce your risk of ACL injury. Good news is that some programs now exist to improve not only strength, but good balance, proprioception, good alignment and proper technique. Neuromuscular training programs that work on increasing these components have been shown to reduce the risk of ACL injuries by up to 65%. These benefit have not only been seen in adults, but also in kids too, when ACL ruptures can have serious consequences.

FIFA 11+

This is a fantastic ACL focussed injury prevention program designed to be performed by players as a warm-up prior to training and competitive games. The program was designed specifically for soccer players, however it is applicable to most sports requiring pivoting actions, including netball, basketball, footy etc. Studies on the FIFA 11+ program have shown significantly reduced injury rates of around 45% and decreased time lost to injury by 30% in competitive soccer players. It can also be very useful for patients trying to avoid a re-injury to a successful ACL reconstruction after graft healing has occurred (around 6-9 months) and the player is working towards a return to training and play.

Details of the program:

  • The program takes around 20 minutes to perform and research has shown that performing the program at least twice a week reduces injury rates amongst soccer players
  • It consists of 15 exercises which incorporate running, plyometric exercises, strength and balance exercises, all with a big focus on technique/proper alignment
  • It requires no special equipment, and can be implemented by coaches, physiotherapists, or by the player themselves
  • The FIFA 11+ manual has specific instructions and pictured examples of each exercise
  • Here is a download link here for the complete program
  • The FIFA 11+ poster is a great quick guide to the program and can easily be stored in coaches bags, displayed at training grounds and clubhouses

FIFA 11+ program

K.N.E.E Program

The Knee injury prevention for Netballers to Enhance performance and Extend play program (or the K.N.E.E program) was launched in 2015 after years of careful development by the head Physiotherapist for the Australian Diamonds in collaboration with Netball Australia and the Australian Institute of Sport.

The K.N.E.E program is an evidence-based neuromuscular warm-up program

The K.N.E.E program is an evidence-based neuromuscular warm-up program that aims to optimise movement patterns, build strength, increase players performance, and most importantly prevent injury. If followed properly, it may reduce the risk of ACL injuries by up to 70% and reduce other lower limb injuries such as ankle and hip injuries too.

The program consists of simple exercises focused around good technique of key netball movements involving take off, landing, deceleration and change of direction. It is grouped into four categories; warm-up and footwork, strength, balance/landing and agility.

The program caters for three specific groups with exercises relevant to each age and skill level. Detailed manuals and quick guides are available for downloading. Check out your relevant team’s category here:

·       Junior: 10-14 year olds

·       Recreational: 14 years and older

·       Elite: Talent, Elite and Mastery categories of Netball Australia’s Athlete Pathways 

The K.N.E.E online platform provides easy access to videos of all the exercises with simple directions and a heavy emphasis on instructions for coaches regarding correct technique and execution of each exercise. These videos are also mobile device compatible which is a great resource as it allows all coaches to have easy access during training and game warm-ups. Check it out before next season starts and help reduce the risk of an ACL injury for you, your team and your whole club!

caringbah physio





Maddy Parker is a (wonderful) Physiotherapist who works in our Caringbah team.

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