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ACL Prevention Strategies Part I


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ACL injuries are reaching epidemic proportions amongst athletes from the junior high/high school level on through the professional levels of all sports. The occurrence of ACL injuries is on the rise among the weekend warriors as well. Prevention programs are popping up all over the web and in schools with research showing that progress can be made depending on the approach.

This series of three articles will cover some of the best preventative strategies available when it comes to jump mechanics. Landing incorrectly is a major cause of ACL injuries. These strategies are simple to implement and extremely effective.

When discussing jump mechanics and ACL injuries, it is the landing that is potentially most dangerous. Landing in a knee “valgus" position puts the athlete at a higher risk of injury. The valgus position means the knees are moving inward and bending simultaneously. The athlete looks “knocked kneed’. Knee hyper extension is the other common cause.

Landing correctly involves the all of the following:

  • Landing on balls of the feet sinking down into the heels
  • Knees aligned with the feet - vs knees buckling in (valgus position)
  • Hips are back absorbing force - this will enhance performance as well if the landing is followed by another jump or sprint in any direction
  • Slight forward lean of the trunk with back flat

Many jump programs emphasize landing with correct technique but don't address the ability to get into a safe landing position. Athletes often lack the mobility or strength to get into the correct positions. This is where prevention needs to start.

Looking at the bio-mechanics of landing, the following are all required:

  • Ankle mobility - specifically dorsiflexion
  • Hip mobility and stability
  • Trunk stability
  • Thoracic spine and shoulder mobility and stability - especially for athletes that must go overhead such as getting a rebound in basketball.

The ‘Squat Stretch’ is the exercise I use to address all these factors. The most basic form of the stretch involves starting with feet a little more than shoulder width and facing straight ahead. The athlete goes into a hamstring stretch for 10 seconds placing the hands under the inside ball of the foot. Knees are allowed to bend to get into this position if hamstring tightness is an issue. Relax the low back and hamstrings, then begin to drop the hips into a deep squat position keeping the elbows between the knees. Sit down as deep as possible. The goal is to break thighs parallel to the floor with knees apart, feet still pointing straight ahead, and head and chest up. Hold the stretch 10 seconds.

Common difficulties with this stretch include feet start turning out, losing balance backward, and inability to get the head and chest up. The athlete may not be able to reach full depth right away with great technique but work to it. Placing a 2x4 or towel rolls under the heels can help with balance and ankle mobility issues. Start with this if needed then remove it later as technique improves.

Progressions with this exercise include:

  • Press into a medicine ball or basketball during the hamstring stretch to engage the abdominals, and continue to press as you drop into the squat. This will improve trunk control.
  • Turn head to the right and reach the right arm up and back like you were going to touch the ceiling behind you. Reach hard 10 seconds then back to the start position. Repeat with the left arm. The other arm will continue pressing into the ball to keep abs engaged throughout. Once you have reached both directions, then take both arms overhead and stand back up. The goal is to keep the head and chest up as the arms go overhead. This technique improves upper back and shoulder mobility and stability which is critical for overhead athletes.
  • Drop squats involve starting from a standing position, then dropping into a deep squat position. Remember to keep the knees apart, feet forward, and chest up. Arms forward is the easiest position. Take the arms overhead as you drop to increase the challenge. Arms can be taken to one side or the other to add a rotary force but fight to keep good alignment. Progress the difficulty by reaching with a medicine ball.

A full squat position is rarely ever going to be needed in sports, but to be able to achieve this position with just body weight is important. The deep squat stretch gives a ‘buffer zone’ when the forces becomes higher as in landing from spiking a volleyball, making a tackle, or fighting for a rebound.

Master the deep squat stretch exercise then get ready for part II of ACL injury prevention.

Joe Heiler PT, CSCS is a physical therapist specializing in sports medicine and orthopedics in Traverse City, Michigan. As a certified strength and conditioning specialist he has worked with athletes at all levels improving speed, power, and strength. Check out more great articles, exercise videos, audio interviews, and more from top physical therapists, athletic trainers, and sports performance coaches at


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