Outline for “How to Prevent an Acute Injury”
Whether you’re a young adult playing club soccer or a weekend warrior enjoying pick-up basketball, building strong and resilient knees is essential to avoid strains or, even worse, an ACL tear. Over the past 30 years, I’ve helped individuals of all ages not only avoid ACL injuries but also rehabilitate those who’ve been hurt. There are specific factors that can predispose you to injuries, and they may not be what you typically find in other blogs. In this post, I’ll share simple ways to identify if you—or someone you know—are at risk for injury and offer effective prevention strategies. These methods are the ones I have developed over the last 30 years.
These methods include functional training practices, traditional physical therapy moves, and holistic tools that ensure you leave no stone unturned in your injury prevention.
While I’ve worked with many middle and high school athletes who’ve suffered ACL tears, the most significant number of injuries I’ve seen are in adults over 40. This highlights the crucial need for conditioning our bodies to handle the challenges we face as we age. Preparing your body properly is essential for minimizing the risk of injuries, especially as we continue to stay active later in life.
Understanding If You Are At Risk
- Hypermobility in the Knees: If your knees naturally hyperextend or bend backward when you stand, you’re at a higher risk for ACL injuries due to reduced joint stability.
- Female Anatomy: Women are more prone to ACL injuries because of the natural angle of the hips (known as the Q-angle), which can place additional stress on the knees during activity.
- Weekend Warriors: Individuals who participate in sports that involve sudden changes in direction, like basketball, soccer, or tennis—especially if there’s physical contact—face an increased risk of ACL injuries.
- Lack of Flexibility or Strength Training: Failing to incorporate regular stretching and strength training into your routine leaves your muscles and joints less equipped to handle the demands of physical activity, increasing your risk of injury.
- Lifestyle Factors: High stress, inadequate sleep, and poor nutrition weaken the body’s ability to recover and adapt, making it more susceptible to injuries, including ACL tears.If you have hypermobility in the knees- particularly they tend to move backward when you are standing
Functional Strength Training: A Key for Injury Prevention
Functional training is a type of exercise that focuses on improving movements you use in everyday life or specific activities. It emphasizes building strength, balance, mobility, and coordination in ways that enhance your ability to perform daily tasks, sports, or other physical activities efficiently and safely. By training multiple muscle groups and joints to work together, functional training helps prevent injuries, improves posture, and increases overall performance. Examples include squats, lunges, and rotational movements that mimic real-world actions like lifting, reaching, or twisting.
Mirroring the forces and movements in life is important but strength in general improves the integrity of joints. As mentioned in the above paragraph the movements are no secret but let’s delve deeper into understanding each of the major movement patterns and making them specific to avoid ACL issues.
One essential part of every movement I’ll go over is that it can be scaled (adjusted to meet you at your current level). In my experience, there is no way for athletes or active people to do every movement on this list. Success leaves clues, and finding a way to integrate some variation of each of these movements will pay off.
Squats
Squats – There’s no way around incorporating a squat variation into your training if you’re serious about building leg strength. My personal favorite is the high bar back squat, but other excellent options include goblet squats, front squats, Zercher squats, and belt squats. These variations challenge your legs in unique ways, allowing for versatility in training.
When it comes to squat depth, it’s important to understand that each person’s “strong squat” depth will vary based on their anatomy and goals. While I generally encourage breaking 90 degrees for heavy squats, I always take individual factors into account, such as build and the specific sports or activities they participate in. Additionally, the other movements on this list will help promote deep knee flexion, making squats a foundational part of a well-rounded training program.
Knees Over Toes Squats
I know what you’re thinking—Squats, again? But hear me out! The concept of “knees over toes” has been around since the dawn of strength training. Before machines took over the fitness world, bronze-era lifters relied on their bodies and creative angles to challenge specific muscles. Squats were a cornerstone of their training, often performed with the intention of allowing the knees to move over the toes.
One of my favorite ways to incorporate this concept is by using a slant board. It enables both a proper knees-over-toes position and a full “Ass to Grass” (ATG) squat, maximizing range of motion and building bulletproof strength in the knees and legs. This variation not only enhances leg strength but also improves mobility and resilience. This is a must for anyone looking to avoid an ACL issue.
Kettle Bell Swing
The strength and explosive power of the posterior chain are crucial for maintaining knee integrity. One of the best movements to train this is the basic two-handed kettlebell swing to shoulder height—it’s pure gold. While it may not be the go-to exercise for muscle hypertrophy, its ability to build functional, whole-body strength is life-changing for many.
As coaches, much of our work revolves around preventing imbalances in strength. For example, weak hamstrings relative to quad strength (leg extension strength) significantly increase the risk of ACL injuries. What I love about the kettlebell swing is that it addresses this imbalance while training at “game speed.” This means the muscles experience loads and movement patterns similar to those encountered in real-life activities and sports, making it one of the most effective tools for injury prevention and athletic performance.
Hinge
Under the category of “hinge,” you’ll find a wide array of movements—and for good reason. I avoided labeling this section as just “deadlift” because people are built so differently. It’s important to avoid dogmatic thinking that any one movement is universally the best.
The hinge encompasses exercises such as deadlifts, Romanian deadlifts (RDLs), good mornings, rack pulls, and even two-hand or Jefferson lifts. These can be performed with various tools like barbells, trap bars, or dumbbells, making the hinge incredibly versatile.
The true value of the hinge lies in its ability to strengthen the entire posterior chain, which is essential for optimal athletic performance. A stronger posterior chain not only improves movement efficiency but also plays a critical role in injury prevention, especially for the knees and lower back. However, finding the right hinge variation for each individual is key. Taller athletes or those with longer leg-to-torso ratios, for example, may struggle with certain hinge movements and benefit from tailored approaches to suit their anatomy.
