Neuromuscular training and ACL injuries

Neuromuscular training and ACL injuries



ACL is an abbreviation for anterior cruciate ligament. The ACL is one of four main ligaments along with the medial collateral ligament, lateral collateral ligament, and the posterior cruciate ligament, that assist in stabilizing the knee joint. The ACL originates within the notch of the distal femur(thigh bone) and attaches in front of the intercondyloid eminence of the tibia(shin bone). These attachments allow the ACL to resist anterior translation (forward movement) and medial rotation (rotation towards the middle of the body) of the tibia, in relation to the femur. Injuries to the ACL commonly occur during sport, but can also happen during activities of daily living. Injury ensues when the ligament is loaded with excessive force usually when pivoting or suddenly changing direction through the knee joint. When the ACL is compromised, the knee joint can become unstable, painful, and dysfunctional when performing movement.


Having neuromuscular ability is the capacity of the nerves to send signals to the muscles to contract. Why do we need this ability? The body needs to be able to contract muscles to counteract force. For example when squatting down to pick up an object, muscles have to contract to support body weight. When balancing on two feet, muscles are contracting to keep the body upright and stable. When jumping and landing; muscles are contracting to propel the body forward and then to land and stabilize the body. We use tactile stimuli (the ability to feel) to translate messages from our nerves to our muscles to perform activity. Without neuromuscular ability it is difficult to balance, move, and maintain stability through the joints of the body.

Neuromuscular training focuses on performing exercises that train the nerves and muscles to react and communicate. Neuromuscular training programs are designed to both increase the strength of the knee joint and increase the individual’s awareness of proper balance and technique. The programs accomplish this goal by using a number of different exercises to train both the body of the individual as well as their conscious mind.


A study from the Journal of Orthopedic and Sports Physical Therapy concluded that neuromuscular training programs can effectively reduce primary-ACL injury prevalence by between 43.8% and 73.4%! A new clinical report from the American Academy of Pediatrics(AAP) asserts that the continued rise in ACL injuries in adolescent athletes could be partially countered by neuromuscular training to “preprogram” safer movement patterns before an injury occurs. Better training could be of particular benefit to female adolescent athletes, who could see their rates of ACL injury risk drop by as much as 72%.While some ACL injuries are unavoidable, many are the result of muscle weakness, incorrect technique during exercise, and improper body alignment when performing exercise. Neuromuscular training places an emphasis on proper form as well as strengthening often neglected parts of the body.

What Exercises Are Involved in a Neuromuscular Training Program?

It is possible for a neuromuscular training program to incorporate any variety of physical activity as long as it supports increasing the strength and balance of the knee. However, most programs incorporate several similar exercises. Exercises commonly utilized in neuromuscular training programs include: plyometric and movement, core strengthening and balance, resistance training, and speed training.

Keep in mind that the focus to perform any exercise in which bending at the knee and the hip is required, is to maintain good form. Keeping the ankles, hips, and knees all in a straight line is important. If these structures are not in line with one another, this may indicate weakness, and as a result, more stress is being placed on other joints which can lead to injury. The emphasis of the following exercises are to strengthen the muscle surrounding the knee, to train the nerves and muscles to communicate and activate effectively to facilitate stabilization of the knee joint, and to educate the body how to move to prevent injury.

Retrieved from: Dan  Balogh PT Tech at Peak Performance Physical Therapy.