Based on 14 previous studies, the researchers say training programs
that focus on strengthening the legs and hips and stabilizing the
abdomen are the most effective for preventing injury to the anterior
cruciate ligament (ACL), and doing more than one type of exercise is
“We know neuromuscular training can reduce ACL injury in female
athletes, but we were not sure what exercises are the best to attain
the maximal prophylactic effects,” said Dai Sugimoto of The Micheli
Center for Sports Injury Prevention and the Boston Children’s
Hospital Orthopaedics and Sports Medicine department, in
The ACL is the key stabilizing ligament in the knee, and is most
often injured during sports that involve quick turns or pivoting
ACL injuries are very serious and can take a long time to heal, the
researchers write in the British Journal of Sports Medicine. College
athletes with ACL injuries lose more time on the field than athletes
with ankle or traumatic head injuries, according to the researchers.
Young women facing the greatest risk are those who play sports
involving a lot of pivoting, such as soccer, basketball, lacrosse
and handball, according to Sugimoto. He added that the most common
age for women to be injured is around 14 to 17 years.
Grethe Mykelburst, who outlined the risks involved with ACL injury
in an email, said, “it takes you out of your sport for 6-12 months,
and some don’t succeed to return to their previous level.” She added
that the risk of getting osteoarthritis, a degenerative condition,
in the knee is high after injury.
Mykelburst, a sports physical therapist and associate professor at
the Oslo Sport Trauma Research Center in Oslo, Norway, was not
involved in the review.
Sugimoto’s team analyzed 14 studies of exercise intervention
programs, looking specifically at four different exercise approaches
including balance, jump training, abdomen stabilizing exercises and
strengthening of the legs and hips.
Training programs that aimed to build strength in the back of the
legs and in the hips significantly reduced the number of ACL
injuries when compared with programs that did not. That was also
true of programs that focused on strengthening and developing more
control of the abdomen.
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Programs that included more than one type of exercise were
significantly more effective than those using only one type.
“Neuromuscular training has to incorporate many exercise modes,”
Sugimoto told Reuters Health. “Performing only one exercise mode
The researchers note that while balance and jumping exercises were
somewhat helpful in reducing injury, they were not effective unless
combined with other exercises.
The study lists a number of specific helpful exercises, including
Russian hamstring curls, sit-ups, pushups and bench press. Sugimoto
emphasized the hamstring curls in particular, as they work both to
strengthen the legs and hips and require abdomen control.
“With inclusion of these exercises as well as a variety of exercise
modes, athletes can attain the fullest benefit from neuromuscular
training and prevent ACL injury,” Sugimoto said.
Every year 350,000 people seek ACL reconstruction surgery in the
United States, the authors point out.
Sugimoto said that although surgery is the best available treatment,
24 to 30 percent of high school athletes who undergo the surgery
tear their ACL again within the next several years.
“That’s why we need to prevent ACL injury in first place to avoid
subsequent ACL injury and preserve a healthy knee joint,” Sugimoto
“The evidence is strong that neuromuscular training works,”
Mykelburst agreed. “As an athlete or a coach, you can’t afford not
using the prevention program and exercises that exist,” she added.
SOURCE: http://bmj.co/1wATVNF British Journal of Sports Medicine,
online December 1, 2014.
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