ACL. In recent months that three-letter acronym for anterior cruciate ligament has become the biggest talking point in women’s sport, far greater than the names of any of the star athletes taking to pitches, tracks, courses and slopes around the world.
There are lots of calls for more research into the issue to find out why women are more likely to suffer these serious knee injuries, but there is already a lot of data on how to reduce the risk. The key? Performing the right warm-up.
The importance of warming up before exercising has long been drilled into people but rather than the more habitual elements of, say, a few stretches and a light jog, it is about including specific types of drills into pre-training and pre-match routines.
In 2019, the American Journal of Sports Medicine published a review of ACL injury prevention programmes that found the risk of injury was reduced by 53 per cent when they incorporated plyometric (jumping), strengthening and agility exercises. For example, a warm-up that includes walking lunges and single-toe raises (strengthening), single-leg hops and vertical jumps (plyometrics) and runs with changes of direction and speed (agility) would contain those various elements.
Technique is also key: Keeping the knee and foot aligned, landing on the balls of the feet and so on. The underlying idea is that these exercises help to improve stability and control, strengthen muscles and reinforce strong body positions.
This type of warm-up is not new: Back in 1972, researchers in Santa Monica devised the Prevent Injury Enhance Performance (PEP) programme that incorporated the same principles. However, it has not cut through to wider public consciousness.
Tom Jacobs is a chartered physiotherapist who helped set up the Sporting Knee Injury Prevention Programme (SKIPP) after seeing an increase in ACL ruptures amongst teenagers doing sport and the charity’s new Power Up To Play campaign aims is to raise awareness of the importance of doing the right warm-up.
“There is hard data that shows if you spend 10 to 15 minutes warming up the right way, the risk of ACL ruptures goes down,” says Jacobs. “The focus is on getting the warm-up right and there is a big difference between a traditional warm-up and an evidence-based warm-up. The idea is to include some changing direction running, some jumping and landing, and some strength drills.
“It’s not known why it’s so effective. The two leading theories are because it fires up the neuromuscular control centres in the brain [which help with dynamic joint stability] and that it is quite physically demanding, so it gets people fitter and stronger.”
