Score Big: Protecting High School Soccer Players from ACL Tears

Score big ACL injury prevention in hs soccer

Soccer players– what scares you more: open water swimming with the possibility of sharks and jellyfish around, or tearing your Anterior Cruciate Ligament (ACL) at the start of season? I’d bet it’s the latter. 

What if I told you that I know a way to decrease risk of ACL injury by 50%? You’re in luck, because I’m about to unlock that secret for you. 

Before you can know how to defeat an opponent, you first must know the opponent. Same is true with ACL injuries. Who is most at risk? How often does it occur? Why is this such a common foe for young soccer players? Once we know this information we can then ask ourselves how we can prevent the injury from occurring in the first place. 

Who is most at risk?

So, who’s at the highest risk for an ACL injury? Well, there are two categories: non-modifiable and modifiable risk factors that contribute to adolescent ACL tears.

Non-modifiable factors

Non-modifiable factors include sex (sorry, ladies, but anatomical differences put us at a disadvantage), age (puberty can be a tricky time), and injury history (past ACL tear? Watch out!).

Sex: Females– There are some anatomical differences that make women predisposed to ACL tears which are often magnified by poor biomechanics (which we will discuss in the “modifiable risk factors”)

Age: Pubescent Years- There is a correlation between pubescent years and time of ACL tear

  • Females- Early teenage years: Hormonal changes that occur during the menstrual cycle play a role 
  • Males- late teenage years

Injury History: The most profound risk factor for an ACL tear is history of a previous ACL tear.

  • 30% of athletes with one ACL tear will tear again, most prevalent on the opposite leg
soccer player alex morgan
Fun Fact! Did you know soccer superstar Alex Morgan tore her ACL when she was a senior in high school? Goes to show, that with the right Post-Op Plan, tearing your ACL isn't the end of the road. For Alex, it was the begining to fine tuning her ACL injury prevention focus. And look at her now!

Modifiable factors

Now, let’s talk modifiable risk factors. Think biomechanics, insufficient quad strength, weak hip muscles—the list goes on. But fear not, because knowledge is power, and armed with the right information, we can significantly reduce these risks.

Biomechanics: The way we move and respond to load

  • Insufficient quad strength with difficulty controlling body during deceleration, pivoting, cutting actions
  • Insufficient hip strength leading to lack of dynamic knee control 


  • Sudden increase in training load with/without insufficient caloric intake.
  • Low quality and/or quantity of sleep. Studies show that adolescent athletes who average less than 8 hours of sleep at night are 1.7X more likely to experience injuries! 

Psychological Readiness:

  • Lack of confidence in bodies ability to perform coming back from injury. 

What we know from the research

Research supports the implementation of ACL injury-prevention 6-weeks pre-season as well as sustained strength training 2x/week for at least 20 minutes per session throughout the season. There are four well-studied ACL injury-prevention programs: 

  • Prevent injury and Enhance Performance (PEP)
  • The 11+
  • Perform+
  • The Knee Control Program

All the programs have four key foundational components which include plyometrics, strength (quad, hip, adductors, hamstrings), core stability, and balance. Here are a few ideas to get you started: 

  1. Plyometric exercise: Square hops
  2. Strength: Rear foot elevated split squat
  3. Core stability: Plank on soccer ball
  4. Balance: Runners march with soccer volley

1. Square Hops: 

Square hops are one of my favorite plyometric drills because you can do them pretty much anywhere. Using the corners of the soccer field, lines on a court, tape on the ground, or for creative points, lay your soccer socks on top of each other to make an X.  See how many times you can hop into each quadrant of a 4×4 square grid in 30-60 seconds clockwise, then counter clockwise. Goal: 2-3 sets total. 

To advance exercise: Try it with one leg at a time

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2. Rear Foot Elevated Split Squat: 

If I could only do one strength exercise for the rest of my life, this might be it. A rear foot elevated split squat is a great way to strengthen the quads and  glutes (protect the knees!), and improve balance (you spend a lot of time on one foot kicking a soccer ball!). Place one foot behind you on a box, bench, or chair. Balancing on one leg, squat down (holding weight for extra challenge). Repeat 6-10 times on each leg. 

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3. Plank on Soccer Ball 

When you hear the word “plank” do you cringe? If so, grab a soccer ball to add some spice to it! Keep your hips, ankles and shoulders in one line. Hold for 30-60 seconds. Repeat 3-4 times. 

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4. Runners March + Soccer Volley 

You’ll need a partner for this one! (Add a BOSU for an extra balance challenge.) Starting balancing on one leg, reach down to touch your toe, come back up to a single leg stance, your partner will toss the ball to you. Volley it back all while balancing on one leg. Feel the burn! 

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Where to start?

Don’t let your worst nightmare become a reality. Let’s team up to ensure you step onto the soccer field feeling confident and ready to tackle anything that comes your way. What are you waiting for? Give us a call for an appointment and let’s score big together!  

Not ready for a full appointment or on the fence about an injury prevention program? I invite you to click below to ask me any questions you have about your knee health and training in general, on the house!

By Morgan Lash, PT, DPT, CSCS
Morgan Lash PT DPT CSCS Runners Edge Physio Anchorage Alaska

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