How to Prevent ACL Injuries: Build Stronger, Safer Knees for Sport
- williamholroyd
- Apr 14
- 5 min read
ACL injuries don’t just happen by chance. Whether it’s a footballer changing direction, a skier catching an edge or a runner landing awkwardly, there are usually underlying factors that increase the risk.
The important part? Most of them are trainable.
At Summit Rehabilitation in Tring, many of the ACL injuries we see, particularly from athletes travelling from Berkhamsted and surrounding areas share common patterns. This means prevention isn’t guesswork. It’s structured. If your goal is to stay active, avoid time out of sport and maintain long-term knee health, here’s what actually matters.
Why Do ACL Injuries Happen?
Around 70% of ACL injuries occur without contact, they typically occur when the knee is exposed to high force in a poor position, such as:
Landing from a jump with the knee collapsing inward
Sudden deceleration with an upright posture
Twisting on a planted foot
Poor control during single-leg loading
It’s not just the force that causes injury, it’s how your body absorbs and controls that force.
The 4 Key Risk Factors You Can Control
1. Poor Landing Mechanics
One of the most common patterns in ACL injuries is knee valgus collapse. This is where the knee drops inward during landing or cutting.
This often comes with:
Limited hip control
Weak glutes
Poor coordination
What good looks like:
Knees tracking over toes
Soft, controlled landing
Hips and knees bending together
2. Lack of Strength (Especially the Posterior Chain)
Strength is your first line of defence. Key muscle groups:
Glutes → control hip and knee position
Hamstrings → support the ACL by resisting forward tibial movement
Quadriceps → absorb landing forces
Calves → control deceleration
Strength deficits of 20–40% are common after ACL injury if not properly addressed, which increases the likelihood of poor movement mechanics and future injury risk. Without adequate strength, force goes straight to passive structures like ligaments.
3. Poor Single-Leg Control
Sport happens on one leg. If you can’t control your body weight on a single leg, you’re more likely to:
Lose alignment
Collapse at the knee
Struggle to decelerate safely
This is where many injuries occur.
4. Fatigue and Load Management
Even strong athletes break down under fatigue. Late in games or long ski sessions:
Landing becomes stiffer
Knee control reduces
Reaction time slows
Fatigue changes movement quality and that’s when risk increases.
The Most Effective ACL Prevention Strategy
Prevention isn’t about one exercise, it’s about a holistic programme. Structured neuromuscular training programmes have been shown to reduce ACL injury risk by up to 50–70%, making them one of the most effective tools in injury prevention.
A well-structured programme includes:
Strength Training
Squats
Split squats
Deadlifts
Hamstring loading (e.g. RDLs, Nordic curls)
Plyometrics (Jump Training)
Jump and stick drills
Drop landings
Lateral hops
Deceleration Training
Controlled stopping drills
Change of direction work
Eccentric strength focus
Neuromuscular Control
Balance work
Reactive drills
Perturbation training
This combination trains your body to handle force safely, not just produce it.
Simple Exercises That Make a Big Difference
If you’re not sure where to start, these are highly effective:
Single-leg squat → builds control and alignment
Hop and hold → trains landing stability
Romanian deadlift (RDL) → strengthens posterior chain
Lateral bound and stick → improves cutting mechanics
Focus on quality over quantity. If your knee collapses inward, the exercise is reinforcing the problem not fixing it. You need to regress the exercise.
ACL Prevention for Skiers
Skiing places unique demands on the knee:
Fixed foot position
High rotational forces
Long-duration fatigue
Key focus areas:
Eccentric quadriceps strength
Rotational control
Hip stability
Reaction training
Many ACL injuries in skiing occur when:
The skier gets back-seated
The ski doesn’t release
The knee twists under load
Preparation before the season is critical.
ACL Prevention for Field Sports
Football, rugby and netball involve:
Cutting and pivoting
Acceleration and deceleration
Contact and unpredictability
Female athletes have a 2–8x higher risk of ACL injury in pivoting sports, highlighting the importance of targeted strength and control training.
Key focus areas:
Change of direction mechanics
Deceleration strength
Reactive agility
Fatigue resistance
The goal isn’t just to be strong, it’s to be strong under pressure and speed.
When Should You Start ACL Prevention Training?
Pre-season
During general strength training phases
As part of ongoing gym work
Even 2–3 sessions per week can significantly reduce injury risk.
The Bigger Picture: Performance and Protection
ACL prevention isn’t just about avoiding injury. It improves:
Power
Control
Efficiency
Confidence
Up to 1 in 4 athletes who return to sport after an ACL injury will go on to suffer a second ACL injury, often due to inadequate strength or poor movement control. Athletes who train these qualities don’t just stay injury-free, they perform better.
Return to Play Starts Before Injury
At Summit Rehabilitation, the goal is always Return to Play. But the smartest athletes don’t wait until they’re injured to think about it. They prepare. They build strength. They train control. They understand how their body moves. Around 50% of individuals develop knee osteoarthritis within 10–15 years of an ACL injury, making prevention and long-term strength training critical not just for sport but for lifelong knee health.
References:
Ardern, C.L., Taylor, N.F., Feller, J.A. and Webster, K.E., 2016. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. British Journal of Sports Medicine, 50(10), pp.596–606.
Beischer, S., Gustavsson, L., Senorski, E.H., Karlsson, J., Thomeé, C., Samuelsson, K. and Thomeé, R., 2020. Young athletes who return to sport before 9 months after anterior cruciate ligament reconstruction have a rate of new injury 7 times that of those who delay return. Journal of Orthopaedic & Sports Physical Therapy, 50(2), pp.83–90.
Di Stasi, S., Myer, G.D. and Hewett, T.E., 2013 (updated relevance supported by later reviews), Neuromuscular training to target deficits associated with second anterior cruciate ligament injury. Journal of Orthopaedic & Sports Physical Therapy, 43(11), pp.777–792.(Note: Often still cited in newer consensus papers)
Filbay, S.R. and Grindem, H., 2019. Evidence-based recommendations for the management of anterior cruciate ligament rupture. Best Practice & Research Clinical Rheumatology, 33(1), pp.33–47.
Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L. and Risberg, M.A., 2016. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. British Journal of Sports Medicine, 50(13), pp.804–808.
Lai, C.C., Ardern, C.L., Feller, J.A. and Webster, K.E., 2018. Eighty-three percent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review. American Journal of Sports Medicine, 46(5), pp.1287–1296.
Myer, G.D., Sugimoto, D., Thomas, S. and Hewett, T.E., 2015. The influence of age on the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury. American Journal of Sports Medicine, 43(8), pp.203–211.
Sugimoto, D., Myer, G.D., Foss, K.D.B. and Hewett, T.E., 2015. Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis. British Journal of Sports Medicine, 49(5), pp.282–289.
Webster, K.E. and Hewett, T.E., 2019. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of Orthopaedic Research, 36(10), pp.2696–2708.
Wiggins, A.J., Grandhi, R.K., Schneider, D.K., Stanfield, D., Webster, K.E. and Myer, G.D., 2016. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. American Journal of Sports Medicine, 44(7), pp.1861–1876.
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