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How To Save Your ACL
April 26th, 2007 7PM
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By Dr. Dev Mishra

"You've torn your ACL." That's a phrase no player wants to hear. If you are a competitive soccer player, chances are fairly high that you know of a teammate (or perhaps yourself) who has sustained a tear of the anterior cruciate ligament (ACL).

The ACL is a ligament -- a tough fibrous structure that joins a bone to another bone -- that is a major stabilizer for the knee. In soccer it is critical in rotational movements such as planting, cutting and pivoting.

In the United States it is estimated that 250,000 people tear an ACL each year, and a substantial number of them will undergo reconstructive knee surgery. In my practice I am seeing ACL tears in girls as young as 12. Female athletes are particularly prone to injury.

In a study conducted at Duke University by Drs. Bing Yu and William Garrett a female athlete is more than seven times as likely to tear the ACL as a male athlete. A player unlucky enough to tear the ACL will have substantial lost playing time, and some players will not come back to the same level of play.

But recent studies suggest that specific training methods can reduce the number of ACL tears sustained by soccer players.

About 70 percent of ACL tears occur during non-contact movements such as decelerating or cutting while sprinting, or on landing from a jump. Improved mechanics for jumping, sprinting and cutting are at the heart of the programs designed to reduce the rates of ACL tears.

At a recent meeting of the American Orthopaedic Society for Sports Medicine, Drs. Julie Gilchrist and Bert Mandelbaum reported their results of a training program used on female collegiate soccer players. This free program was developed at the Santa Monica (Calif.) Orthopaedic and Sports Medicine Research Foundation, and goes by the name "PEP," which stands for Prevent Injury and Enhance Performance. ( The PEP program has reduced ACL injury rates by 72 percent -- a very impressive number.

Another program that is excellent is the Core Performance soccer training program designed by Mark Verstegen of Athletes' Performance.

The programs focus on form during jumping, sprinting, and cutting. They are also excellent for development of the "core" muscles -- large groups such as the abdominals, obliques and large leg muscles. They should be used at least three times per week.

The full program incorporates a warm-up, stretching, core strengthening, agility, and a form of jump training called plyometrics. As long as you adhere to the principles of proper form there is room to add variety to the program as your training progresses. For example, I like to emphasize more abdominal strengthening, and utilize small hurdles, rings and speed ladder. The programs can be used with any age group, male or female.

No training on earth can prevent the ACL tear that occurs from a vicious tackle, but I believe there is a great opportunity to reduce tears from non-contact events. At the very least, you will end up with better flexibility, power, speed and agility. Those are attributes any player would welcome.

Dr. Mishra is an orthopedic surgeon in private practice in Burlingame and Walnut Creek, Calif. He is a team physician for U.C. Berkeley, the California Victory USL-1 club, and the U.S. Soccer Federation. Mishra's Web site is

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