ACL injury prevention with 3 core exercises that take less than 20 minutes to complete

• Many of us these days are leading less active lifestyles as we perform daily jobs and activities that are confined to a desk.  
• Unfortunately, sedentary job roles can lead to your hip and butt muscles becoming weak unless they are properly exercised.  
• Consequently, weakened hip muscles can expose you to an increased risk of a tragic ACL injury during sport.  
• Strong butt muscles are important for preventing excessive hip rotation during physical activity, which can place stress on your ACL.
• If ACL injury prevention is a goal of yours then consider including in your weekly exercise routine the 3 core leg exercises described below to strengthen your butt muscles.  They take less than 20 minutes.
• These 3 exercises are called (1) the bridge, (2) the clam, and (3) pelvic dip step downs.  They are designed to help activate your hip muscles especially the gluteus medius which can help reduce the risk of an ACL tear 
• In other words ACL injury prevention can be positively impacted by activating your hip muscles especially the gluteus medius.
• The 3 exercises below can easily be completed at your home, anywhere outside on a flat surface, or in a gym and they do not require special equipment. Start with 2 to 3 sets per exercise and 5 to 10 repetitions per set. 

ACL Injury Prevention Exercises  - How to activate your hip muscles

ACL injury prevention: exercise 1 - “the bridge”

• To activate your gluteus muscles start with bridges otherwise known as single leg hip lift (see picture above).
• As the name implies this exercise requires you to lie on your back with your legs bent and hips flat on the ground.
• Then extend one leg out straight locking the knee and pushing with the other foot raise your buttocks off the ground.  
• Taking notice to contract your glutes as you push your hips upwards so that your body from the knee caps to shoulders is flat and straight at the top of lift. 
• Return back to your starting position with your hips flat on the ground and repeat.  Complete 5 to 10 repetitions.  
• If the single leg hip lift exercise proves challenging, then an easier alternative to get you started is to lift your hips with both feet remaining planted on the ground.  Then move onto the single leg bridge (shown above) once you build your strength.
• A good way to increase the level of difficulty of this exercise is to increase the number of repetitions per set.  

ACL injury prevention: exercise 2 - “the clam”

• Another good exercise designed to activate your gluteus medius is the clam. Using a rubber band around the thighs just above the knee, stride sideways both sides for 5 to 10 steps and then return the other way.
• Being mindful to stride against the band so that you can feel the bands resistance and fatigue in your thighs and gluts. Only allowing the other leg to slowly follow.
• A good way to increase the level of difficulty of this exercise is to use a tighter band around your thighs and / or increase the number of sideways steps. 

ACL injury prevention exercise 3 - “pelvic dip step downs”

• Another good exercise for contracting the gluteas medius is the pelvic dip.
• Standing on one leg on a small step lower or dip your opposite foot below the the step so that your pelvis drops a few inches below before contracting your hip muscles (on the stance side) to extend your pelvis back level again

Why are hip muscles important to help prevent ACL tears?

• Proper hip strength is considered critical to preventing and treating knee problems
• The hips muscles such as the gluteas medius effectively control the alignment of the thighs and knees.
• Further, the gluteus medius is effectively responsible for allowing the hip and thigh to abduct which therefore enables your leg to move outwards to the side.
• However, a weak gluteus medius is problematic as without proper strength in these butt muscles the hip is allowed to rotate.  Excessive rotation can result in strain on the knee and in turn increases the risk of an ACL tear.
• This additional stress on the ACL caused by hip rotation is commonly seen during sports that require twisting, jumping and pivoting actions.

Is it possible to train weak hip muscles to help prevent an ACL injury?

• If your gluteas medius is weak a physio can help prescribe specific exercises to target strengthening of your hips muscles in particularly with a focus on the gluteus medius.
• The hip exercises should be designed to improve balance and proprioception. Proprioception is effectively the sense of knowing where your body part is and occurs subconsciously within the mind. 

How do you know if you are at an increase risk of an ACL tear?

• There are certain ACL tear prevention screening exercises that you can do to assess your hip muscle strength and or weakness.
• To see if your hip muscles are weak and therefore at an increased risk of an ACL tear you can simply test yourself by doing a Single Leg Stance.
• Whilst standing on one leg in front of the mirror, you can observe how your pelvis and hip moves whilst lowering your knee from a standing position to a slight knee bend or slight single leg squat.
• Effectively, you are looking to see that your hip and pelvis remain in line with your knee and also in line with your ankle at all times.
• If there is any abnormal tilt or collapse this is a strong indicator of weakness in your butt and therefore training and strengthening of the hip muscles is in order.
• It is important to try this one leg squat on both sides of your body and take note of any differences in your form as this may indicate specific hip weaknesses to one side.  

Does having weak glutes increase your risk of an ACL injury?

• As a society more and more people spend hours sitting at a desk. This results in developing lazy glutes and weak butt muscles which do not function properly
• If your glutes do not function properly this can cause other muscles such as the hamstrings to be activated to do the job of the glutes and can result in injury plus lower back, hip and knee pain.
• Glute and hip exercises will help activate and strengthen your butt muscles and can be simple as doing them in the space of your own home. 

Are females at a greater risk of an ACL injury than males?

• Statistics indicate that females are up to 4 to 8 times more likely to injure their ACL. One theory is related to the position of the hip which for females is at a more exaggerated angle relative to the knee when compared to males

ACL injury prevention programs

• Above, we have discussed 3 simple exercises that you can perform to help strengthen your hip muscles and reduce your risk of an ACL tear.  These exercises could be particularly relevant if you are a sports participant or generally enjoy physical activity. 
• It is important to also be aware that there are also a number of well credentialed ACL injury prevention programs that have been designed to help reduce the frequency of ACL tear injuries in particularly in sport. These programs include the FIFA 11+ and the PEP programs. 

Summary of ACL injury prevention

• ACL injury prevention is certainly a concept that more and more physicians and sports participants alike are becoming more aware of.
• It is certainly possible to train and exercise certain areas of your body, such as your glutes, to help reduce the risk of an ACL tear.  
• This can be even more important for people who work office jobs or live sedentary lifestyles which can cause the gluteus medius to become weak.
• Weak hips may lead to excessive rotation of the hips during physical activity or sports which in turn places greater stress on the ACL in your knee.
• A proactive exercise regime to reduce the risk of an ACL tear makes good sense in particularly if you feel your knees are susceptible to an ACL tear. This may be because your are in a high risk category and participate in physical activities or sports that require twisting and pivoting motions.
• 3 key exercises recommended to help strengthen your hip muscles include the bridge, the clam and pelvic dip step downs.

1. The bridge

• The bridge requires you to lye flat on the ground and with one leg extended out fully push your hips high into the air keeping your shoulders to knees straight like a board. 
• Upon elevation of your hips focus on pushing up through your glutes. Lower your hips back down to the ground and repeat.

2. The clam

• The clam requires you to place an elastic band around your thighs just above your knees and stride sideways 5 to 10 times so that your thighs and glutes fatigue.
• Only allow the trailing leg to slowly follow. Do this exercise in both directions and repeat.

3. Pelvic dips

• Pelvic dip step downs. Standing on a small step this exercise requires you to slowly lower one leg below the level of the step so that your pelvis drops and then contract your hip muscles to return your pelvis back to level again. Repeat this movement until fatigued and on both legs.
• Speaking to your physio is recommended who can assist with proper exercise technique and developing a weekly training program to assist with strengthening muscle groups that help support your knees.  
• Alternatively, give these exercises a go yourself and see if you notice improvement in hip strength. 

Good Luck With Your Physical Activity and Sports!

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