What is the role of an ACL prevention program for a young athlete? Can it lower your risk of an ACL tear, and should you do these exercises every day? I address this concept in my latest Ask Dr. Geier column.

Reta in South Africa asks:

Good Morning,

My son has never have any form of injury. Do you think that he needs to go on a proprioception program?

Kind Regards,

I am going to start with my thoughts. I also asked this question of Michael J. Barr, PT, DPT, MSR, a physical therapist in Charleston, South Carolina. He has been active in teaching an ACL injury prevention program to sports teams for years, but Mike is helping to design a lower extremity injury prevention program to try to decrease a number of potential injuries and improve performance.

Injury prevention programs have gained attention in recent years as sports medicine has evolved into a field not only dedicated to treating injuries in athletes but also trying to prevent them. The programs that have gained the most headlines lately have been those aiming to prevent ACL tears. These programs have traditionally focused on preventing these injuries in female athletes, as females have a much higher risk of the injury. It is believed that neuromuscular factors such as quadriceps/hamstring strength and balance as well as tendencies for females to land and turn with their knees fully extended contribute to the increased risk. An ACL prevention program teaches females to land and turn with increased knee flexion and better balance and control, and early data has at least shown a tendency to reduce the rate of the injury.

Recently programs have been designed to try to prevent other lower extremity injuries such as ankle sprains and hip and groin strains. It has been suggested that athletes with a prior history of these injuries, especially ankle sprains, should use these exercise programs to lessen the chance of a new injury.

Mike works with an athlete to learn to balance on the injured knee while doing functional activities with the rest of the body.

I am not an athletic trainer or physical therapist, but it seems to me that while preventing reinjury in athletes is a good use for such programs, they potentially benefit all athletes – male or female, no prior injury or history of multiple injuries. Exercises that can be incorporated into a daily warmup routine and therefore do not increase overall practice time would be best and most likely to be continued. Learning to land and turn with proper mechanics is critical to decrease the chances of any lower extremity injury. If an athlete can learn the proper mechanics ahead of time so that they become second nature, they would seem to be much less likely to use poor mechanics out on the field. Improving proprioception (a joint position sense) and balance and strengthening the muscles that surround a joint hopefully would also decrease the chance that the force from an injury tears the ligaments or tendons around that joint.

Barr agrees and adds, “Proprioception training involves balance and stabilization exercises. It is basically a combination of strengthening through co-contractions surrounding a joint. All athletes would benefit from this type of training to improve their joint stability and increase strength and muscular endurance. The stronger the surrounding musculature of a joint is the more stable the joint will be and will be at less risk for injury.”

Soccer player doing ACL prevention program exercises

An ACL prevention program can never completely eliminate the risk of injury, as sports often involve traumatic events. However, if we can decrease the risks of even one injury, that is potentially a young athlete who might play uninjured for an entire season instead of sitting on the bench watching.

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