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Exercise Program Reduces ACL Injuries in Female Athletes

We are one step closer to solving the problem of anterior cruciate ligament injuries among female athletes. Improving neuromuscular control with a specific exercise program three times per week may be the answer.

In this study, women's college soccer teams were divided into exercise versus control groups. The control group did their own warm-up routines, practiced, and played as usual without any special exercise intervention.

The exercise group did a special warm-up program before practice three times each week. Stretching, strengthening, agility drills, and plyometrics were included. The exercise group was also shown how to avoid positions that put the knee at risk for ACL injury.

Plyometrics is a training program that loads and contracts the muscles maximally and quickly. The muscle generates as strong a contraction as possible in the shortest amount of time. Fast, powerful movements improve the speed of the nervous system function and enhance sports performance.

This particular exercise program was first developed by the Santa Monica Orthopedic and Sports Medicine Research Foundation. They called it the Prevent Injury and Enhance Performance (PEP) Program. The program consists of 19 parts that can be done by the whole team in less than 30 minutes. It was studied and found to be successful in the late 1990s. This study is a continuation of the work that was done at that time.

National Collegiate Athletic Association (NCAA) Division I soccer teams from around the country were included. There were 61 teams with over 1400 athletes involved. The goal was to see if this alternative warm-up program could reduce the number of ACL injuries. The specific focus was on noncontact injuries among female athletes.

The exercise groups used the PEP program for 12 weeks during the regular soccer season. The teams had to complete the PEP program at least 12 times to be included in the data analysis. Most teams reported completing an average of 25 exercise sessions.

Knee injuries requiring medical care and causing missed days of practice or play were counted for all participants in both the exercise and the control groups. The most common knee injury in both groups was a medial collateral ligament injury. Rates of MCL injury were equal between the two groups.

New ACL injuries and repeat injuries were less in the exercise group. Only injuries confirmed by MRIs or arthroscopy were considered true ACL injuries. This was especially noticeable among noncontact injuries and included both practices and games. Noncontact refers to the fact that the athlete did not collide with another player or object. The injury occurs most often when landing from a jump or when the foot is planted on the ground and the athlete is doing a cutting (side-step) motion.

The authors note that injuries continued to be reduced in the exercise group late into the season. They suspect this is the result of the benefits of the training as strength, balance, and joint proprioception (sense of position) improve. And although the program was designed for soccer players, it's possible it could be modified to use with basketball or volleyball players.

In summary, the PEP program is safe and effective in reducing the number of all ACL injuries in female soccer players. The program can be carried out easily during the regular practice time. No special equipment is needed.

A training video can be used to demonstrate all the exercises. This type of neuromuscular program takes several weeks to improve strength, balance, and proprioception. Athletes reported the program got easier as time went by. After six to 12 training sessions, the exercises were no longer perceived as physically challenging.


Julie Gilchrist, MD, et al. A Randomized Controlled Trial to Prevent Noncontact Anterior Cruciate Ligament Injury in Female Collegiate Soccer Players. In The American Journal of Sports Medicine. August 2008. Vol. 36. No. 8. Pp. 1476-1483.

08/14/2008

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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