ACL Risk Assessment

Young Athlete ACL Injury Risk Assessment Tool The ability to perform athletic activities can be greatly affected by limitations in flexibility, posture, strength and balance. These limitations have been shown to affect the quality of an athletes movement when jumping, landing or when running and changing speed or direction. This change in movement quality can result in an increased risk of injury.

The HSS Sports Safety team has developed this ACL Injury Risk Assessment Tool to help coaches and parents identify musculoskeletal deficiencies in young athletes. This series of flexibility, posture, strength and balance assessments can help to identify factors that limit the ability to safely and efficiently perform athletic activities for beginner, intermediate or advanced-level athletes.

Table of contents � Posture Assessment � Flexibility Assessment � Strength Assessment � Balance Assessment � Scoring

Description of Athlete Skill Level Please use the following descriptions to determine your athlete’s skill level.



Beginner



Intermediate



Advanced

� Little to no experience with current sport (participated in 3 or fewer competitive seasons)

� Minimal to moderate level of experience with current sport (participated in 4 to 6 competitive seasons)

� Moderate to high level of experience with current sport (participated in more than 6 competitive seasons)

� Poor technique with performance of sportspecific skills

� Fair technique with performance of sportspecific skills

� Good technique with performance of sportspecific skills

� Most often youth level athletes, 12 years old and younger

� Most often junior high school athletes, 13 to 15 years old

� Most often high school athletes, 16 to 18 years old

ACL Injury Risk Assessment Tool | 1

Posture Assessment: Side View

To perform this test: � Stand in a relaxed position with either right or left side facing someone with a camera. � Take a picture from a side view. � Place a straight edge over the picture that connects the athlete’s ear and ankle bone vertically.

To score this test: Athlete’s shoulder, hip and knee are aligned vertically between their ear and ankle.

YES

NO





ACL Injury Risk Assessment Tool | 2

Posture Assessment: Front View

To perform this test: � Stand in a relaxed position facing someone with a camera. � Take a picture from the front view. � Place a straight edge over the picture that connects both of the athlete’s ears horizontally. Repeat this step with their shoulders, knees and ankles.

To score this test: Athlete’s ears, shoulders, knees and ankles are aligned horizontally with each other.

YES

NO





ACL Injury Risk Assessment Tool | 3

Flexibility Assessment: Hamstring Flexibility Test

To perform this test: � Lie on a firm surface (such as the floor) with arms crossed on chest. � Raise left leg as far as possible with the knee completely extended while the right leg remains stationary. � Repeat the test by raising right leg while the left leg remains stationary.

To score this test: Athlete is able to raise both legs to 90 degrees (or beyond) with their knee extended, while the opposite leg remains stationary.

YES

NO





ACL Injury Risk Assessment Tool | 4

Flexibility Assessment: Calf Flexibility Test

To perform this test: � Sit with legs supported on a firm surface (such as the floor) with knees extended and feet aligned vertically. � Bend left ankle back toward body as far as possible while maintaining vertical alignment of the foot. � Repeat the test with right foot.

To score this test: Athlete is able to bend both ankles back at least 20 degrees with their knee extended.

YES

NO





ACL Injury Risk Assessment Tool | 5

Strength Assessment: Side Plank Test

To perform this test: � Lie on left side with body in a straight line from head to feet, resting on forearm with elbow beneath shoulder. � Press down with forearm and lift hips from the floor, maintaining a straight body position.

Hold this position for as long as possible. � Rest and then repeat this test on right side.

To score this test: If you are a beginner-level athlete: Athlete is able to hold the proper side plank position on both sides for 30 seconds.

If you are an intermediate-level athlete: Athlete is able to hold the proper side plank position on both sides for 45 seconds.

If you are an advanced-level athlete: Athlete is able to hold the proper side plank position on both sides for 60 seconds.

YES

NO





YES

NO





YES

NO





ACL Injury Risk Assessment Tool | 6

Strength Assessment: Wall Sit Test

To perform this test: � Stand with upper back against a wall, with feet shoulder width apart. � Slowly lower body along the wall until hips and knees are bent to 90 degrees. � Cross arms in front of body and lift left foot from the floor as you support your body against the wall with only right leg. � Hold this position for as long as possible. Do not shift body to the side while performing test. � Rest and repeat this test using left leg.

To score this test: If you are a beginner-level athlete: Athlete is able to hold the proper wall sit position with both legs for up to 15 seconds.

YES

NO





If you are an intermediate-level athlete: Athlete is able to hold the proper wall sit position with both legs for up to 30 seconds.

YES

NO





If you are an advanced-level athlete: Athlete is able to hold the proper wall sit position with both legs for up to 45 seconds.

YES

NO





ACL Injury Risk Assessment Tool | 7

Balance Assessment: Single Leg Stance Test

To perform this test: � Stand with feet shoulder width apart, arms at their sides and hands resting on hips. � Raise left foot from the floor by bending knee and maintain balance as you stand on right leg. � Rest and repeat this test with left leg.

To score this test: If you are a beginner-level athlete: Athlete is able to maintain balance in both single leg stance positions for 30 seconds.

YES

NO





If you are an intermediate-level athlete: Athlete is able to maintain balance in both single leg stance positions for 45 seconds.

YES

NO





If you are an advanced-level athlete: Athlete is able to maintain balance in both single leg stance positions for 60 seconds.

YES

NO





ACL Injury Risk Assessment Tool | 8

Balance Assessment: Tandem Stance Test

To perform this test: � Stand with the heel of right foot directly in front of and touching the toes of left foot. � Rest hands on hips and maintain balance in this position. � Repeat the test with the left heel.

To score this test: If you are a beginner-level athlete: Athlete can hold the proper tandem leg stance position for 30 seconds.

YES

NO





If you are an intermediate-level athlete: Athlete can hold the proper tandem leg stance position for 45 seconds.

YES

NO





If you are an advanced-level athlete: Athlete can hold the proper tandem leg stance position for 60 seconds.

YES

NO





ACL Injury Risk Assessment Tool | 9

Young Athlete ACL Injury Risk Assessment Tool Scoring Add up all the “YES” and “NO” to arrive at final score

Posture Assessment Side View

YES

NO





YES

NO





YES

NO





YES

NO





Front View

YES

NO





YES

NO





YES

NO





YES

NO





Flexibility Assessment Hamstring Flexibility Test

Calf Flexibility Test

Strength Assessment Side Plank Test

Wall Sit Test

Balance Assessment Single Leg Stance Test

Tandem Stance Test

Total

YES

NO

To grade: � 2 or less musculoskeletal insufficiencies: lowest risk of ACL injury � 3–5 musculoskeletal insufficiencies: moderate risk of ACL injury � 6 or more musculoskeletal insufficiencies: highest risk of ACL injury This tool is only a guide and is not intended to diagnose specific medical conditions. The HSS Sports Safety team encourages coaches and parents to share the results of this assessment with a trusted medical provider who can further evaluate your child’s musculoskeletal status.

ACL Injury Risk Assessment Tool | 10