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Athletes who have already torn their ACL are 10x as likely to re-tear their ACL than someone with no prior injury. Individuals who have torn their ACL are also at higher risk of tearing their ACL on the contralateral leg as well. Your health is our priority and although we can reconstruct an ACL it is better to never tear it at all.
The PEP Program: Prevent injury and Enhance Performance
This prevention program consists of a warm-up, stretching, strengthening, plyometric, and sport specific agility section to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint. It is important to use proper technique during all of the exercises. Coaches and trainers need to emphasize correct posture, straight up and down jumps without excessive side-to-side movement, and reinforce soft landings. This program should be completed 3 times a week. The field should be set up 10 minutes prior to the warm-up. This will allow for a smooth transition between the activities. This program should take approximately 15 – 20 minutes to complete. Alongside each exercise you will notice the approximate amount of time that should be spent on each activity. This will serve as a guideline to you in order to conduct your warm-up in a time efficient manner.
Warming up and cooling down are a crucial part of a training program. The purpose of the warm- up section is to allow the athlete to prepare for activity. By warming up your muscles first, you greatly reduce the risk of injury.
- Jog line to line (cone to cone)
- Elapsed Time: 0 – .5 minute
- Purpose: Allows the athletes to slowly prepare themselves for the training session while minimizing the risk for injury. Educate athletes on good running technique; keep the hip/knee/ankle in straight alignment without the knee caving in or the feet whipping out to the side.
- Instruction: Complete a slow jog from near to far sideline
- Shuttle Run (side to side)
- Elapsed Time: .5 to 1 minute
- Purpose: engage hip muscles (inner and outer thigh). This exercise will promote increased speed. Discourage inward caving of the knee joint.
- Instruction: Start in an athletic stance with a slight bend at the knee. Leading with the right foot, sidestep pushing off with the left foot (back leg). When you drive off with the back leg, be sure the hip/knee/ankle are in a straight line. Switch sides at half field.
- Backward Running
- Elapsed Time: 1 – 1.5 minutes
- Purpose: continued warm- up; engage hip extensors/hamstrings. Make sure the athlete lands on her toes. Be sure to watch for locking of the knee joint. As the athlete brings her foot back, make sure she maintains a slight bend to the knee.
- Instruction: Run backwards from sideline to sideline. Land on your toes without snapping the knee back. Stay on your toes and keep the knees slightly bent at all times.
It is important to incorporate a short warm-up prior to stretching. Never stretch a “cold muscle”. By doing the exercises outlined here, you can improve and maintain your range of motion, reduce stiffness in your joints, reduce post-exercise soreness, reduce the risk of injury and improve your overall mobility and performance.
- Do a large muscle warm- up such as brisk walking for five to 10 minutes before stretching.
- Don’t bounce or jerk when you stretch. Gently stretch to a point of tension and hold.
- Hold the stretch for 30 seconds. Concentrate on lengthening the muscles while stretching.
- Breathe normally. Don’t hold your breath.
- Calf stretch (30 seconds x 2 reps)
- Elapsed Time: 1.5 to 2.5 minutes
- Purpose: Stretch the calf muscle of the lower leg.
- Instruction: Stand leading with your right leg. Bend forward at the waist and place your hands on the ground (V formation). Keep your right knee slightly bent and your left leg straight. Make sure your left foot is flat on the ground. Do not bounce during the stretch. Hold for 30 seconds. Switch sides and repeat.
- Quadricep stretch (30 seconds x 2 reps)
- Elapsed Time: 2.5 to 3.5 minutes
- Purpose: Stretch the quadricep muscle of the front of the thigh.
- Instruction: Place your left hand on your partner’s left shoulder. Reach back with your right hand and grab the front of your right ankle. Bring your heel to buttock. Make sure your knee is pointed down toward the ground. Keep your right leg close to your left. Don’t allow knee to wing out to the side and do not bend at the waist. Hold for 30 seconds and switch sides.
- Figure Four Hamstring stretch (30 sec x 2 reps)
- Elapsed Time: 3.5 – 4.5 min
- Purpose: Stretch the hamstring muscles of the back of the thigh.
- Instruction: Sit on the ground with your right leg extended out in front of you. Bend your left knee and rest the bottom of your foot on your right inner thigh. With a straight back, try to bring your chest toward your knee. Do not round your back. If you can, reach down toward your toes and pull them up toward your head. Do not bounce. Hold for 30 seconds and repeat with the other leg.
- Inner Thigh Stretch (20 sec x 3 reps)
- Elapsed Time: 4.5 – 5.5 min
- Purpose: Elongate the muscles of the inner thigh (adductor group).
- Instruction: Remain seated on the ground. Spread your legs evenly apart. Slowly lower your torso to the floor with a straight back. You want to feel a stretch in the inner thigh. Now reach toward the right with the right arm. Bring your left arm overhead and stretch over to the right. Hold the stretch and repeat on the opposite side.
- Hip Flexor Stretch (30 sec x 2 reps)
- Elapsed Time: 5.5- 6.5 min
- Purpose: Elongate the hip flexors of the front of the thigh.
- Instruction: Lunge forward leading with your right leg. Drop your left knee down to the ground. Placing your hands on top of your right thigh, lean forward with your hips. The hips should be square with your shoulders. If possible, maintain your balance and reach back for the left ankle and pull your heel to your buttocks. Hold for 30 seconds and repeat on the other side.
This portion of the program focuses on increasing leg strength to stabilize the knee joint. Technique is everything; close attention must be paid to the performance of these exercises in order to avoid injury.
