In 2015 statistics show ~200,00 ACL tears happen annually. To say this is a major problem would be an understatement.

“Females suffer UP TO 9 TIMES more ACL tears than male athletes.” says David Black, Physical Therapist at ORS.  ACL injuries are significant for a number of reasons.


  1. Pain
  2. Loss of Multiple Sport Seasons
  3. Potential Loss of Scholarship
  4. Cost
  5. Surgery
  6. Physical Therapy
  7. Greater Risk of Osteoarthritis

In fact, the North American Journal of Sports Physical Therapy (Dec 2010) stated that females have had an almost “epidemic rise” in ACL injuries since the introduction of Title IX in 1972.

So, for you Mom, Dad or Coach if you read that or have seen reports or stories of other athletes that have gone through this injury, you might be a little concerned, especially if you are a parent or coach of a female athlete! We get it!  We know how important of an issue this is.

Not all of these issues can currently be altered or addressed, and the number of ACL injuries that occur each year will never be zero.  There is however a way to SIGNIFICANTLY reduce the risk the your athlete tearing their ACL.

Every week, we have kids that walk through our doors looking to get better for their sport.  They’re not concerned about getting hurt, they just want to get FASTER, STRONGER & BETTER.  Behind them though are the parents that want to help fulfill a dream or achieve a goal.  They trust us to help their kids get better, but also to protect them as best we can and prepare them for their season.

When we look at our athletes, we have 2 rules.

  1. Do the very best we can to prevent injury.  Both Here and On the Field or Court
  2. Push them to be there best.

We can’t put our kids in a bubble and the risk of injury is always there, but we can make a difference.  There is good news for both those looking to prevent ACL injuries and those looking to recover to your prior level or go beyond that.

When looking at ACL injuries, we start by evaluating what we can and cannot control.

Contributing Factors to ACL injuries we CANNOT control:

  1. Direct Traumatic Contact Injury
  2. How Q Angle affects internal rotation of the knees.
  3. Hormones
  4. Females having a smaller ACL and Intercondy
  5. Playing surface, turf or grass or court conditions

Here’s what we CAN control:

  1. We can improve Movement Patterns.
  2. We can improve muscular imbalances
  3. Neuromuscular Patterns
  4. Overall Strength (Especially Core, Hip Abductor/Glute & Hamstring Strength)
  5. Training of Landing Patterns
  6. Training of Cutting Angles & Abilities
  7. Deceleration & Reacceleration Patterns

So how do we accomplish all of those things?

ACL Prevention Strategies

Research shows the reduced risk of ACL tears through proper neuromuscular training

Mike Boyle, world champion strength coach from the Boston Red Sox, Bruins and Boston University talks about how training an athlete is like a recipe.  All of these ingredients are important to make the meal work.  An ACL program should include multiple factors to reduce risk.  Actually, we think they are so good, we use them with all of our athletes. We have 5 Principles of Training:


  1. A Well Thought Out Warmup
  2. Change of Direction Strategies
  3. Landing Strategies & Technique
  4. Strengthening (Especially Single Leg Training)
  5. Change of Direction Conditioning


Let’s break down those 5 things:



The Purpose of the warm up is to:

  • Improve the tissue temperature and quality of a muscle
  • Get the body ready for the training session
  • Improve Overall Movement Patterns

We utilize the Joint by Joint approach created by Mike Boyle and PT Gray Cook, developer of the Functional Movement Screen.  This approach believes that:

  1. Human Movement is an interplay of Stable and Mobile Joints.
  2. Mobilize join that need mobilization  and work to build stability in the stable joints.
  3. We work from the ground up

What We Do:

  1. Ankle Mobility
  2. Hip Mobility
  3. Thoracic Spine
  4. Shoulder Mobility
  5. Hamstring Stretching
  6. Quad Stretching
  7. Anti Rotation & Flexion for Core

Next, we move into the dynamic portion of the warm-up

  1. Band Abduction for Glute Activation
  2. Band Walks: Lateral & Linear
  3. Ladder Drills for Neuromuscular Development
  4. Marching and Skipping
  5. Linear or Lateral Movement preparation


Change of Direction Strategies


The Purpose of Change of Direction Strategies is to:

  1. Teach deceleration
  2. Change direction with appropriate postures
  3. Teach Reacceleration

Lee Taft calls Multidirectional Speed, or Agility, the money maker for sport performance.  This is where we spend a significant amount of time playing, rather than just linear running.

