The Key to Successful ACL Injury Prevention

Looking at the numbers of ACL tears and “revisions” – that’s a nice way to say re-tears – it is very clear this an injury we want to prevent. At all costs. The question is, can we?

Sportsmetrics (Hewett in Ohio) and the PEP program (Santa Monica, CA) say YES. These groups have done solid science with large groups of athletes to show that well-designed training programs bring the ACL tears down by 60% or more. Their pre-season training incorporates 60-90 minutes of training on 3 non-consecutive days and includes strength, balance, plyometrics and agility.

The science: These programs include biomechanical training to correct 4 factors which predict 94% of the risk for ACL:

  1. knee adduction or valgus
  2. straight knee landings 
  3. hamstring/quadriceps strength ratios < .55 (quads more than 2x stronger than hamstrings)
  4. balance and instability

From Hewett’s original research, many people have come up with their own versions of “injury prevention” training. Most attempt to incorporate this into a 10 minute warm up before training and games.

On tournament day when I look out onto 20 or more fields I see a few coaches running these warm ups with their kids. Bravo. But they’re all different. Most have cones; some even have hurdles. Most the time the girls are not executing the warm up with good form. Recently, I saw girls with good form but they had to dodge equipment left in their running path. Coach, Injury Prevention, please?

Unfortunately, though, many coaches are just sitting and talking strategy with their kids. Little to no warm up. (ugh!)

So, if your child is playing soccer – particularly if she is a she – be sure your coach does injury prevention training.

If your coach is running an injury prevention warm up, how do you know if it will be effective. First, be sure the coach is paying attention during the drills. He/she shouldn’t send the kids off to “do their warm up” but must insist on proper form and intensity. Here are the components identified in successful injury prevention programs:

  1. high intensity plyometric training with instruction and feedback about controlling the landing with soft, flexing knees
  2. balance training – single leg static and dynamic landings
  3. core stability training – trunk and torso strengthening
  4. hamstring strengthening
  5. training frequency more than 1x/week for at least 6 weeks (Myklebust et al 2003)
  6. compliance is essential. otherwise you are wasting your time.
  7. This is more than a warm up, but once they have developed healthy biomechanics, this will sustain them during play.

Programs have the best chance of effectiveness if they are:

  • sport-specific
  • age-appropriate
  • designed and implemented by a knowledgeable instructor
  • ideally, incorporated into team practice and training sessions

At Fit2Finish we designed our initial programs based on Dr. Hewett’s work, but modified the activities for a younger population of athletes. Plus, we made them into games so they are more fun than “working out” and can easily be incorporated by coaches into practices using only simple equipment.

We’re frog-hopping for plyometric fun. (and healthy knees)


To date, no ACL injuries have been reported on teams who have employed the F2F program. Rich Gleason, with the Chantilly Firecats (shown here in 2004) who are now a U18 team with a national ranking of #4 writes…


 ” I always enjoyed your “classes” and the girls always had a great deal of fun with them…and the big bonus was that they learned a lot during the classes too. In all those years, we only had one with a knee injury and it was one of the “new” kids who hadn’t been through your classes. Thanks again.”

I began working with them when they were U10’s. We had fun AND got them off to a good start. It’s paid off, wouldn’t you say?

Find out more about Fit2Finish on our website. Contact Wendy LeBolt, PhD, founder and CEO here.

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