ACL Injury Prevention Program Rolls Out to Monroe County High Schools

Proven Program Aims to Reduce Risk of Injury by 90 Percent

August 22, 2007

Spiking, kicking and dribbling may take a temporary back seat this season as female athletes learn to master new skills proven to reduce the risks of one of the most serious knee injuries that can sideline their athletic careers. The program, called PEP (Prevent injury, Enhance Performance), targets the prevention of non-contact anterior cruciate ligament (ACL) tears, an injury that female athletes are at six to nine times greater risk than males to sustain.

Organized by University Sports Medicine (USM), the PEP program is being rolled out to 24 high schools in Monroe County, funded by a two-year grant from the Greater Rochester Health Foundation.  The program will cover junior varsity and varsity female athletes playing soccer, volleyball and basketball – the three main sports tied to overall higher incidences of ACL tears. USM officials expect to train about 1,200 athletes during this upcoming academic year.

The PEP program is based on a two-year clinical prevention trial among 1,400 NCAA Division I female soccer players completed by the Santa Monica Orthopaedic and Sports Medicine Research Foundation in 2003. Results showed that increased flexibility, strength, proprioception, and agility can substantially reduce by up to 88 percent non-contact ACL tears in female athletes.

Athletic trainers at USM reviewed the Santa Monica research and program results, and in 2004, developed Rochester’s first program aimed at decreasing ACL injuries. Since then, USM estimates it has trained hundreds of female athletes in the PEP program through school-sanctioned sessions or through specialized camps. Though USM was unable to collect and analyze ACL injury data in Rochester, anecdotal results of a decrease in ACL tears encouraged organizers to pursue a community-wide educational effort. 

According to Michael Maloney, M.D., director of USM, few, if any, regions have such a dedicated commitment to reduce the incidence of an injury that can produce a significant blow to a successful athletic career.

“It’s a heartbreaking experience to see an athlete, who has devoted so much of herself to her sport, to be sidelined for a season or more by an injury that we now know ways to prevent,” Maloney said. “I’m excited at the potential we have here in Rochester to develop a community-wide approach to substantially reduce the risk of these injuries, and allow our young athletes to stay in the game and attain their goals, whatever they may be.”

Mystery Surrounds Female ACL Tears

The numbers on female ACL tears are astounding. Over 1.4 million women have been afflicted in the past 10 years alone — twice the rate of the previous decade. It is estimated that more than 30,000 high school and college age females will rupture their ACL every year.  In the last 15 years, ankle sprains have decreased by 86 percent while knee ligament injuries have increased by 172 percent.

Much speculation exists on the cause of the higher non-contact ACL injury rate in females, with hormones, biomechanics and environment some of the common culprits named. While researchers have been unable to definitively pinpoint the exact cause for the increased incidence in females, they have been able to develop a series of specific stretching, strengthening, flexibility and balance exercises that have been shown to significantly reduce injury rates.

“PEP works by retraining the nervous and muscle system in female athletes to be more efficient, and as a result, reduce the potential for non-contact ACL tears,” said Andy Duncan, P.T., A.T.C., director of sports rehabilitation at USM.

Beginning in late August, USM trainers will begin working with teams at each of the 24 high schools to teach the PEP program. It consists of a specialized warm-up program that must be completed two to three times a week, and includes exercises and training to increase muscle strength, plyometrics (active strengthening like jumps), agility, balance and flexibility.  The program takes about 20-25 minutes to complete.

“We stress quality versus quantity with the girls.  These exercises are so precise that they must be done properly or they will not receive any benefit at all,” Duncan said.  “In effect, we are re-teaching the muscles how to fire and respond to signals from the nervous system.  At the end of six weeks, if the program is done correctly and consistently, these athletes will have a much better chance at preventing an ACL tear.”

Sample PEP Exercises

  • Warm-ups:       Jog, slides, backpedals
  • Strengthening:   Lunge walk, ball bridge, calf raise
  • Plyometrics:      Lateral, front/back and single leg hops, rebound jumps, scissor jumps
  • Agility:  Shuttle and pivot runs
  • Stretching         Hamstrings, quads, calves, groin and hip flexors

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Germaine Reinhardt
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