ACL Injury Prevention: Can You Reduce Your Risk? What the Research Says
By Julia Cole, CAT(C) – Proactive Therapy | Athletic Therapy & Strength Coaching in Victoria, BC
ACL injuries are among the most devastating injuries in sport. Whether you're a soccer player, skier, basketball player, volleyball athlete, or simply someone who enjoys being active, an ACL tear often means months of rehabilitation, surgery for many athletes, and a long road back to sport.
The encouraging news?
While no injury prevention program can eliminate the risk entirely, research consistently shows that well-designed neuromuscular training programs can significantly reduce the risk of ACL injury.
If you're wondering what actually works—and what doesn't—this guide will walk you through the evidence.
What is the ACL?
The anterior cruciate ligament (ACL) is one of the major stabilizing ligaments inside your knee. It helps prevent the shin bone from sliding forward and controls rotational movements of the knee.
ACL injuries typically occur during movements such as:
Landing from a jump
Cutting or changing direction
Pivoting
Suddenly decelerating
Skiing falls
Interestingly, most ACL injuries occur without contact from another player. They often happen during movements athletes perform hundreds of times in practice and competition.
Who Is Most at Risk?
Anyone can tear their ACL, but the risk is higher in sports involving:
Soccer
Basketball
Volleyball
Football
Rugby
Team handball
Skiing
Female athletes have a higher incidence of ACL injury than males in comparable sports. This difference is likely due to a combination of anatomical, biomechanical, hormonal, and neuromuscular factors—not one single cause.
Can ACL Injuries Be Prevented?
Not completely.
But they can often be reduced.
Large systematic reviews have shown that neuromuscular training programs reduce ACL injury risk by approximately 40–60%, with some studies reporting even greater reductions when programs are performed consistently.
The biggest factor?
Consistency.
Doing a few exercises occasionally won't have the same effect as incorporating a structured warm-up into training two or more times each week throughout the season.
What Should an ACL Prevention Program Include?
The best programs don't focus on just one exercise.
Instead, they combine several important components.
1. Strength Training
Strong muscles help absorb force before it reaches the ACL.
Key areas include:
Quadriceps
Hamstrings
Glutes
Calves
Core
Exercises I commonly prescribe include:
Bulgarian split squats
Romanian deadlifts
Step-ups
Copenhagen planks
Single-leg calf raises
Dead bugs
Farmer carries
The goal isn't simply stronger muscles—it's improving the body's ability to control movement.
2. Plyometrics
Learning to jump is only half the battle.
Learning how to land is equally important.
Good plyometric training teaches athletes to:
Land softly
Absorb force through the hips and knees
Maintain good trunk control
Avoid excessive knee collapse inward (dynamic valgus)
Examples include:
Box jumps
Hop and stick
Single-leg hops
Lateral bounds
Drop landings
3. Balance and Single-Leg Control
Many sporting movements occur on one leg.
Improving single-leg stability helps athletes better control unexpected movements.
Examples include:
Single-leg balance
Single-leg RDLs
Star excursion reaches
Step-downs
Hip airplanes
4. Agility and Change of Direction
Most ACL injuries don't occur while running in a straight line.
They happen during rapid deceleration and cutting.
Training should include:
Shuttle runs
Cutting drills
Deceleration drills
Figure-8 running
Reactive movement drills
As athletes improve, these drills should become more sport-specific.
5. Technique
It's not just about getting stronger.
It's about moving well under load.
Athletes benefit from coaching that emphasizes:
Good trunk control
Soft, controlled landings
Appropriate knee and hip flexion when landing
Efficient deceleration mechanics
This doesn't mean there's one "perfect" movement pattern. Instead, the goal is to improve the body's ability to manage forces safely and efficiently.
Does Stretching Prevent ACL Injuries?
Not by itself.
Stretching may improve mobility and help athletes feel prepared for activity, but there is little evidence that stretching alone reduces ACL injury risk.
If you only have 10–15 minutes before training, your time is better spent on a dynamic neuromuscular warm-up that includes strength, balance, plyometrics, and agility.
Warm-Ups Matter
One of the easiest ways to reduce injury risk is to stop thinking of the warm-up as something to "get through."
Instead, think of it as your first training session.
Well-designed warm-up programs—such as FIFA 11+ and similar neuromuscular programs—have been shown to reduce ACL and other lower-limb injuries when performed consistently.
Should You Only Do Prevention Exercises If You've Torn Your ACL?
No.
The best time to begin injury prevention is before an injury occurs.
These programs are beneficial for:
Youth athletes
Recreational athletes
Competitive athletes
Adults returning to sport
Athletes after ACL reconstruction
Many of the same exercises used to prevent injury also improve performance by enhancing strength, power, balance, and movement efficiency.
How Athletic Therapy Can Help
Every athlete moves differently.
An assessment can identify individual factors that may increase injury risk, including:
Strength deficits
Poor single-leg control
Balance deficits
Limited mobility
Landing mechanics
Training load
Sport-specific movement patterns
From there, we can develop an individualized program that helps reduce injury risk while improving performance.
The Bottom Line
You can't eliminate the risk of an ACL injury—but you can significantly improve your odds.
The strongest evidence supports:
✔ Neuromuscular warm-ups performed consistently✔ Progressive strength training✔ Plyometric training with good landing mechanics✔ Balance and single-leg control exercises✔ Agility and deceleration training✔ Gradual progression of training loads
Whether you're preparing for soccer season, basketball, skiing, volleyball, or simply want to keep doing the activities you love, investing a few minutes in injury prevention each week can pay off for years to come.
If you're looking for Athletic Therapy in Victoria, BC, I'd be happy to help assess your movement, identify areas for improvement, and build an individualized injury prevention program.
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