ACL Injury Prevention in the Female Athlete

Vern Gambetta is a gentleman whose work I respect immensely in the world of exercise, coaching and fitness. Although I have not had the pleasure of speaking with Vern one on one, I have attended some of his seminars and followed his writing’s and blog with much interest, and particularly like his ability to “cut to the chase”. Vern does not suffer fools, and anyone who spends time examining his work will soon realize that training and exercise without function or purpose has little place in his coaching.

Recently Vern has posted on a topic for which I have much interest, namely ACL injury prevention in the female athlete.The consequences of ACL injury to a young female athlete cannot be underestimated.

Vern’s most recent post discusses his thoughts and illustrates several excellent exercises which assist hip and knee control. As an addition I would encourage the reader to consider research and activities designed to assist the athlete with hip and knee control in more dynamic landing/cutting activities, which does require  progression in the complexity of the exercise prescription – however only after the athlete has demonstrated appropriate control in the pre-requisite exercises so nicely documented in Vern’s post. Indeed, as all good coaches will agree- advancement or progression is only after the athlete has “earned the right” by displaying competency at less complex exercises. In my experience progression is often prescribed on a recipe approach, where the athlete is advanced to more complex exercises on the basis of time at previous level rather than any degree of assessment of competency.

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Clear Illustration of various lower limb landing postures demonstrating the difference between good (A,B,C) and poor (D,E,F) neuromuscular control of hip and knee during landing.

In my experience it is at this time when athletes are performing activities or exercises beyond their level of competence , where they are “out of control” that injury occurs. Interestingly, it is not just exercise competence (or lack of) that may result in an athlete competing or undertaking activities where control is compromised- I have observed an increase in musculoskeletal (not only knee) injuries in the weeks post an athlete suffering concussion. These observations, and my reading of the literature have reinforced to me the importance of neuromuscular control as an essential element of injury prevention, rather than the oft cited but poorly defined “core stability”.

Given the many competing time demands on coaches and athletes, when does one find time for neuromuscular control exercises aimed at assisting injury prevention? My solution to this difficulty has been to include these activities as part of the sports specific dynamic warm up for training.  This ensures athletes get time to practice landing and cutting maneuvers in an appropriate environment- however the athlete must be aware of correct technique, and offered relevant and appropriate feedback along with instruction on how to achieve appropriate control. In this regard- the foundational exercises illustrated in Vern’s blog go a long way towards providing the athlete with the necessary pre-requisite strength and control to be able to practice and achieve dynamic neuromuscular control.

 

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