Plyometric Exercises to Prevent ACL Tears

By: Dr. Rebecca Van Heuklon, DPT, FAFS, FMR

Good Form
Correct Form
Bad Form
Incorrect Form

Over the past 2 months, we have discussed what puts athletes at risk for having anterior cruciate ligament (ACL) tears and have dug deeper into the strength deficits that make athletes more prone to having an ACL injury.  This final article in our series on ACL Injury Prevention will look into jumping errors that put athletes at risk for injury and how to address them.  Risk factors for having an ACL tear related to jumping all involve the position of the body when landing.  These include knock-kneed position; inability to control side-to-side motion at the trunk and hips; poor shock absorption; small trunk, hip, and knee flexion angles; and preferring to land with more weight on one leg versus the other or on the ball of the foot.¹  These faults can be addressed with education and training, which can effectively decrease the risk of an ACL tear.

So how do you begin to teach athletes optimal jumping technique?  First, encourage soft landings to improve shock absorption.  This can be achieved through emphasizing generous trunk, hip, and knee bending when landing. Maintain knees over the second toe position and do not allow the knees to fall inward or travel forward past the toes. Finally, encourage landing with the athlete’s weight evenly distributed between the legs and evenly distributed throughout the foot, avoiding landing on just the balls of the feet.  Research shows that instructing athletes to “land softly,” “have a quiet landing,” “increase knee bend when you land,” “land with knees over toes,” and “land with equal weight on each foot” were the most successful in improving jump landing technique.³  It is important to note that even with athletes using safer techniques for landing, their jump height was maintained, thus reducing their injury risk without negatively impacting performance.³  

The most successful way to teach good landing technique is to first describe what the ideal landing should look like.  It can be helpful for athletes to visualize landing technique by viewing a digital clip such as our YouTube video demonstrating the MotionWorks Plyometric Exercises for ACL Injury Prevention, view live expert demonstration, and/or take a video of the athlete performing the jump and landing with discussion of the any errors identified.  Once the athlete knows what technique to use, then give feedback as he or she performs lands a jump to correct any faults.  In addition, the athlete can also use a mirror so he or she can see technique in real time and work on self-correction.  To improve technique, any demonstration must be combined with verbal instruction, as just demonstration of good technique is not sufficient.³

Athletes should begin their injury prevention program during the preseason and then continue the exercises throughout the regular sport season.  Performing the exercises year round is a good idea, but not necessary.²  Research has found that performing the combination of both strengthening and plyometric exercises for 30 minute sessions twice a week provides the highest reduction in injury rates;² however, this may be unrealistic, especially with tight practice times and game days during the regular season.  Researchers still found some benefit to doing the exercises for 15 minutes once a week, so any time dedicated to the exercises with excellent technique can still be helpful at reducing ACL injury rates.  If time is tight, emphasis should prioritize the strengthening exercises introduced in last month’s article over the plyometric exercises, as simply performing plyometric exercises alone was not sufficient at reducing ACL injuries.²  Research and common sense supports that the more compliant the athlete is in practicing the exercises, the lower the risk of having an ACL tear.  

Below is a table listing the key plyometric exercises with both beginner and advanced options that should be included in an exercise program to prevent ACL tears.  Shoot for performing each exercise for 30 seconds.  Click on our YouTube video above to visualize each exercise with excellent technique for optimal success.  

  

  Beginner Advanced
Plyometric 
Exercises
Multi-Directional 2-Legged Jumps Multi-Directional Single-Leg Hops
Scissor Jumps Scissor Jumps with Weight
Ice Skater Jumps in Place Ice Skater Jumps Advancing Forward
90-Degree Jumps 180-Degree Jumps
Forwards and Backwards 
Jumps over Obstacle
Forwards and Backwards Single-Leg Hops over Obstacle
Lateral Jumps over Obstacle Lateral Single-Leg Hops over Obstacle
Step Off Box with 
2-Legged Soft Landing
Step Off Box with 
Single-Leg Soft Landing
Squat Jumps Tuck Jumps

 

After reading this article series, we hope you feel more confident as an athlete, parent, or coach in reducing the risk of having an ACL tear while encouraging a healthy, active lifestyle throughout the lifespan.  If you have questions on how to start an ACL exercise prevention program for you or your athlete, or if you are interested in additional modifications or progressions for these exercises, contact Rebecca@motionworkspt.com.  The Doctors of Physical Therapy at MotionWorks are trained in sport specific ACL Injury Prevention program design for teams and individual athletes, as well as rehabilitation for ACL tears both before and after reconstructive surgery.  Contact MotionWorks Physical Therapy for more information at info@motionworkspt.com or call 920-215-2050.


1. Hewett TE, Myer GD, Ford KR, et al.  2016.  Mechanisms, Prediction, and Prevention of ACL Injuries: Cut Risk with Three Sharpened and Validated Tools.  J Orthop Res.  34(11):1843-1855.
2. Arundale AJ, Bizzini M, Giordano A, et al.  2018.  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.  J Orthop Sports Phys Ther.  48(9): A1-A42.
3. Armitano CN, Haegele JA, Russell DM.  2018.  The Use of Augmented Information for Reducing Anteiror Cruciate Ligament Injury Risk During Jump Landings:  A Systematic Review.  J Athl Train.  53(9): 844-859.