Torn ACL

ACL Rehabilitation Program

Since the inception of Title IX in 1972, a federal law that allowed young women to participate in sports and athletic events, there has been a surge in female participation in organized sports both at high school and college levels. This increase in participation has been associated with an increase in the number of injuries in female athletes, specifically, injury to the anterior cruciate ligament (ACL). Female athletes are reported to be eight to ten times more likely to sustain a non-contact ACL injury than a male athlete, of the same age, playing the same sport. The highest incidence being reported in individual’s 14-25 years of age. Injury to the ACL often requires surgery to repair the ligament, followed by 6-9 months of rehabilitation before the athlete can return to their sport. The high physical, emotional and financial cost of this severe knee injury has prompted investigation into risk factors and prevention strategies for this injury.

How do ACL injuries occur in female soccer players?

70% of young female ACL injuries are non-contact injuries, caused by:

  • Sudden explosive leg movements on the part of the athlete.
  • Deceleration (slowing down) maneuver combined with a change in direction while the foot is
    in a planted position.
  • Landing from a jump with the knee almost straight (with decreased hip and knee bend).

Prevention programs:

There are several programs focusing on the prevention of ACL tears in female soccer players that have been proven to reduce severe ACL injuries by 89%. The programs consist of a warm-up, stretching, strengthening, plyometrics (training for power or explosiveness-jumping, bounding and hopping exercises) and soccer specific activities to optimize the strength and co-ordination of the stabilizing muscles around the knee joint.

The programs focus on the following:

  1. Training female soccer players to bend their hips and knees when landing from a jump.
  2. Maintaining proper knee alignment.
  3. Replacing one stop step or change in direction movements with multiple stop step movements.
  4. Promoting better neuromuscular firing patterns, allowing the hamstring muscles to assist in
    stabilizing the knee joint.

These modifications will improve biomechanical aspects of many of the common movements found in soccer by increasing the stability of the knee.

Program Duration:

Athletes must participate in the injury prevention program three times a week, for 15 minutes at a time, for 6-8 weeks in order for the injury prevention program to become effective. The injury prevention program is to be used in place of a general warm-up program during the regular season.


The incidence of non-contact ACL injuries is reported as 2-10 times greater in young women compared to young men. Although various internal and external factors may predispose a female athlete to injury, prevention strategies that focus on biomechanical and neuromuscular factors are beneficial for reducing injury risk in young female athletes. Routinely including sprint, agility and jumping drills with specific movement cues will help to improve faulty movement mechanics and reduce the risk of non-contact ACL injuries in female athletes.