ACL Injury Prevention Exercises for Young Athletes

     Female athletes are 4-8 times more prone to tearing their ACL than males in the same age groups. Although the anterior cruciate ligament can be torn with sudden contact, the most common mechanism of injury for tearing the ACL is actually non-contact (pivoting and cutting sports such as soccer and basketball). 

     The injury usually occurs when the tibia (leg bone) internally rotates on an externally rotating femur (thigh bone) while the foot is planted to the ground, creating a torsional friction stress and a tear internally across the ligament.

     In the recent years, studies have been emerging on why female athletes are more prone to tearing this ligament. There are theories that have investigated increased values among female athletes (inward collapse of the knees) upon landing, less absorptive landing such as "landing on a straight knee", and muscular weakness. Although there are a few studies that highlight hormonal influences as possible factors influencing ACL ruptures. Lastly, women have wider pelvis and more flexible hips than men causing a greater tendency to be in genu valgum. 

     Because of these studies and focus, in the recent years, there are more and more preventative exercises specifically designed to help prevent ACL injuries among female athletes. Males can do these too, of course! 

I have always classified majority of my treatment regimens into four types:
1. Stability training (includes proprioception, balance)
2. Mobility drills (dynamic warm ups, flexibility routines)
3. Strength training (weight training)
4. Functional (return to sport, return to work)

     These exercises I am highlighting might fall into any of the four I listed above. These were published on the latest edition of the Current Concepts of Orthopedic Practice for Physical Therapists. My purpose is to educate trainers, coaches and therapists alike into preventative measures and to be able to help these young athletes get to a level they deserve without injuries. It is not my goal, however, to change your programing (if you were a trainer or coach) but rather help you understand why including some of these (or all of these) in your programming will eventually help the holistic approach we all do for our clients. Please note that programs incorporating strengthening and proximal control reduced the injury risk by 68% and 67% respectively!

     In a study performed by Sugimoto and associates, they concluded that ACL prevention programs should be structured with the following:
1. multi-plane movements
2. unilateral and bilateral activities
3. incorporating unanticipated reaction type movements simulating game scenarios
4. correct foot positioning in cutting and dynamic activities
5. consider implications of playing surface, fatigue and prophylactic bracing

Here are the preventative exercises. 

1. Squat with isometric holds

  • Advice to client: keep the feet within shoulder width apart, knees do not cross toes, keep leg as vertical as possible (keeping knees over ankles when possible)
  • What to watch out for: look out for the alignment of the knees over the ankles, watch for equal weight bearing.
2. Lunges
  • Advice to client: make sure knees do not cross toes (valgus), keep your posture upright
  • What to watch out for: look out for the alignment of the knees over the ankles, watch for equal weight bearing, check pelvic alignment ensuring it is symmetrical if possible.
3. Squat jumps with soft landing
  • Advice to client: keep feet within shoulder width apart, stick the bottom out when you perform the squats, keep knees over ankles, explode upwards using full hip and knee extension with ankles providing a good force up, land softly.
  • What to watch out for: look out for the knee alignment, check to make sure knees do not cross toes, no valgus!
4. Box jumps
  • Advice to client: perform this jump and land softly, keeping the knees in line with the shoulders, knees over ankles
  • What to watch out for: look out for proper alignment of knees over ankles
5. Single leg lateral jumps
  • Advice to client: knees in line with toes, do not bow knees in or out, keep posture upright and land softly
  • What to watch out for: proper alignment of the knee over ankle, ensure knee do not cross toes, no pelvic drop during single leg stance

Written and compiled by

Physical Therapist, Board Certified Orthopedic Clinical Specialist


1. Sugimoto D1Myer GDMcKeon JMHewett TEEvaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses.  2012 Nov;46(14):979-88. doi: 10.1136/bjsports-2011-090895. Epub 2012 Jun 28.

2. Mihata LC1Beutler AIBoden BPComparing the incidence of anterior cruciate ligament injury in collegiate lacrosse, soccer, and basketball players: implications for anterior cruciate ligament mechanism and prevention. 
 2006 Jun;34(6):899-904. Epub 2006 Mar 27.

3. Prodromos CC1Han YRogowski JJoyce BShi KA meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen.  2007 Dec;23(12):1320-1325.e6.

4 1995 Apr;19(4):288-302. Knee injuries in female athletes.Hutchinson MR1Ireland ML.

5. . 2007 Aug; 41(Suppl 1): i52–i59. Prevention of anterior cruciate ligament injury in the female athlete Holly Jacinda Silvers and  Bert R Mandelbaum

6.  2009 Jun;43(6):417-22. doi: 10.1136/bjsm.2009.059162. Epub 2009 Apr 15. Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: lateral trunk and knee abduction motion are combined components of the injury mechanism. Hewett TE1Torg JSBoden BP.

7.  2007 Mar;35(3):368-73. Epub 2007 Jan 31. The effects of core proprioception on knee injury: a prospective biomechanical-epidemiological study. Zazulak BT1Hewett TEReeves NPGoldberg BCholewicki J.

8.  2000 May-Jun;8(3):141-50. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. Griffin LY1Agel JAlbohm MJArendt EADick RWGarrett WEGarrick JGHewett TEHuston LIreland MLJohnson RJKibler WBLephart SLewis JLLindenfeld TNMandelbaum BRMarchak PTeitz CCWojtys EM.

9.  2006 Sep;34(9):1512-32. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Griffin LY1Albohm MJArendt EABahr RBeynnon BDDemaio MDick RWEngebretsen LGarrett WE JrHannafin JAHewett TEHuston LJIreland MLJohnson RJLephart SMandelbaum BRMann BJMarks PHMarshall SWMyklebust GNoyes FRPowers CShields C JrShultz SJSilvers HSlauterbeck JTaylor DCTeitz CCWojtys EMYu B.

10.  2015 Mar;49(5):282-9. doi: 10.1136/bjsports-2014-093461. Epub 2014 Dec 1.
Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis.
Sugimoto D1Myer GD2Foss KD3Hewett TE4.


  1. Great blog, thanks for sharing such a great post with us, it is really very useful for Dr. Shailendra Patil thane


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