ACL Injury Prevention for Female Athletes: What Parents and Coaches Should Know
Why Should Parents Be Thinking About ACL Prevention?
Fall sports bring some of the highest-risk movements for ACL injuries. It is difficulty to fully prevent these injuries but we can significantly reduce the probability of these injuries occuring.
Young athletes in soccer, volleyball, football, basketball and other cutting or jumping sports repeatedly perform:
Sprinting
Cutting
Jumping
Landing
Deceleration
Rapid changes of direction
ACL injuries can be devastating for young athletes. These injuries take them out of their sports, out of their element and away from their fellow sports friends.
They can result in surgery, months of rehabilitation, missed seasons and significant physical and psychological challenges.
The good news?
There are modifiable physical factors that can be addressed.
ACL prevention isn't about guaranteeing that an athlete will never get injured.
It's about improving the athlete's ability to produce and absorb force and better prepare them for the demands of their sport.
Why Are Female Athletes at Higher Risk?
Research has identified differences in ACL injury rates between male and female athletes, particularly in certain sports.
There isn't one single reason.
Potential contributing factors include:
Strength
Neuromuscular control
Landing mechanics
Deceleration ability
Training history
Hormonal factors
Anatomy
Sport exposure
Fatigue
The important takeaway is that there isn't one exercise that prevents ACL injuries. If there was, we would prescribe that all the time and to everybody!
A comprehensive approach is better.
Build Lower-Body Strength
Strength is the foundation. You have heard us say this before and we will continue to say this to you relentlessly.
Athletes should develop the ability to produce force through:
Quadriceps
Hamstrings
Glutes
Calves
Exercises may include:
Squats
Split squats
Lunges
Romanian deadlifts
Step-ups
Hamstring curls
Calf raises
Strength training should be progressive and appropriate for the athlete's age and training experience.
Develop Single-Leg Strength
Sport is rarely performed with both feet planted evenly on the ground.
Athletes sprint, cut, land and push off one leg at a time.
Therefore, single-leg training matters.
Examples include:
Rear-foot elevated split squats
Single-leg Romanian deadlifts
Step-downs
Single-leg squats
Single-leg calf raises
Train Deceleration
One of the biggest mistakes in injury prevention is focusing only on acceleration.
Athletes need to learn how to slow down.
Deceleration training can include:
Controlled stops
Sprint-to-stop drills
Lateral deceleration
Single-leg braking
Cutting drills
The ability to absorb force is just as important as the ability to produce it.
Teach Jumping and Landing
Landing is a skill.
Athletes should progressively learn how to:
Land
Absorb force
Stabilize
Rebound
Jump repeatedly
This doesn't mean every athlete needs to use one perfect landing technique.
Instead, athletes should develop enough strength, coordination and control to handle different landing situations.
Build Hamstring Strength
The hamstrings play an important role in lower-extremity force production and knee control.
They should be trained through multiple movement patterns.
Examples include:
Romanian deadlifts
Hamstring curls
Nordic variations
Single-leg hinges
Strength should then be integrated into sport-specific movement.
Don't Forget the Calves and Feet
ACL prevention shouldn't only focus on the knee.
The entire lower extremity contributes to how force is absorbed.
Foot and ankle limitations can influence lower-extremity mechanics.
Athletes should develop:
Calf strength
Ankle mobility
Foot control
Single-leg stability
This may also help reduce other common fall sports problems such as:
Plantar fascia irritation
Achilles tendon pain
Shin pain
Ankle sprains
Address Hip Strength
The hips are critical for controlling the lower extremity during single-leg movements.
DynaMo testing can provide objective information regarding:
Hip abduction
Hip extension
Other relevant strength measures
Rather than simply telling an athlete that their hip is "weak," objective testing allows clinicians and athletes to track meaningful changes.
Use Objective Testing
At Carolina Movement Doc, we use technology such as VALD ForceDecks and DynaMo to add objective information to the evaluation process.
ForceDecks can assess characteristics such as:
Jump performance
Force production
Landing
Asymmetry
DynaMo can measure strength across multiple muscle groups.
This can help establish a baseline and track progress.
Movement Analysis Matters
An athlete can have good strength but still struggle with movement.
A performance assessment may evaluate:
Squat
Can the athlete control the lower extremity under load?
Single-Leg Squat
Can they maintain control when the demand becomes unilateral? This is likely the difference maker when it comes to side-by-side comparison.
Jump
Can they produce force?
Landing
Can they absorb force?
Deceleration
Can they safely slow down? (this is when we say “put on the brakes”)
Cutting
Can they control the body during rapid changes of direction?
This is much more comprehensive than simply performing a few exercises and calling it ACL prevention.
ACL Prevention Should Be Sport-Specific
A volleyball player experiences different demands than a soccer player.
A soccer player experiences different demands than a football player.
Therefore, ACL prevention should eventually progress into the movements athletes actually perform.
For example:
Strength → jumping → landing → acceleration → deceleration → cutting → reactive movement → sport-specific drills
The goal is to prepare the athlete for unpredictable situations.
Don't Forget Training Load
Even a very strong athlete can become injured if training load increases too quickly.
Pay attention to sudden changes in:
Practice frequency
Game volume
Tournament schedule
Conditioning
Sprinting
Jumping
Strength training
Athletes need recovery.
A young athlete shouldn't be expected to go from relatively low summer activity directly into full-intensity practices every day without an appropriate transition.
ACL Prevention Isn't Just About ACLs
One of the biggest benefits of a comprehensive performance program is that the same physical qualities that may help reduce ACL injury risk can also improve overall athletic performance.
Strength, power, deceleration and movement control can help athletes become better at:
Sprinting
Jumping
Cutting
Changing direction
Absorbing contact
Producing force
And improving overall physical capacity may also help address other common complaints such as:
Knee pain
Patellar tendonitis
Achilles tendonitis
Plantar fasciitis
Hamstring strains
Ankle injuries
Low back pain
When Should an Athlete Get Tested?
A preseason assessment can be particularly valuable for athletes who:
Have a previous ACL injury
Have a history of knee pain
Have recurring ankle injuries
Demonstrate strength differences
Are returning from an injury
Are entering a higher level of competition
Want to improve athletic performance
Testing isn't about giving an athlete a simple "pass" or "fail."
It's about identifying opportunities for improvement.
Build a More Resilient Athlete
ACL injury prevention shouldn't be a 10-minute warm-up that athletes perform twice per week and forget about.
It should be part of a larger training system.
At Carolina Movement Doc, we combine:
Objective testing + movement analysis + strength training + plyometrics + deceleration + sport-specific performance training
to help young athletes build the physical qualities necessary to perform at a high level.
If you're a parent, coach or athlete preparing for the fall season, don't wait until an injury happens to find out where the weaknesses are.
Test. Train. Build capacity. Perform.
Carolina Movement Doc is here to help young athletes in Gaston County and the greater Charlotte area prepare for their sport—not just recover from it.
