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Can We Prevent ACL Injuries?

The statistics we often hear about anterior cruciate ligament (ACL) re-injury rates are pretty scary. While the statistics vary: anywhere from 30-50% of patients who go through ACL reconstruction will suffer a second injury to their ACL or meniscus within 5 years. This makes both prevention of initial ACL injuries as well as prevention of secondary injuries extremely important. This article will take a look at what you can do for ACL injury prevention!


What Are ACL Injury Prevention Programs?

ACL injury prevention programs are exercise programs designed to prevent both primary (first time) ACL injuries as well as secondary injuries after an ACL reconstruction surgery. Because of the prevalence of ACL injuries today, particularly in females, there are a number of exercise-based prevention programs. These include ACL injury prevention programs as well as general knee injury prevention programs for specific populations, such as the the FIFA 11 program which reduced knee injury rates in soccer players by 30%! The American Academy of Sports Physical Therapy and the Academy of Orthopedic Physical Therapy took the time to collect all programs available and synthesize the key components for an exercise program to prevent both knee and ACL injuries.


What are the Keys to preventing an ACL injury?

The ACL injury prevention programs that have the most success include some key components. Firstly, the most effective programs were performed at least twice/week for periods > 20 minutes as a time. Additionally, all successful programs focused on strength training. Strength of the lower extremity, especially the quadriceps, has been shown decrease ACL injury risk substantially. In fact, after ACL surgery, every 1% increase in quadriceps strength led to a 3% reduction in re-injury rate.


knee extension machine quad strength acl injury prevention the prehab guys


Quad Strengthening Exercise Example

Sample ACL Injury Prevention Program Exercise

The Bulgarian Split Squat is a great way to target not only the quadriceps, but the glutes and the rest of the lower quarter as well! Looking for some strategies to help you master this movement. Lucky you, we have a whole article on the bulgarian split squat you can read HERE!


Are You Looking For An ACL Injury Prevention Program?

knee program acl injury prevention the prehab guys

Do you want a program that can show you how to put you in the best position to prevent ACL injury?ย This is the program for you. This is a Doctor of Physical Therapy designed program, that will take you step-by-step through progressive phases of exercises, packed with education and resources specifically for you. Click HERE to decrease your ACL injury risk today.


The Importance of Plyometric Exercises

Another crucial component is the inclusion of plyometric or jumping exercises. These exercises should be performed with a focus on landing mechanics and the inclusion of intermittent feedback on these landing mechanics.

ย Tuck Jump

Sample ACL Injury Prevention Program Exercise


Lateral Bound

Sample ACL Injury Prevention Program Exercise

The lateral bound is a great way to train jumping and plyometric movement in a side-to-side (frontal plane) direction. We are meant to move in all 3 planes of movement, especially with sports and other daily activities!


Want To Learn More About Plyometric Exercises? Watch This Video!


Deceleration Control Exercises

Programs that successfully reduced ACL injuries also included proximal control exercises such as those focusing on core and trunk strength. Stability of the core and trunk help athletes during change of direction and deceleration activities where the ACL is at the highest risk of tearing.

Anterior Lunge Deceleration – Med Ball

Sample ACL Injury Prevention Program Exercise


Will improving balance decrease my risk of injury?

Interestingly, programs focused primarily on balance exercises were not successful at reducing knee and ACL injuries. While this does not mean that balance exercises have no value, we know that they should not be the focus of an ACL injury prevention program. Incorporating balance may be appropriate after the requirements for strength, plyometric, and proximal control exercises have been met. If you are looking for some different balance exercises, read this article.


Closing Thoughts:

ACL injury prevention programs work when they include some key components. These include:

  • Strength Training


  • Jump-landing Mechanics training


  • Core and Trunk Strengthening exercises.


When performed at least twice a week for > 20 minutes consistently, programs that include these components have been shown to:

  • Reduce the risk of ACL injury in athletes by 43%



While balance may be included in an ACL injury prevention program, it should not be the focus of one and should not take time away from the more important elements listed above. If you’re looking to listen to more content related to the ACL, check out this podcast episode below!


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  1. Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport.ย Am J Sports Med. 2014;42(7):1567-1573. doi:10.1177/0363546514530088
  2. ร˜iestad BE, Engebretsen L, Storheim K, Risberg MA. Winner of the 2008 Systematic Review Competition: Knee Osteoarthritis after Anterior Cruciate Ligament Injury.ย The American Journal of Sports Medicine. 2009;37(7):1434-1443. doi:10.1177/0363546509338827
  3. Sadigursky, D., Braid, J.A., De Lira, D.N.L.ย et al.The FIFA 11+ injury prevention program for soccer players: a systematic review.ย BMC Sports Sci Med Rehabil9,ย 18 (2017).
  4. Arundale AJH, Bizzini M, Giordano A, et al. Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention.ย J Orthop Sports Phys Ther. 2018;48(9):A1-A42. doi:10.2519/jospt.2018.0303
  5. Grindem H, Snyder-Mackler L, Moksnes H, et alSimple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort studyBritish Journal of Sports Medicine 2016;50:804-808.
  6. Sugimoto D, Myer GD, McKeon JM, et alEvaluation 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 analysesBritish Journal of Sports Medicine 2012;46:979-988.


About The Author

Tommy Mandala, PT, DPT, OCS, SCS, CSCS

[P]Rehab Writer & Content Creator

tommy mandala the prehab guys acl injury prevention Tommy Mandala is currently a Doctor of Physical Therapy and Board Certified Clinical Specialist in Sports from New York City, where he specializes in ACL Rehab. Prior to that he trained as a sports resident at the University of Delaware working with the ACL researchers in the field. He has additional experience working with the Philadelphia 76โ€™ers NBA G-league affiliate, the Delaware Blue Coats. His experiences have given him a passion and expertise for treating patients struggling with ACL Rehab. One of his favorite aspects of his job is empowering patients to return to sports with full confidence in their knee after ACL Reconstruction.


Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

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