Core Work
Core work that prioritizes function over aesthetics—training for “go” rather than just “show”—is essential to any well-rounded program. When working with clients, I emphasize teaching proper bracing techniques, often using an ab wheel to develop strength and control. In addition to this, I incorporate rotational, anti-rotational, and anti lateral flexion movements which are critical for building a resilient and dynamic core.
One of my favorite anti-rotation exercises is the Pallof press, which challenges the core to resist rotational forces by holding a cable or resistance band and extending the arms forward. This movement strengthens the obliques and deep stabilizers, ensuring the core stays solid against external forces.
Trunk Rotation with a Cable or Band is a powerful core exercise that builds rotational strength and stability, making it ideal for improving athletic performance and functional movement.
This exercise targets the obliques, improves spinal rotation, and enhances the core’s ability to generate and control rotational force. It’s particularly beneficial for athletes involved in rotational sports like golf, tennis, or baseball. Focus on maintaining a stable core and avoiding excessive lower-back movement for maximum effectiveness.
Another key movement I use is the landmine counter-lateral flexion, where a barbell is anchored in a landmine setup. Holding the barbell with one hand, you resist lateral bending as the bar tries to pull you to one side. This exercise not only strengthens the obliques but also improves lateral stability, making it an excellent tool for both athletic performance and injury prevention.
By integrating these functional core exercises, you develop a strong, stable core that can handle the demands of real-life movements.
Balance Work
To avoid the pitfalls of ACL strains or tears, incorporating balance work into your routine is essential. Over the years, I’ve focused on three key types of movements with clients, athletes, and young adults: single-leg exercises, BOSU ball movements, and wobble board work.
Unlike some of the trendy, exaggerated exercises often showcased on social media, I avoid overloading these movements with excessive weight. The goal isn’t to replace barbell squats with inverted BOSU squats but rather to stimulate stability, identify imbalances, and strengthen the mind-body connection.
Some of my favorite exercises include inverted BOSU squats, single-leg stands paired with upper body movements, and balancing on a wobble board. These movements help develop proprioception, enhance joint stability, and create a more resilient foundation for high-demand activities. By targeting deficits in balance and coordination, these exercises play a vital role in protecting against ACL injuries and improving overall athletic performance.
Lunges
Last but certainly not least, lunge variations are a fantastic tool for preventing ACL injuries. They closely mimic many of the dynamic movements seen in sports, making them both functional and effective.
The lunge variations I teach serve a dual purpose. Not only do they strengthen key muscle groups and improve stability, but they also act as an evaluation tool for me as a coach. These movements help uncover asymmetries and imbalances that could increase the risk of injury.
Some of my go-to lunge variations include reverse lunges, walking lunges, single-leg Bulgarian split squats, and fixed split squats. Each of these exercises challenges the body in unique ways, promoting balance, coordination, and unilateral strength—essential components for building resilient knees and avoiding ACL issues.
Stretching and Mobility Work
The intensity of competition and rigorous workouts can leave muscles tight, increasing the risk of injury. Incorporating stretching and traditional physical therapy techniques into your routine is incredibly beneficial for maintaining flexibility and preventing strain.
I’m also a strong advocate for yoga, which can be an excellent complement to your training. If you’re new to yoga, I recommend starting with a yin or easy vinyasa class. These are beginner-friendly options that will help you ease into the practice, learn the terminology, and get accustomed to the flow and vibe of a class.
Stretching, much like strength training, is its own discipline. I encourage my clients to incorporate mobility and stretching exercises between sets to maximize recovery time. Keeping stretches low-load and holding each position for about a minute can yield significant benefits. Prioritizing stretches for the hips, quads, and hamstrings is especially important for maintaining knee health and overall lower-body mobility.
The Role of Breathwork and Meditation
Meditation and breathwork are powerful tools for health, recovery, and overall well-being. They help calm the nervous system, reduce stress, and improve focus, which is crucial for both physical and mental recovery. Breathwork, in particular, enhances oxygen delivery to tissues, supports energy production, and facilitates better movement by improving diaphragmatic function. Incorporating meditation into your routine not only promotes relaxation but also trains your mind to stay present and resilient under pressure.
Visualization, a key element of many meditative practices, amplifies these benefits by harnessing the mind’s power to reinforce positive outcomes. Whether it’s picturing yourself recovering from an injury, mastering a skill, or achieving a fitness goal, visualization helps bridge the gap between intention and action, making your efforts more effective.
Together, meditation, breathwork, and visualization form a cornerstone for optimal health, accelerating recovery and keeping both your body and mind in peak condition.
Conclusion
Preventing ACL injuries and maintaining knee health requires a comprehensive, well-rounded approach that blends strength, stability, mobility, and recovery. From foundational movements like squats and hinges to advanced techniques such as balance training and functional core work, each exercise plays a critical role in building resilience. The inclusion of lunges, kettlebell swings, and rotation-focused exercises ensures complete development of the muscles, tendons, and ligaments supporting your knees.
Equally important is prioritizing recovery through stretching, yoga, and mobility work, which keeps the body flexible and prepared for the demands of intense activity. Meditation, breathwork, and visualization not only enhance recovery but also sharpen mental focus and foster a deeper mind-body connection, giving you a performance edge while reducing injury risk.
By addressing imbalances, strengthening the posterior chain, and incorporating tools like anti-rotation exercises and balance work, you create a foundation of stability and power. Remember, injury prevention isn’t just about training harder—it’s about training smarter. With the right strategies, you can protect your knees, optimize performance, and enjoy an active, pain-free lifestyle for years to come.