Recovery Insights Blog | Foundational Rehab

Understanding ACL Injuries

The anterior cruciate ligament (ACL) is one of the major stabilizing ligaments of the knee. ACL tears are devastating injuries that:

Often require surgery

Take 9-12 months to recover

Increase risk of knee arthritis

Have significant re-injury rates (15-25%)

Good news: 50-70% of ACL injuries are preventable with proper training.

Who Is at Risk?

Sports with High ACL Risk

Soccer

Basketball

Volleyball

Football

Skiing

Lacrosse

Handball

Risk Factors

Female athletes (3-6x higher risk than males)

Previous ACL injury

Poor neuromuscular control

Knee valgus (knees caving in)

Weak hamstrings relative to quads

Fatigue

Poor landing mechanics

How ACL Injuries Happen

Non-Contact Injuries (70%)

Most ACL tears happen without contact:

Landing from a jump

Cutting or pivoting

Sudden deceleration

Awkward landing position

Common position at injury:

Knee relatively straight

Knee collapsing inward (valgus)

Foot planted

Body rotating over planted foot

Contact Injuries (30%)

Direct blow to the knee, often from the side.

Prevention Program Components

1. Neuromuscular Training

Single-Leg Balance

Stand on one leg, 30 seconds

Add eyes closed

Add arm movements

Add unstable surface (foam pad)

Balance with Perturbation

Stand on one leg

Partner gently pushes you

React to maintain balance

Builds reactive stability

2. Plyometric Training (Landing Mechanics)

Box Drops with Stick

Step off 12-inch box

Land softly with bent knees

Knees track over toes (not caving in)

Stick the landing (no wobble)

Broad Jump to Stick

Jump forward

Land on both feet

Absorb through hips and knees

Knees aligned over feet

Single-Leg Hop and Hold

Hop forward on one leg

Land softly

Control the landing for 3 seconds

Progress to lateral and diagonal hops

3. Strength Training

Hamstring Focus

Hamstrings are ACL's "helper muscle" — they resist forward tibial translation.

Nordic hamstring curls (gold standard)

Romanian deadlifts

Hamstring curls

Single-leg deadlifts

Glute and Hip Focus

Strong hips prevent knee valgus.

Hip thrust

Clamshells with band

Lateral band walks

Single-leg hip hinges

Quadriceps (Balanced)

Squats (proper form)

Lunges

Step-ups

Leg press

4. Cutting and Pivoting Technique

Deceleration Training

Forward running to controlled stop

Learn to "sink" into stop (bent hips and knees)

Practice slowing over several steps

Cutting Technique

Plant foot should be outside body

Knee bent during cut

Push off from whole foot

Avoid straight-leg planting

FIFA 11+ Program

The FIFA 11+ is the most researched ACL prevention program. Originally designed for soccer but applicable to all sports.

Structure:

Running exercises (8 min)

Strength and plyometrics (10 min)

Advanced running (2 min)

Key exercises include:

Running with hip and shoulder contact

Single-leg balance

Nordic hamstring curls

Jump and landing drills

Running with change of direction

Evidence: Reduces ACL injuries by 50-70% when performed 2-3x/week.

Sample ACL Prevention Routine

Warm-Up Component (Before Practice/Games)

1. Jogging: 2 min

2. Lateral shuffles: 30 sec each direction

3. Backward running: 1 min

4. Single-leg balance: 30 sec each leg

5. Forward lunges: 10 steps

6. Lateral lunges: 5 each direction

7. Jump squats (controlled landing): 8 reps

8. Vertical jumps with stick landing: 5 reps

Strength Component (2x/Week)

1. Single-leg Romanian deadlift: 3 x 8 each

2. Goblet squats: 3 x 10

3. Lateral band walks: 3 x 15 each direction

4. Nordic hamstring curls: 3 x 5-8

5. Single-leg hop and hold: 3 x 5 each

6. Plank: 3 x 30 sec

Key Landing Cues

When landing from a jump:

**Soft knees** — Land with bent knees

**Quiet landing** — Less sound = better absorption

**Knees over toes** — Not collapsing inward

**Hips back** — Absorb with hips, not just knees

**Trunk control** — Stay balanced, not leaning

When to Start Prevention

Youth athletes: Begin around age 12-14

Before the sports season starts

Continue throughout the season

Year-round for high-risk athletes

The Bottom Line

ACL prevention essentials:

1. Hamstring strength — Nordic curls are king

2. Hip strength — Prevents knee valgus

3. Landing mechanics — Soft, controlled, aligned

4. Neuromuscular training — Balance and reaction

5. FIFA 11+ works — 50-70% injury reduction

Foundational Rehab offers sport-specific injury prevention programs.

ACL Injury Prevention: Exercises to Protect Your Knees