Alan Stein on Reducing ACL Issues

What You Knee’d To Know

This article was written by Basketball Strength and Conditioning Coach Alan Stein and published on his Stronger Team Blog

Although statistically female athletes are 5-8 times more likely to suffer and ACL injury, as we’ve seen from the likes of NBA superstars Derrick Rose, Ricky Rubio and Rajon Rondo, these injuries unfortunately can and will happen to even the most elite male athletes on the planet.

To help raise awareness of ways to ‘bullet proof’ the knees and reduce the occurrence of ACL issues, I have declared this entire month #ACLAugust (follow me on Twitter and/or search this hash tag). I will post a 4-part video series this month on the Stronger Team YouTube channel that features exercises taught in ACL Injury Reduction 101.

Quick Facts:

• Nearly 70% of all ACL injuries are non-contact and are the result of an improper landing or from a quick change of direction.
• The ACL is located inside the knee and stabilizes the joint by preventing the shinbone (tibia) from sliding forward beneath the thighbone (femur). A hard twist or excessive pressure on the ACL can tear it
• The cause of most ACL tears is a sudden, abrupt change in force to the knee. This can occur during a quick change of direction or when landing from a jump.
• Female athletes are at a higher risk because of a wider pelvis and larger “Q” angle, greater incidence of knee valgus and foot pronation. NOTE: these are structural and genetic issues and can’t be addressed through training.
• Additional factors that contribute to ACL injuries include a smaller hamstring to quadriceps strength ratio, poor recruitment of the hamstrings during landing, inappropriate jumping/landing mechanics and weak hip abductors.
• Every basketball player on the planet over the age of 10 should participate in an ACL injury reduction program. Notice the word reduction. It isn’t possible to prevent ACL injuries (or any injury for that matter). But proper, consistent training can absolutely reduce the occurrence.

Here are 4 key pillars to a sound ACL injury reduction program:

1. Improve ankle and hip mobility. The knee joint is designed to be stable. The ankle and hip joints were designed to be mobile. Allowing both the ankle and hip joints to go through a full range of motion during movement reduces stress on the knee. If the ankle (in particular), has a limited range of motion when landing from a jump, because it is either immobile or locked in a rigid ankle brace, the vast majority of the impact is redirected and absorbed by the knee. Barefoot exercises can be an excellent tool in strengthening the feet and improving the mobility in the ankles.
2. Increase strength in the posterior side of the lower body (hamstrings & glutes). Running and jumping are fairly quad (thighs) dominant, so it is vital to target both the hamstrings and glutes (butt) when strength training. Both the hamstrings and glutes play a major role in protecting the ACL when landing from a jump and when planting and cutting. Some tips when strength training include using iso-lateral exercises when possible (one leg at a time), controlling the eccentric (negative, lowering) part of the exercise and always maintaining proper body alignment and form.
3. Use proper footwork when decelerating, planting and cutting. Basketball is not a speed game. It is a starting & stopping game, a reaction game and a change of direction game. Incorporating acceleration and deceleration drills into the yearly training program is essential in preparing the body for the rigors of the game. A ‘T-Step’ or ‘Hockey Stop’ is an ideal way to safely and efficiently “put on the brakes” to plant and cut. Prior to planting and cutting, you want to quickly turn your hips and plant your outside foot perpendicular (90 degrees) to the direction you were going. For example, if running a sprint from the baseline to mid-court and back to the baseline, you would want to plant with your foot parallel to the mid-court line (thus perpendicular to the direction you will be running). This foot position will provide a strong braking mechanism for the knee as well as be the best position for a strong transition into the desired direction. It is important to keep your center of gravity low during each transition and in training, make sure you get an equal number of reps for each foot.
4. Use sound landing mechanics. It is very rare a player injures their knee when jumping. It’s the landing that causes the problems! Players need to learn to land with their weight distributed along the power pads of their feet. They should not land on their toes or on their heels. They should allow the impact to be absorbed in their ankles, knees and hips (let it dissipate over 3 joints). An easy way to teach this is to practice landing barefoot on a soft surface. Use a verbal cue of a quiet landing or a soft landing. The key is conditioning a player to subconsciously land softly, quietly and on balance every time. Players should avoid a knocked knee’d position in both jumping and landing.

I am a huge advocate of going through a comprehensive, movement-based warm-up before all workouts, practices and games. I strongly encourage you to incorporate these 4 pillars in to each and every warm-up. That way you are working on ACL injury reduction techniques every day!

Alan Stein
http://www.About.me/AlanStein