August 13, 2020

Anterior Cruciate Ligament Injury Prevention Program

‘You should be fit to play sport – not play sport to get fit’ Lesley Hall

No one wants to be out of their sport due to injury however, certain activities do carry an increased risk. Sports which involve contact, pivoting, jumping and cutting movements are often linked with serious lower limb injuries particularly around the knee and ankle ligaments. You may be aware that historically, cruciate ligament damage at the knee, was a career ending injury for many professional footballers; thankfully, with advances in knowledge and treatment this is no longer the case, but it is nevertheless, a serious injury which can mean a lengthy absence and failure to return to the same level.

In recent years there have been a significant number of studies showing that specific focus on certain aspects of training can directly reduce the incidence of these injuries. Most of the studies focused on reduction of ACL injuries, particularly in women, who inherently have an increased risk compared to men. Interestingly, studies found a decrease in all lower limb injuries, and programmes have now been tailored across various sports for both men and women, boys and girls.

The basic principle of any injury prevention scheme, is to ensure that adequate training encompasses the following key elements:

  1. Flexibility – optimise joint mobility and muscle length.
  2. Strength – It is imperative that the individual has the strength to participate in the relevant sport for the relevant time – lack of adequate strength leads to increased vulnerability to injury.
  3. Good technique during exercise and skills training will reduce vulnerability. Individuals need to have body awareness and work with coaches, teachers and trainers to develop this. The classic example of this is jump landing technique which is frequently a contributory issue in sports such as basketball, handball, football and netball.
  4. Incorporate rebound (plyometric) activities in the training programme.
  5. Increase speed and agility (proprioception) with appropriate training.

Example:                             Control of jump landing

Poor position
Ideal position


Note: feet pointing forwards, hip distance apart (the outside of the thighs are parallel). Softly flexed knees bending directly over the 2nd toe.

   Depth of bend on landing



    Soft landing on flexed hips and knees.

Much of the original work in this area was carried out on female soccer players in L.A. – see the ‘PEP’ programme (prevent injury, enhance performance), developed by the Santa Monica Orthopaedic and Sports Medicine Group. FIFA have developed the 11+ programme for young footballers. Both of these suggest a warm up programme done a few times per week, prior to training, which incorporates all of the above elements.

In recent years many more studies have replicated these results across various sports and such programmes are becoming an integral part, particularly of youth, training.

With regards to non professional or individual sportsmen and women, there may not be this help readily available and therefore it is up to you to find relevant information.

Here are some tips and examples you might like to incorporate in a regular training programme:

  1. Always gently warm up to get your blood flowing to your muscles and joints, before training or playing.
  • Flexibility is important to enable you to move freely and reduce the risk of stresses and strains – or tears, of tight structures. Don’t forget calves, quads, hamstrings, hip flexors, adductors, glutes and trunk. Do not stretch cold – after warm up and/or at the end of the exercise.
  • Strength – Your muscles control and protect your joints. Maintain adequate strength for your sport and always concentrate on getting this back before competing after a   holiday or lay off (close season!!!!!) – pre-season training is for this preparation.

Squats, lunges, steps, walking lunges, etc are all appropriate but good technique is imperative.


Split squats (step lunges)
  • Core strength – pay special attention to this. Bridging, plank etc, again with good technique.
  • Balance, speed and agility – Practice controlled movements/skills balancing on one leg, fast feet activities and change of direction activities – initially steady and controlled and gradually increasing speed and difficulty.
  • Plyometric – rebound and jump training – think about landing technique –  hips, knees and ankles in line and soft landing with flexed hips and knees.

As you can see, any training programme must contain multiple elements to give all round balanced fitness and this will minimise the risk of serious injury.


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