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This prevention program consists of a warm-up, stretching, strengthening, plyometrics, and sport specific agilities to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint. It is important to use proper technique during all of the exercises. The coaches and trainers need to emphasize correct posture, straight up and down jumps without excessive side-to-side movement, and reinforce soft landings. This program should be completed 2 to 3 times a week at a minimum.

The field should be set up 10 minutes prior to the warm-up (Click Here to see field). This will allow for a smooth and quick transition between all of the activities. A sample field set-up has been included in your packet.

This program should take approximately 15 minutes to complete. Alongside each exercise you will notice a box with the approximate amount of time that should be spent on each activity. This will serve as a guideline to you in order to conduct your warm-up in a time-efficient manner.

Replacement Exercises For Alternative Warm-Up Program

1. Warm-Up

	A.	Laps around the field (2 to 3 laps) Purpose: Increase heart rate Instruction: Slowly jog around the perimeter of the field for 2 to 3 laps to increase heart rate and prepare for the days training session.
	B.	Backward running with heel slap (20 to 40 yds) Purpose: Increase coordination, increase heart rate, and engage hamstrings Instruction: Run backwards from sideline to sideline. As you bring heel toward your buttock, strike side of ankle with your hand. Repeat on opposite side. Remember proper landing technique: land on your toes with slight knee and hip flexion (bending).

2. Stretching

	A.	Standing calf stretch with straight knee and bent knee (30 - 60 seconds) Purpose: stretch both the gastocnemius and the soleus (Achilles) of the lower extremity Instruction: Stand in a lunge position with the right leg forward and the left leg back. Keep the left knee straight and the left heel on the ground. The right knee should be bent 90º. Hold the stretch for 30 - 60 seconds. Slightly bend the left leg (back leg) and hold for 30 - 60 seconds (Achilles). Hold for 30 to 60 seconds.
	B.	Sidelying Quadricep stretch (30 - 60 seconds) Purpose: Stretch the quadriceps muscle (front of thigh). Instruction: Lie on your left side in a straight line (shoulder, hip knee and ankles should be aligned). Reach back for your right ankle. Grab onto your ankle and pull right hip backward. Feel stretch across the front of the right thigh. Hold for 30 to 60 seconds and repeat on opposite side.
	C.	Sidelying Quad stretch with contralateral hip flexion with heel grab Purpose: Stretch the hip flexor muscle (30 - 60 seconds) Instruction: Lie on your left side in a straight line (shoulder, hip knee and ankles should be aligned). Bend the left hip and knee to 90º (right angle position). Reach back for your right ankle and pull right leg backward. Feel stretch along the junction of the hip and thigh. Hold for 30 to 60 seconds and repeat on opposite side.
	D.	Butterfly stretch (30 - 60 seconds) Purpose: Stretch the adductor (inner thigh) Instruction: In a tall-seated position, bend your knees and bring your feet toward your center (with the soles of your feet together). Attempt to get the outside of your knee to the ground (you may use your elbows to push on the inside of the knee). Hold for 30 to 60 seconds.
	E.	Pretzle stretch - SI joint (30 - 60 seconds) Purpose: Stretch the deep hip rotators and gluteals Instruction: Lie on your back folding your right knee directly over the left knee. Pull knees to chest and feel stretch on the right side of your hip and leg. Hold for 30 to 60 seconds and repeat with the opposite leg.
	F.	Prone cat stretch with lateral stretch (30 - 60 seconds) Purpose: Stretch the low back and transverse muscles Instruction: While on all fours, sit back onto your heels with arms outstretched in front of you as far as possible. Hold stretch for 30 seconds. Now, side bend to the right and reach arms ahead of you. You should feel a good stretch on the left side. Hold the stretch for 30 seconds and repeat this stretch to the left.

