Knee Injury Prevention

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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.<ref>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.

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)

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)

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)

Resources

References