Knee Injury Prevention

Introduction

Knee injuries are common among people who play sports or do activities in competitive and non-competitive settings. There is strong evidence to support exercise-based knee injury prevention programs. These exercises/programs have been shown to help prevent anterior cruciate ligament injuries and other knee injuries.[1]

Exercise Recommendations

Exercise programs for knee injury prevention should incorporate multiple types of training including strength, plyometric, and core conditioning. Prevention exercises should be performed for at least 20 minutes multiple times a week and sport specific training should occur for >30 minutes multiple times per week. Prevention exercises should start in the "pre-season" before the athletic sport commences and should continue throughout the regular season.

Sample Exercises for Field Sports (e.g. soccer, field hockey, ulitmate frisbee)[1]

Athletes should perform Phase I, II, III before training and practice. Before games, Phase I and II should be performed

Phase I (Warm up prior to game and practice)

Jog forward, Airplanes dynamic, Jog backwards, Lunge with opposite arm sky reach, High skips/bounding skips, Dynamic thigh/quad stretch with opposite arm sky reach and heel raise, Skips with front kick, Lateral lunge both sides with 180 pivot, Karoke, Open gate (hip flex ER) with side shuffle, Circle drill side shuffle, Close Gate (hip flex IR) with forward shuffle

Phase II Functional movement (prior to training/practice only)

Participant should be able to perform Tier 1 exercises for 45 seconds x2 with good form before progressing to next tier.

2x45 sec (a, b) or 2x30 sec (c, d, e)

Tier 1 Tier 2 Tier 3 Tier 4
a. Forward ½ plank Forward full plank Plank hands on ball Plank feet on ball
b. Side plank ½ Side plank full Side plank ½ leg lifts Side plank full left lift
c. Single leg bridge alternating Double leg roll outs on ball Single leg roll outs on ball Eccentric hamstring curl
d. Lunge holds Alternating lunges Scissor/switch lunges 180 scissor lunges
e. Squat lateral weight shift Squat heel raise Squat jumps 4-square squat jumps
f. Single leg ball dribble around standing leg Single leg passing Single leg volley Skater hop passing

Phase III Coordination/alignment/cutting/reaction/plyometrics

Landing alignment
Tier 1 Tier 2 Tier 3
Squat heel raise arm swing Clock hops Single leg diagonal forward hops
Diagonal single leg hops V 90 degrees single leg hops Skater hips pause forward
Cutting
Tier 1 Tier 2 Tier 3
3-6 step deceleration outside leg cutting 1 step deceleration outside leg Diagonal cut with ball
3-6 step deceleration inside leg cutting 1 step deceleration inside leg Scissors lateral leap diagonal
Reaction
Tier 1 Tier 2 Tier 3
Lateral jump with side contact 3 step deceleration with 90-180 degree pivot (with cuing on when to cut) 1 step deceleration with 90-180 degree pivot (with cuing on when to cut)
Squat jump with lateral cut 3-6 feet with cuing on which way to cut 3 step deceleration with diagonal cut (with cuing on when to cut) 1 step deceleration with diagonal cut (with cuing on when to cut)

Sample Exercises for Court Sports (e.g. volleyball, basketball)[1]

Athletes should perform Phase I, II, III before training and practice. Before games, Phase I and II should be performed.

Phase I Dynamic Warm up

Jog

Bear crawl

Backwards Jog

Lunge with side reach

Lateral shuffle

Thigh/quad stretch with heel raise and overhead reach dynamic

Carioca

Lateral lunge

High Skips

Open Gate

Forward Skips

Close Gate

Phase II Foundational Movements trunk and hip strengthening

Participants can progress to higher tiers when they have appropriate form and endurance.

2x45 seconds or 2x30 seconds

Tier 1 Tier 2 Tier 3 Tier 4
Forward ½ plank Forward full plank Plank hands on ball Plank feet on ball
½ side plank Full side plank Full side plank with leg hold Full side plank with repeated left lifts
Lunge holds Alternating step back lunges Jumping scissor lunge Jumping scissor lunge with 180 degree turn
Double leg bridge Double leg bridge with roll out Single leg bridge with top leg straight Single leg bridge ball rollout
Squat holds with lunges Double leg squat with toe raise Double leg squat jumps Squat jump square both directions
Single leg balance arm swing/dribbling ball Single leg balance passing Single leg squat Single leg squat clocks

Phase III: Movement, coordination, deceleration, cutting, and plyometric training

Tier 1 Tier 2 Tier 3 Tier 4
Broad jumps Forward/lateral jumps Jump with single leg landings Forward and lateral single leg landings
3 step deceleration 3 step deceleration and lateral shuffle 1 step deceleration 1 step deceleration and lateral shuffle
Lateral cuts Diagonal cuts Skater hops with pause Skate Hops

Resources

  1. 1.0 1.1 1.2 Arundale AJ, Bizzini M, Giordano A, Hewett TE, Logerstedt DS, Mandelbaum B, Scalzitti DA, Silvers-Granelli H, Snyder-Mackler L, Altman RD, Beattie P. Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy. Journal of Orthopaedic & Sports Physical Therapy. 2018 Sep;48(9):A1-42.