3. Strengthening

	A.	Single leg squat (3 sets of 10 reps) Purpose: To strengthen the quadriceps and improve balance Instruction: Stand with feet together. Bend right hip/knee to approximately 90º. With all of your weight on the left leg (stance leg), squat down on left leg while maintaining your balance. The goal is to achieve 90º of knee flexion (bend) on the stance leg, but begin exercise in a comfortable range. Repeat 3 sets of 10 repetitions and repeat on opposite leg.
	B.	Cross over lunges (20 yards) Purpose: Increase strength of lower extremity and improve coordination Instruction: Similar to walking lunges. Lunge forward leading with your right leg, however, cross right leg over midline. Bend right knee to 60 - 90º (as tolerated). Now bring the left leg across the right. Lunge yourself forward alternating legs for 20 yards. You may increase the yardage as you gain strength.
	C.	Bridging on ball (knee to chest) - (3 sets of 10 repetitions) Purpose: Increase hamstring and hip strength Instruction: Lying on your back with knees bent, place both feet on top of soccer ball. Lift hips off the ground so that your shoulders, hips, and knees are in a straight line. Slowly straighten knees and follow by bringing knees to chest (without lowering hips). Repeat 3 sets of 10.
	D.	Toe touch on ball (quick feet) (3 sets of 1 minute duration) Purpose: Increase calf strength and coordination Instruction: Standing with ball slightly ahead of you, place toe on top of ball (without moving it) and quickly switch feet. Repeat exercise for 1 minute and rest.
	E.	Hip band walking (A/P and lateral) - 20 yards Purpose: Increase lower extremity and trunk strength, build dynamic stability Instruction: Resistance band needed for this exercise. Place band around ankles. Face forward and repeat walking lunge exercise utilizing resistance band. Remember to keep knee over the ankle to prevent excessive pressure on the knee. Now, step out with the right leg to the side and squat down keeping the knee over ankle joint. Bring left leg to right and repeat this for a distance of 20 yards. Repeat exercise leading with the left leg. You can increase the yardage as you get stronger.

4. Plyometrics

	A.	Diagonal Plyometrics (20 repetitions) Purpose: Increase power, strength and coordination of the lower extremity Instruction: Stand with small flat cone (2" in height) in front of you to your right. Hop over cone in a diagonal fashion landing on the ball of your feet while bending at the hip and knee. Now, hop backwards and to the left over the cone to return to your starting position. Repeat 20 times and then step to the left and repeat the exercise in the opposite diagonal.
	B.	Successive plyometric jumps with Sprint (8 to 10 cones with 20 yd sprint) Purpose: Increase power and strength. Instruction: Place 8 to 10 cones in a straight line approximately 18 to 24" apart. Hop over each cone quickly with proper landing technique (on toes with bent hips and bent knees). After the last cone, sprint for 20 yards and slowly jog to starting point. Repeat 3 times.
	C.	Jump and tuck (20 repetitions for 1 to 3 sets - strength dependent) Purpose: Increase hip strength and power Instruction: Jump up bringing knees toward chest (tucked position). Land on your toes with hips and knees bent (flexion) and quickly repeat exercise. Repeat 20 times and rest. Increase number of repetitions and sets as you gain strength.

5. Agilities

	A.	Star Exercise Purpose: Increase balance (proprioception) and coordination Instruction: Place five cones in a circular fashion and stand in the center of the cones. Stand on one right foot with a slightly bent knee. Reach for each cone while maintaining your balance. To increase the difficulty of this exercise, close your eyes while your reach for each cone. Repeat exercise for 1 minute and rest. Repeat 3 times.
	B.	Two cone twist and reach Purpose: Increase hip strength and balance Instruction: Place two cones at a 45° angle from your hip (2 o'clock and 10 o'clock position). Stand on right foot with knee slightly bent. Reach for the left cone with the right hand. Then reach for the right cone with the left hand. Do this quickly while maintaining your balance on one leg. Repeat 30 times and switch legs.
	C.	Quick feet - ladder or cones (10 yards) Purpose: Increase reaction time and power Instruction: Using plyometric ladder or cones placed ahead of you, quickly step through each rung of the ladder (cone) pushing off with the ball of your foot. Slowly jog back to the starting point and repeat 3 times.
	D.	Juggle with ball at feet/knees Purpose: Lower extremity coordination Instruction: Juggle ball at feet and knee (alternating) for 1-minute duration. To increase difficulty, utilize one leg only attempting to control the ball.

6. Additional Exercise

	A.	Bridging with Hip extension Purpose: Increase hip and trunk strength and improve balance Instruction: Lying on your back with knees bent, place both feet on top of soccer ball. Lift hips off the ground so that your shoulders, hips, and knees are in a straight line. Slowly lift one foot off the ball and straighten the knee without dipping the hip down. Return foot back to the ball and repeat on the opposite leg. Repeat 30 times and rest.
	B.	Ball toss with abdominal toss (buddy) Purpose: Increase abdominal/trunk strength Instruction: Lie on your back with hips and knees bent. Have your partner toss a soccer ball to you. Catch the ball and bring your arms overhead. Now, catapult yourself by bringing arms back toward your center as your perform an abdominal crunch and toss the ball to your partner. Wait for your partner to toss the ball again and repeat exercise 30 times.

If you have any questions or concerns regarding this program, please contact Holly Silvers, MPT at (310) 315-0292 ext. 1283.

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