Good Training is ACL Prevention Training

I read the following quote from strength coach and Ph.D candidate Bret Contreras yesterday.

Well, most men do too, but numerous studies show that women need increased glute strength to prevent Valgus collapse. Some studies indicate a need for increased glute medius strength, some studies indicate a need for increased glute maximus activation, and some studies show a need for increased hip abductor and adductor coactivation. Furthermore, studies show that women’s H:Q ratio (concentric hamstring to concentric quadricep strength) is lower than that of men at angular velocities that approach speeds seen in sports. Women don’t seem to increase their hamstring contribution as speed increases. Whatever the case, it’s quite obvious that increased single leg stability and posterior chain strength is exactly what’s needed to help “bulletproof” females and prevent them from experiencing knee pain and injury.

Although injuries can never be prevented, intelligent training can greatly reduce their likelihood. When it comes to knee injuries, particularly the ACL, we take a few extra precautions at Ageless with both our female and male athletes that you don’t find in most workout programs. I don’t know if there is a more devastating injury than an ACL tear to a strength/power athlete.

We know that everyone can’t afford personal training, so we try to put as much of our training philosophies/workouts as possible on-line for free.  The following contains our progressions for movement patterns we feel are essential to minimizing knee injuries.

Much like what Bret says above, we focus on a few of the risk factors that we have control of: glute max and medius activation/strengthening, adbductor/adductor coactivation, ankle mobility, hip mobility, proper landing and decel technique, etc.

Prior to each training session, we focus on activating the glute maximus and medius, two muscles that are usually underdeveloped in most athletes.

Activation Exercises

Glute medius exercise progression:

Lying Clams – Lying Clams with band – Lateral Knee Band Walk – Lateral Ankle Band Walk – Lateral Double Band Walk

Glute maximus exercise progressions

Bridge: Cook Hip Lift – 2 Leg Bridge – Single Leg Bridge – Single Leg Valslide Bridge/Curl combo

Quadraped: Incline Heel Lift – Quadraped Single Bent Leg Ext – Quadraped – Quadraped Single Leg Bent Ext with parallel dowel rod – Quadraped Single Leg Bent Ext with vertical dowel rod

We’ll choose 1 exercise from each group (starting with the easiest and progressing every 2 weeks), and we’ll perform anywhere from 5-10 repetitions. With our activation exercises, we really focus on slowing down the movement so the athlete can “feel” the muscle being activated. Each time we switch exercises, we’ll have the athlete hold the contracted position for anywhere from 4-8 seconds so they can get a feel for how the exercise should be performed. These are not meant to fatigue the athlete. Load is not our concern. Technique and feel are!

Landing Technique

In most programs, all they care about is how high of  hurdle or a box an athlete can jump on/over. While that’s important, the landing is actually just as important. If the athlete can’t land correctly, we don’t increase the height of the hurdle or box. On the landing, we’re looking for:

• Soft landing
• Landing on the whole foot, with the balls of the feet landing first and heel slightly behind
• Landing in the power position: you should be able to place a dowel rod on the athlete’s back and it should touch the head, upper back, and butt. An athlete should land  like she should be able to jump maximally again, not too high and not too low.

Mobility

If the athlete doesn’t have enough mobility in the ankle and hip, then the body will find it in the knee. That’s not a good thing. We’ll post a video later with some of our mobility exercises. There are too many to list.

Strength Work

Unlike the traditional bodybuilding approach, we rarely isolate muscles. Sports are based on movement patterns, not muscles. A powerful movement pattern will beat a strong muscle every time. The central nervous system rules sports, not the muscular system.  Thus, we train movement patterns when we strength training. We use at LEAST 1 of the following movement patterns once every 7 days.

Bent Leg Extension: Cook Hip Lift – Bridge – Single Leg Bridge – Single Leg Valslide Bridge/Curl combo – Hip Thrust – Single Leg Hip Thrust

Single Leg Hip Hinge: Dowel Rod single leg deadlift (SLDL) – 1 kettlebell SLDL – 2 kettlebell SLDL – Barbell SLDL – Elevated SLDL

Double Leg Hip Hinge: Trap Bar Deadlift – Sumo Deadlift, Trap Bar Elevated Deadlift – Band Trap Bar Deadlift – Chain Trap Bar Deadlift

Single Leg Squat: Split Squat Iso Holds – Single Leg Split Squat – Rear Foot Elevated Split Squat (dumbbell, kettlebell, or barbell) – Lunge – Single leg squat

Double Leg Squat: Goblet Squat – Front Squat with band around knees – Front Squat – Squat with band around knees – Squat

Lateral/Transverse movement: Transverse step ups – Lateral lunge

If you can incorporate those elements intelligently into your child’s training program, you’ll be much better off than 90% of the training we see at the middle school and high school level.