ACL Injury Overview (Research Review)

Today's post if from our Conditioning Expert, Scott Moody with Soccer FIT Academy. This post was interesting to me as a coach but also as a father of a high school aged soccer player. I'm all for anything that can help reduce the risk of injury while also improving performance.

In the past, we have put up several posts on ACL injury, rehab and risk reduction exercises, but I ran across a summary of research articles (Serpell, Scarvell, et al 3160-3176) compiled in the NSCA’s Journal of Strength and Conditioning Research that I wanted to break down for you. The following is a brief breakdown of some of the risk factors, and risk reducers along with some of my own observations.

When do ACL Injuries Occur:

  • Landing from a jump, or when changing direction
  • Agility: Side step cutting (outside leg as the primary decelerator) increases risk over crossover cutting (using the inside leg as the primary decelerator).
  • Torso Sway: Allowing the torso to sway over the base of support (plant leg)

Risk Factors associated with ACL Injury:

  • Taller, Heavier Athletes with a Low Strength to Body Weight Ratio = High Risk
  • Gender Specific Hormonal Changes = Potential High Risk (monthly cycle)
  • Strength: Strength alone may not reduce risk, but strength training combined with landing/agility training = Decreased Risk
  • Neuro-Muscular Control: Improving proprioception can improve landing/agility mechanics = Decreased Risk
  • Fatigue: Fatigue leads to decreases in proprioception and neuro-muscular control (and focus) = High Risk
  • Injury History: Injuries can lead to imbalances which can lead to altered landing/agility mechanics = High Risk
  • Age/Skill/Gender: Growth spurts, hormonal changes and variable levels of skill/speed in competition = High Risk

Additional Risk Factors:

  • Clothing and Protective Wear: Neoprene sleeves can improve proprioception = Decreased Risk
  • Shoe-Survace Interface: More or longer cleats along the edge of shoe sole can increase surface friction = Increased Risk
  • Playing Surface: Wetter conditions and turf surfaces = Increased Risk

Reducing Your Risk of Injury:

As a player begins to mature (puberty) and go through a rapid phase of growth, it is essential that they take part in a risk reduction program. Risk reduction programs should have a duel focus on decreasing the risk while also improving performance. Programs such as this, seem to have better adherence rates and players find it more valuable, therefore putting more effort into the training.

The mission of these programs should be to improve the strength to body weight ratio while also improving the players neuro-muscular control (the intensity and efficiency in which they move athletically). Strength programs that combine progressive levels of plyometric and agility training in a low volume, high focus/intensity manner seem to have great results. Warm ups that develop mobility/stability and body awareness should progress to plyo/agility technique drills. After this, the session should blend age appropriate strength training with athletic movement skills training to help the player enhance their neuro-muscular control and confidence. Strength training for risk reduction is not about how much weight is being lifted, but rather how and why we are lifting the weight.

Finally, a risk reduction program should revolve around fitness. It doesn’t matter how prepared you are, if you are fatigued in a reactive or competitive environment, both your mental and muscular response times are compromised. If you are late to perceive, and late to react, you will most likely be out of position. If the efficiency of the muscular firing process is also compromised, you are in a perfect storm of risk factors associated with ACL tears.

Fitness programs should focus on establishing a solid aerobic base, and then use both short and long intervals to prepare the body to tolerate high levels of fatigue. Fitness programs should not be confused with plyo / agility programs designed to improve the way and the speed in which an athlete executes high intensity bursts of acceleration and deceleration.


As we are fully aware, it is imposable to prevent an injury, but there are several ways to decrease the risk of injury. The more prepared you are (strong, efficient and fit), the less likely you are to be injured.

  1. Serpell, Benjamin, Jennie Scarvell, et al. “Mechanisms and Risk Factors for Noncontact ACL injury in age mature athletes who engage in field or court sports: A summary of the literature since 1980″ Journal of Strength and Conditioning Research. 26.11 (2012): 3160-3176. Print.
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