Connective Tissue: The Key to Preventing ACL Injuries [ARTICLE]

Connective Tissue: The Key to Preventing

ACL Injuries

By: Damon Amato

Provided by: Stack


The anterior cruciate ligament is the last thing you want to injure. If you need ACL surgery, you have a 6- to 12-month rehabilitation period ahead of you, and you may not return with the same speed and agility you once had.

So you want to do everything you can to prevent this injury. But where to start? Currently, ACL injury prevention focuses on muscle strength, quad-to-hamstring ratios and proper technique. This overlooks the most important part of prevention-strengthening the connective tissue.

For our purposes, "connective tissue" includes ligaments, tendons, fascia and even bone. Catastrophic injuries typically happen in these areas, which aren't as resilient as muscle tissue. Muscle tissue takes roughly 90 days to replace itself on a cellular level. So every 90 days, every molecule in your muscle tissue has been replaced, repaired, and has possibly grown and adapted to new demands (if you are training).

Tendons and ligaments have a replacement rate of 7 to 9 months. Bone takes 2 to 3 years. So any damage doesn't go away as quickly.

The following exercises may look and feel funny, but they stress your ligaments and tendons just enough to cause adaptations that will protect your knee joints, improve your body control, increase your muscle strength and ultimately help you become a better athlete. Chris Sommer, former USA gymnastics coach, helped provide the framework for these exercises, many of which come from Coach Sommer's Gymnastics Strength Training manual.


• Do each set with the strength exercise immediately followed by the accompanying mobility exercise. Do not rest between them.

• Don't move on to the next set of exercises until you have completed the previous one.

• None of these exercises except the Hip Thrusters require any weight. You should be able to master every single exercise before you even consider putting a bar on your back.

• Hip Thrusters are the only exercise where a barbell is necessary. Start with 60 percent of your body weight and work through the entire progression. Once you can master 5 sets of 10 reps, increase the weight by 20 percent and start over. Continue at this progression until you can do two times your body weight.

• This program is for athletes who do not already have an injury-although it can be used while rehabbing under the supervision of an athletic trainer. You should also have reasonable hip and ankle mobility. If that is not the case, you've got to ratchet back your training to get a solid foundation before getting too intense.

Strength Exercises/Mobility Exercises

1) Cossack Squats / 1) Skier Squats
2) Side-to-Side Squats / 2) Twisting Squats
3) Speed Skater Squats / 3) Hip Bridges
4) Hawaiian Squats / 4) Prone Leg Raises
5) Hip Thrusters / 5) Inside Squats
6) Pistol Squats / 6) Straddle Sit Leg Raises

Cossack Squats

The non-squatting leg stays straight, rising to top position between repetitions.

Skier Squats

Keep your knees stationary and swivel your hips to one side, keeping your feet firmly on the floor.

Side-to-Side Squats

Keep your glutes as close to the floor as possible and fully extend your non-squatting leg. Do not lift up your glutes when moving towards your opposite leg.

Twisting Squats

Lean slightly forward and use the outside edge of your ankles to rise. Note that each rep should go in the opposite direction.

Speed Skater Squats

Your rear knee and foot should touch the ground very gently at the same time.

Hip Bridges


Hip Thrusters

Your feet and knees should be close together, and your hands should be as far behind your shoulders as they can comfortably be while you bring your hips up into tabletop position.

Hawaiian Squats

Descend until your glutes are even with the knee of your standing leg, and keep your arms in front to counter balance.

Prone Leg Raises

Spread your knees as far wide as possible and bent at 90 degrees. Lift your quads off the floor.

Inside Squats


Pistol Squat

Allow your hips and knees to descend slowly as deep as possible while letting your ankles and lower legs roll inward.

Straddle Sit Leg Raises

Keep your knee straight and lift your calf and thigh off the ground as high as possible without bending your upper body forward or backward. Hold for two seconds.


Each strength exercise starts with 3 sets of 2 repetitions. You should do this combination as part of your regular strength training regimen two to three times that week. The progression of dosage is to increase by one set or two reps each week for three weeks, so the second week would consist of 5 sets of 3 reps, and the third week would consist of 5 sets of 6 reps. Every fourth week is a de-load week, meaning you do the same number of sets as you did the previous week, but you cut the reps in half. You want to eventually get up to five sets of ten perfect reps before moving on to the next exercise.

For the combined mobility work, you want to do 5 reps for each set of strength work, so if the dosage a certain week is 4 sets, you'll do 4 sets of 5 reps of mobility work.

If you think you are a stud and can motor through the progressions, try doing 5 sets of 10 reps along with the paired mobility exercise with no rest between sets. If you do all the reps perfectly-congratulations, you're a stud. Move on to the next exercise in the progression. Don't skip exercises; they are in this order for a specific reason. If you can't do Skier Squats, you're sure to hurt yourself attempting Twisting Squats.

I recommend keeping some of the exercises in your warm-up prior to practice or competition, such as 1 or 2 sets of Twisting Squats and Hawaiian Squats to improve blood flow to the connective tissue at the knee joint, even after you have mastered the exercise. Once you're able to complete all exercises with the prescribed dosage, it's time to integrate more difficult exercises such as plyometrics, back squatting and front squatting with a weight on your back. Once you get there, your knees will be bomb-proof.

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23 Aug 2016

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