ACL injuries should be on the decline since we know that ACL injury prevention programs like the FIFA 11+ significantly reduce the risk of this injury. But instead, they’re on the rise — especially among high school athletes and particularly among high school female athletes in running, jumping and cutting sports like soccer, basketball, field hockey and lacrosse.

Not all injuries can be prevented. A vicious tackle from behind can take out an ACL in a split second. But the non-contact ACL tear, the plant and cut ACL tear, the shove and give-way ACL, the straight-legged land and pop ACL — these are injuries we can knock down by half if we train our athletes right.

So how do we do this?

Here’s the key: the ACL in a bent knee, hinged with proper alignment, with balanced muscular support (front-to-back), is nearly impossible to tear. That is, the body in good athletic position, is prepared to play and stay healthy. I call it the “B-B-B”: Bend your knees, Balls of your feet, Balance heads up and ready to play.

The challenge is: kids, particularly girls, have not developed their game using this body positioning. They tend to bend from the waist, not the knees. They jump and land straight-legged. They cut and turn relying on strong quadriceps which over-power weak hamstrings. We need to address those movement errors to protect their joints.*

Here are your cues to coaching healthy body position to prevent ACL injuries:

Teach them to bend their knees in a perfect squat

• “the perfect squat looks like this: – not helpful because they can’t see themselves, so a band around their legs gives physical feedback of their body position
• demonstrate it perfectly. Sink the hips back and down with knees going no further forward than the toes.
• strengthen it by monster-walking right and left
• make it balanced by jumping and landing in place with cone marker

Teach them to jump and land quietly on the balls of their feet

• Show them where the balls of their feet are. Have them touch the place on their feet/shoes/cleats. Don’t assume they KNOW .
• Do not have them “land on their toes.” We have gotten into a bad habit of saying “stay on your toes” to kids and they start tip-toeing and rocking onto their tip toes – completely out of balance. NO. Balls of their feet has them rolling forward and back in good balance on the mid-foot.
• Jumps should go up “straight as an arrow” and land “light as a feather.” Quiet landing will demand they bend the knees.
• See who can go higher AND be quieter. Make it a competition.

Translate the knee bent position into their change of direction

• Practice side to side movement touching tall cones on each side while facing forward. Keep safe good knee bending position.
• Challenge them to sink lower to touch cone without bending over. (head stays up)
• Set up cones in a diagonal course. At each cone, sink to touch to change direction. This reinforces good knee and body position.
• Start with shorter, narrow course to get good position. Widen the cones to develop pace while keeping safe change of direction.

Translate the B-B-B Position into Game Movement

• Once players know and can feel the BBB position, insist they use it in all drills which require footwork, touches, acceleration and deceleration, change of direction, jumps and landings.
• Reinforce good body control in all playing circumstances – on the ground and in the air. Undisciplined, reckless play is dangerous and ineffective.
• Work on good BBB body position when tackling and when being challenged for the ball.

The Gold Standard to Wipe Out ACL injury … start with free play

Because children often don’t participate in neighborhood free play these days, youth sports instruction may be their first introduction to getting to know their body and how it moves. If you work with young children 3-5 years old, please scrap the game plan, the strategy sheet and the scoring play. Let them run around, play tag, duck-duck goose, jump rope, hop scotch, steal the bacon… or a game of their own creation. This is how they will learn who they are when they move.

As a friend described it, I want to see animals in the wild of the Serengetti, not the confines of the zoo. The same with our children. Let’s let them run free in the field, not the enclosure of positions on offense and defense. There’ll be plenty of time for the 4-3-3 or the 5-4-1 when the time comes.

Here’s more on ACL Injuries: Prevention and Recovery.