- Walking Lunges (3 sets x 10 reps)
- Elapsed Time: 6.5 – 7.5 min
- Purpose: Strengthen the quadriceps muscle.
- Instruction: Lunge forward leading with your right leg. Push off with your right leg and lunge forward with your left leg. Drop the back knee straight down. Make sure that you keep your front knee over your ankle. Control the motion and try to avoid your front knee from caving inward. If you can’t see your toes on your leading leg, you are doing the exercise incorrectly.
- Russian Hamstring (3 sets x 10 reps)
- Elapsed Time: 7.5 –8.5 min
- Purpose: Strengthen the hamstrings muscle.
- Instruction: Kneel on the ground with hands at your side. Have a partner hold firmly at your ankles. With a straight back, lean forward leading with your hips. Your knee, hip and shoulder should be in a straight line as you lean toward the ground and slowly lift back up. Do not bend at the waist. You should feel the hamstrings in the back of your thigh working. Repeat the exercise for 3 sets of 10, or a total of 30 reps.
- Single Toe Raises (30 reps x 2 reps)
- Elapsed Time: 8.5 – 9.5 min
- Purpose: Strengthens the calf muscle and increases balance.
- Instruction: Stand up with your arms at your side. Bend the left knee up and maintain your balance. Slowly rise up on your right toes with good balance. You may hold your arms out ahead of you in order to help. Slowly repeat 30 times and switch to the other side. As you get stronger, you may need to add additional repetitions to this exercise to continue the strengthening effect.
These exercises are explosive and help to build, power, strength and speed. The most important element when considering performance technique is the landing. It must be soft! When you land from a jump, you want to softly accept your weight on the balls of your feet slowly rolling back to the heel with a bent knee and a straight hip. These exercises are basic, however, it is critical to perform them correctly. Please take the time to ensure safe and correct completion of these exercises.
- Lateral Hops Over Cone (20 reps)
- Elapsed Time: 9.5 – 10min
- Purpose: Increase power/strength emphasizing neuromuscular control.
- Instruction: Stand with a 6” cone to your left. Hop to the left over the cone softly landing on the balls of your feet while bending at the knee. Repeat this exercise hopping to the right.
- Forward/Backward Hops Over Cone (20 reps)
- Elapsed Time: 10 – 10.5 min
- Purpose: Increase power/strength emphasizing neuromuscular control.
- Instruction: Hop forward over the cone/ball softly landing on the balls of your feet and bending at the knee. Now, hop backwards over using the same landing technique. Be careful not to snap your knee back to straighten it. You want to maintain a slight bend at the knee. Repeat for 20 reps.
- Single Leg Hops Over Cone (20 reps)
- Elapsed Time: 10.5 – 11 min
- Purpose: Increase power/strength emphasizing neuromuscular control.
- Instruction: Hop over the cone/ball on the right leg landing on the ball of your foot while bending at the knee. Now, hop backwards over the ball using the same landing technique. Be careful not to snap your knee back to straighten it. You want to maintain a slight bend to the knee. Repeat for 20 reps. Now, stand on the left leg and repeat the exercise. Increase the number of repetitions as needed.
- Vertical Jumps (20 reps)
- Elapsed Time: 11 – 11.5 min
- Purpose: Increase height of vertical jump.
- Instruction: Stand with hands at your side. Slightly bend the knees and push off jumping straight up. Remember the proper landing technique; accept the weight on the ball of your foot with a slight bend to the knee. Repeat 20 times and switch sides.
- Scissors Jump (20 reps)
- Elapsed Time: 11.5 – 12 min
- Purpose: Increase power and strength of vertical jump.
- Instruction: Lunge forward leading with your right leg. Keep your knee over your ankle. Now, push off with your right foot and propel your left leg forward into a lunge position. Be sure your knee does not cave in or out. It should be stable and directly over the ankle. Remember the proper landing technique; accept the weight on the ball of your foot with a slight bend to the knee. Repeat 20 times.
- Shuttle Run with Forward/Backward Running
- Elapsed Time: 12 – 13 min
- Purpose: Increase dynamic stability of the ankle/knee/hip complex.
- Instruction: Starting at the first cone, sprint forward to the second cone, run backward to the third cone, sprint forward to the fourth cone (etc…).
- Diagonal Runs (3 passes)
- Elapsed Time: 13 – 14 min
- Purpose: To encourage proper technique/stabilization of the outside planted foot.
- Instruction: Face forward and run to the first cone on the left. Pivot off the left foot and run to the second cone. Now pivot off the right leg and continue onto the third
cone. Make sure that the outside leg does not cave in. Keep a slight bend to the knee and make sure the knee stays over the ankle joint.
- Bounding Run (44 yds)
- Elapsed Time: 14 – 15 min
- Purpose: To increase hip flexion strength/increase power/speed.
- Instruction: Starting on the near sideline, run to the far side with knees up toward chest. Bring your knees up high. Land on the ball of your foot with a slight bend at the knee and a straight hip. Increase the distance as this exercise gets easier.
Alternative Exercises – Warm Down and Cool Down
We all know how imperative a cool down is. Please don’t skip it. It allows the muscles that have been working hard throughout the training session to elongate and deters the onset of muscle soreness. Please emphasize the importance of adequate fluid intake (optimally water). Athletes should have a water bottle by their side during the cool down.
The cool down should take approximately 10 minutes. It should begin with a slow jog to allow the heart rate to come down before stretching. This should be followed by some light strength training exercises. Finally, stretch the hamstrings, calves, inner thigh, quadriceps, and low back (all of these are explained in the protocol).
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