With high school sports participation growing in numbers, football and soccer especially, athletes are working harder and becoming more fit with an increased demand form coaches and parents. On occasion, these athletes fall victim to a knee injury that could sideline them for the rest of their season and even up to a year if it involves an anterior cruciate ligament (ACL) injury. However, with the recent article in the September issue of the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) they have outlines an exercise prevention program for young athletes.
Researchers screened 3526 articles and came up with the top 33 studies to come up with a clinical practice guideline (CPG) for all physical therapists to follow. These authors focused on determining whether these programs were effective in preventing injuries, which type of exercises were common across effective prevention programs, and key parameters of exercise intensity and duration required to prevent knee and ACL injuries.
I love it that our national organization, the American Physical Therapy Association (APTA) has these sub-sections like the Orthopaedic and Sports sections that will compile all the latest evidence-based research and put it together for all of us to see the overall summary of a particular type of patient problem. Let me share with you what this recently published CPG is recommending to all young athletes to do for at least 20 – 30 minutes before every workout and game.
To obtain the best results, clinicians, coaches, parents and athletes should all help ensure that the knee prevention programs should start in pre-season and continue throughout the entire season. These programs are designed for the high school and college athletes (ages 12 – 25) and especially female athletes younger than 18 years old. Programs effective in preventing injuries include a combination of dynamic stretches (flexibility), running drills, strength training, core strength, and plyometrics.
Dynamic stretches (flexibility)
These flexibility exercises need to focus on the quadriceps, hamstrings, hip adductors, hip flexors, and calf muscles. To make it dynamic the athlete can perform the stretches in a flowing motion from one stretch to the next. Kicking the leg back and forth or going into a series of lunges moving from one foot forward to the next in a fast-paced manner is one example. The side lunges to the right and the left in quick succession will stretch the adductors dynamically and all of these will stretch the calf muscles.
Running drills
Forwards and backwards running, zig-zag running, and bounding are recommended. The zig-zag running drills should be sport specific to prepare him/her for their sport. Bounding is a precursor to plyometric training exercises. It specifically related to a progression of running drills. Bounding can be like skipping, alternating high knee running, single leg hopping / bounding and reciprocal hoping like a triple jumper in track.
Strength training
Double and single leg squats, lunges, Nordic hamstring exercises are the best for lower extremity strengthening. An athlete should be able to do many double leg squats before attempting to do single leg squats. The knees should be aligned properly so when the athlete squats the knee is tracking over the foot. Performing 3-4 sets of 15 repetitions is a good warm up. Single leg squats and progressive lunges need perfect form in order to prevent injuries. I have seen many pre-competition warm up exercises done poorly and actually contributing to the athletes’ chronic knee pain and injury they are trying to avoid. This last exercise, the Nordic hamstring exercise has been instrumental in keeping the injury rate and re-injury rate decreasing in the highly competitive collegiate and professional soccer and baseball player arenas. This exercise forces the hamstrings to work in an eccentric (heel moving away from the buttocks) and a concentric (heel moving towards the buttocks) manner for optimal hamstring function.
Nordic Hamstring exercise.
Athlete is kneeling on a soft pad, a partner is kneeling behind the athlete and holding the ankles down to the floor. The athlete with crossed arms slowly lowers his/her body to the floor. Once the athlete can’t hold it any longer he/she drops to the ground catching themselves on their hands and quickly presses up to the starting position.
Core strength
Planks and bridges are great exercises in maintaining trunk strength. Having the ability to hold a forward plank (on elbows and toes with a flat back) and a side plank (on elbow and side of foot with both feet stacked on top of each other) for 60 seconds is great strength for an athlete. Bridges can be in the form of keeping the hips level while raising the buttocks off the ground in a double or single leg raise. There are many variations to this exercise and close attention to good posture while performing the exercise is of the utmost importance.
Plyometric exercises
Single leg hopping forwards and backwards, ice skaters, and sports specific drills are plyometric exercises. These ballistic exercises are the last exercises to be performed. The ice skater exercise is a series of hopping from side to side onto the leg and squatting down deep to explode onto the next side. Performed correctly you look like a bounding speed skater.
The way an athlete warms-up has changed drastically over the years and thanks to research we are better informed on how to warm-up. This information has led to a decrease in knee injuries in young athletes. If you have a question about your training program and/or your pre-sport warm-up see your physical therapist for an assessment.