ACL Injury Prevention for Athletes

Jack Wilshere of Arsenal lies on the ground during the Carling Cup quarter final match between Arsenal and Wigan Athletic at the Emirates Stadium on November 30, 2010 in London, England
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The ACL (anterior cruciate ligament (ACL) is one of four major ligaments that provide stability to the knee joint. These fibrous bands attach bone to bone and help control the excessive motion of the knee joint and keep the lower leg from sliding too far forward. Of the four major ligaments of the knee, ​ACL injuries are the most common. The majority of ACL reconstructions that occur each year are done on young athletes (under age 23) and female athletes.


The causes of ACL injury have recently been the focus of research. Factors contributing to ACL injuries include ground hardness, grass type, and cleat type.

ACL injuries are common in sports that involve sudden changes in direction, such as football, and soccer. Most are non-contact injuries that occur during sudden twisting motion (for example, when the feet are planted one way and the knees are turned another way) or when landing from a jump with a straight knee.

A 2018 study published in The American Journal of Sports Medicine found women are four times more likely to have ACL injuries than men.

Some statistics say that a female soccer player is eight times more likely to injure her ACL than a male soccer player.

Researchers believe this may be due to differences in hormone levels on ligament strength and stiffness, neuromuscular control, lower limb biomechanics, ligament strength, and fatigue.

Women also have wider hips and a greater Q angle of the knee, a measurement of the angle between the quadriceps muscles and the patella tendon. Findings have shown a difference in neuromuscular control in women when landing jumps (women appear to have less hip and knee flexion than men).


Athletes can reduce their risk of ACL injuries by performing training drills that require balance, power, and agility. Adding plyometric exercises, such as jumping and balance drills, help improve neuromuscular conditioning and muscular reactions and ultimately shows a decrease in the risk of ACL injury. Many team physicians now routinely recommend an ACL conditioning program, especially for their female players.

The Santa Monica ACL Prevention Project developed an ACL Injury Prevention Program specifically for female soccer players, commonly referred to as the PEP program. This 15-minute training program incorporates balance, agility, and performance drills into the warm-up phase of training and practice.

ACL Injury Prevention Program

Phases of the ACL Injury Prevention Program should be performed at least 2-3 times per week during the season and includes:

  1. Warm-up
  2. Stretching
  3. Strengthening
  4. Plyometrics
  5. Agility Drills
  6. Cool-down

The Bottom Line

For both men and women who participate in start-and-stop sports, appropriate skills training such as those in the above program may be the key to staying injury-free. Regularly performing exercises designed to strengthen the anterior cruciate ligament (ACL) may help lower your risk of injury.

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