We Teach:

  1. Posture
  2. Hip, Knee, Ankle Alignment
  3. Reduce Valgus Stress
  4. Reduce Straight Leg Landing
  5. Reduce One Step Landing with Knee Hyperextension
  6. Sway Stop

We are are trying to incorporate these patterns into an athletes neuromuscular system.  We want engrain these patterns in them, so when they are in practice or a game, their default will become these postures and techniques.

  1. Lower Hips
  2. Lean with Shoulders, Knees, Hips and Ankles
  3. Stay On the Balls of your feet

We utilize a series of programmed and reactive movements such as:

  • Shuffling
  • Crossover
  • Crossover to Sprinting
  • Multi-Directional Cutting and Changing Direction

Landing Strategies


Landing Strategies are critical for athletes.  Rarely is an athlete injured when jumping.  The majority of the time, injury occurs while landing.  We spend a significant amount of time locking in the patterns that will not only improve vertical and horizontal jumping, but also landing safely.  In or landing strategies, we work specifically to learn how to:

  1. Land Soft and Control their Eccentric Movement
  2. Land with Knees Straight Ahead, Bent, Not in a Straight Legged Position
  3. Control Upper Body Posture

We do this by practicing the following types of jumping and landing

  • Jumping  (2 leg takeoff – 2 Leg Land)
    • Forward
    • Rotational
  • Hopping (1 Leg Takeoff- Same Leg Land)
    • Forward
    • Lateral
    • Medial
  • Bounding (1 Leg Takeoff- Opposite Leg Land)
    • Medial
    • Lateral
    • Forward

Learning how to land is essential.  Having an athlete develop the ability to gain the strength and ability to control themselves is essential to reducing injury risks long term.

Strength Training


Getting stronger is crucial for preventing ACL injuries.  Increasing glue and hip strength has been shown to decrease values knee issues, leading to a reduction in ACL tears.  Strength is essential for improving sport performance as well.  Building stronger athletes will help to increase speed, vertical and broad jumping and handle the rigors of their sport.  Athletes should continually work to improve their strength in a progressive fashion.

  1. Control their own bodyweight
  2. Increase Functional Strength
  3. Improve Single Leg Strength and Stability

1.  Athletes should be able to control their own bodyweight first without additional load in exercises such as:

  • Squat
  • Lunge
  • Leg Raise
  • Pushup
  • Row/ Chinup

2.  Next, Athletes should begin building functional strength with external loads in exercises such as:

  • Goblet Squat (Quad)
  • Lunging
  • Deadlift (Hip)
  • Carries (Carry)
  • Pushup/ DB Bench
  • Row/ Chinup


3.  Following that, Single Leg Exercises should be included into athletic performance training.  Sport movements require athletes to be on one leg a significant amount of time.  The ability to display the strength necessary to get in and out of those positions explosively starts with strength.  Athletes should be able to maintain their bodyweight and then handle external loads in exercises such as:

  • Single Leg Deadlift
  • RFESS/ Split Squat


Change of Direction Conditioning

It is imperative that athletes are forced to train in changing direction when they are tired.  We need to focus on making directional changes when tired, so that pattern is programmed into the brain when they are in a game. For this, we utilize drills such as:

  1. Shuttles
  2. Line Drills
  3. Gassers


These 5 things are the principles of ACL Prevention, but also the principles of good athletic performance training.  It is important to train these patterns and drills appropriately, because what is done, is learned and retained in the brain.  We can make a significant reduction in the risk of ACL injuries, but also help our athletes achieve their goals by following these guidelines.