I received an email a couple weeks ago from the one of the captains of a women’s team, asking me for help. Three of her teammates had had ACL tears in a matter of months and they knew they needed to address the issue. But how?

I get messages like this far more often than I’d like, and I’m hoping that I can answer some questions and provide some guidance for other teams and individuals in the community that are concerned and want to take action. I’ve heard from enough people that I’ve developed my own ACL Injury Reduction Plan.

Disclaimer #1: I’m not a physical therapist or a doctor, and I’m not going to give you a prescription or a protocol. I am an experienced strength and conditioning professional who’s seen a dealt with many clients who have suffered ACL injuries.

One of the reasons I usually resist creating programming to address specific issues is that there’s such a large amount of variance from player to player such as: injury history, training age, levels of mobility and strength, years playing the sport, etc. I’m putting this training plan out there hoping that you’ll use it as a jumping off point and not a bible, and that if you have problems executing it, you’ll ask questions of me or another professional you trust!

Disclaimer #2: I use the term ACL injury reduction because ACL injury prevention is a myth. We can’t prevent these types of injuries, but we can definitely reduce their occurrence.

There are two types of ACL injuries: contact and non-contact. We can easily influence the reduction of non-contact injuries, since we can control how we train and work to strengthen ourselves. But there are certain steps we can take to try and avoid contact ACL injuries as well. We can increase our on-field peripheral vision with exercises like these, which will help us avoid getting trucked or trucking someone else. We can continue to call for fair-minded play and encourage teammates and other teams to work to avoid contact. And we can use training plans like mine to increase our resilience and develop good enough knee stability to weather the unexpected.

In order to reduce non-contact ACL injuries, we first need to understand what causes them!

Here are a few big factors:

Uneven ground

Excessive knee abduction (valgus) during force absorption, especially in female athletes

Poor mobility (hips and/or ankles) that causes knee stress

Fatigue (continuing to try to cut and/or jump explosively while tired)

Not enough strength (especially balanced single leg and core strength)

Uneven Ground: We can’t always control our playing surface, but I definitely suggest scouting out the ground before a game or practice. I’ve had elite-level players miss huge tourneys because they stepped in a rabbit hole. Use a disc or a cone to cover up those on-field hazards before you start playing!

Excessive Knee Abduction: Knee valgus is when the knee collapses inwards as force is directed into the ground –usually when taking off and landing a jump or while changing direction– putting strain on the ACL.

There have been many studies suggesting reasons why female athletes have a higher incidence of valgus. Some point to a bigger Q-angle and other to hormone fluctuations associated with the menstrual cycle, but these studies have not been conclusive. Good training plans and warm up movements have been proven to reduce knee valgus and ACL incidence, however, this movement pattern can be shifted! The sternum turn is a big part of that shift. Some women may need to focus on developing inner quad strength to lessen valgus collapse (try wall sits with something between your knees to turn that musculature on)!

Poor Mobility: My very first article for Skyd explained that the joints in our bodies have different jobs, and that they alternate between mobility and stability in terms of what they are designed to do. Many ultimate athletes have either poor ankle or hip mobility (often both), which requires the knee joint to be overly mobile. The problem is that knees are supposed to be stable! When you jump or cut, though, something has to move – if you’re locked up from prior or current ankle injury or have a problem with hip hinge, your knee takes the strain.

Fatigue: Balancing strength and power training with metabolic conditioning is one of the great challenges in ultimate. Many athletes come to the sport from track and field or soccer, which have some movement patterns and energy demands in common with ultimate, but don’t share the requirement to change directions at full speed dozens of times during a game and hundreds of times during a tournament day. It’s important to build your capacity to utilize the right movement patterns while tired!

Strength: Jumping and cutting require that you put a lot of force into the ground. The stronger you are, the more force you can apply, period. More importantly, you need that strength in the right places, or else it will not translate to more powerful and safer movement. Huge quads often come at the expense of your glutes, which are one of your main knee stabilizers. Ultimate athletes often have overactive hamstrings that are too taxed to provide knee support at crunch time. Also, asymmetric core strength makes force absorption sloppy and inefficient, causing stress on connective tissue especially while cutting.

So you wanna reduce ACL injuries?

This list looks daunting, but there’s so much you can do to turn the odds in your favor. Try out my Functional Performance Training Plan for Ultimate! This can be used as a team protocol, as every ultimate player will benefit from the focus on increased knee stability. A couple notes on the plan:

Proper cueing is very important. Try to keep the wording consistent whether you’re lifting, practicing or warming up! The best cues for this plan are some variation on:

Squeeze your butt; open your hips (for best glute activation)

Relax your shoulders; take a punch (for best core activation)

If at any point you feel pain during these exercises, stop!

This includes feeling it in the wrong places like: connective tissue, knees, or only in your hamstring(s) and not in your glute(s). Try to refocus on the cueing to make sure your form is always correct. If the problem persists, do a simpler version of the exercise, decrease the weight you are lifting, or ask for help! And if your form is failing, rest!

Let’s try to keep ourselves and each other safe out there.

P.S. If you’re feeling like you’re ready to make a big change in your training, one that’ll both increase your strength and confidence and reduce risk of injury, the Ultimate Athlete Project is open this week. I offered individualized plans to UAP members! Sign up via this link.