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Important Info for Coaches on ACL prevention

Over the past 20 years, there has been an increase in the number of anterior cruciate ligamant (ACL) injuries in the knee.  With that increase has come more research on how to reduce the risk of an ACL tear.  It is evident that performing a neuromuscular training program and possibly implementing this program into a warm up and/or cool down, can be beneficial in reducing the number of injuries.  From the review of some of the research that we have done at Omaha Physical Therapy Institute, we have found the following information to be important for coaches to know.

Important considerations for coaches about injury reduction programs:

1.  Summary meta-analysis showed an overall 50% reduction in the risk of all ACL injuries in all athletes and a 67% reduction for non-contact ACL injuries in females with the implementation of appropriate injury reduction programs. (13)

2.  Implementation of injury reduction programs should be done at an early age. Fewer ACL injuries were documented in younger athletes who performed a neuromuscular training program compared to older athletes who performed the same program. (2, 3)

3.  Goal is to have at least 20 minutes of exercises focusing on neuromuscular training involving strength, plyometrics, and sport specific agility, at least 3 times per week.  Studies have shown that compliance greater than 66% resulted in an ACL injury reduction rate of 82%.  This training program should be implemented in pre-season and carry through the season as well.  (8)

4.  It is important to be consistent with implementation and always cueing/enforcing good-sound loading and unloading mechanics with the exercises suggested. “Try to keep your knees out when landing.”  Faulty biomechanics and an increased knee valgus (knees collapsing inward) were strong indicators of increased ACL injury risk in several studies.  (4, 5, 6)

5.  Exercises need to target the following: core activation, hip stabilization, balance, proprioception, agility specific to sport, strength training with focus on form, double and single limb plyometrics.  Wake up the nervous system and train it to become efficient with proper muscle firing patterns to protect joints against expected and unexpected forces. (1, 2, 10, 11, 12, 13)


  1. 1. Mandelbaum BR, Silvers HJ, Watanabe D, et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: two-year follow-up. Am J Sports Med. 2005;33:1003–1010. doi: 10.1177/0363546504272261.
  1. 2. Myer GD, Sugimoto D, Thomas S, Hewett TE. The influence of age on the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a meta-analysis. Am J Sports Med. 2013 Jan; 41(1):203-15.
  1. 3. Steffen K, Myklebust G, Olsen OE, Holme I, Bahr R. Preventing injuries in female youth football–a cluster-randomized controlled trial. Scand J Med Sci Sports. 2008 Oct; 18(5):605-14.
  1. 4. Hewett TE, Myer GD. The mechanistic connection between the trunk, hip, knee, and anterior cruciate ligament injury. Exerc Sport Sci Rev. 2011 Oct; 39(4):161-6.
  1. 5. Hewett TE, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, van den Bogert AJ, Paterno MV, Succop P. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005 Apr; 33(4):492-501.
  1. 6. Hewett TE, Torg JS, Boden BP. 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. Br J Sports Med. 2009 Jun; 43(6):417-22.
  1. 7. Sugimoto D, Myer GD, Bush HM, Klugman MF, Medina McKeon JM, Hewett TE. Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes: a meta-analysis. J Athl Train. 2012 Nov-Dec; 47(6):714-23.
  1. 8. Joy EA, Taylor JR, Novak MA, Chen M, Fink BP, Porucznik CA. Factors influencing the implementation of anterior cruciate ligament injury prevention strategies by girls soccer coaches.J Strength Cond Res. 2013 Aug; 27(8):2263-9.
  1. 9. Benjaminse A, Gokeler A, Dowling AV, Faigenbaum A, Ford KR, Hewett TE, Onate JA, Otten B, Myer GD. Optimization of the anterior cruciate ligament injury prevention paradigm: novel feedback techniques to enhance motor learning and reduce injury risk. J Orthop Sports Phys Ther. 2015 Mar; 45(3):170-82.
  1. 10. Gilchrist J, Mandelbaum BR, Melancon H, et al. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med. 2008;36:1476–1483. doi: 10.1177/0363546508318188.
  1. 11. Grimm NL, Jacobs JC Jr, Kim J, Denney BS, Shea KG. Anterior Cruciate Ligament and Knee Injury Prevention Programs for Soccer Players: A Systematic Review and Meta-analysis. Am J Sports Med. 2015 Aug; 43(8):2049-56.
  1. 12. Webster KE1Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. J Orthop Res. 2018 Oct;36(10):2696-2708. doi: 10.1002/jor.24043. Epub 2018 Jun 13.
  1. 13. Nessler T, Denney L, Sampley J. ACL Injury Prevention: What Does Research Tell Us? Curr Rev Musculoskeletal Med. 2017 Sep;  10(3): 281-288. Epub 2017 Jun 27.

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