Can ACL Injuries Be Prevented?
Not all ACL injuries can be prevented — but the risk can meaningfully be reduced. God has designed the knee with both static and dynamic stabilisers working together as a system. When the dynamic stabilisers — your muscles — are strong and well-trained, they can absorb more load and take stress off the static stabilisers like the ACL.
The good news is that the dynamic stabilisers are the ones you can actively work on.
Two Things to Train
Strength
Strong muscles protect the knee. This means training not just the quadriceps and hamstrings, but also the gluteus medius and the hip external rotators — the muscles that control how your knee tracks during movement.
When these muscles are weak, the knee tends to collapse inward — a position known as valgus — especially during jumping and landing. This inward collapse significantly increases the risk of an ACL tear. Targeted gym work to strengthen these muscle groups is one of the most effective things you can do.
Proprioception and Neuromuscular Training
Strength alone is not enough. The nervous system that God has wired into us also needs to be trained to respond quickly when the knee is placed in a vulnerable position.
This is called proprioception — the body's ability to sense its own position and react in real time. Through specific training, the nervous system becomes faster at activating the right muscles when the knee faces sudden stress, such as a change of direction or an awkward landing.
This is backed by evidence. A large-scale study by Professor Stefano Zaffagnini and colleagues at the Rizzoli Orthopaedic Institute in Bologna — one of the world's leading orthopaedic centres — analysed over 6,000 movement trials in young football players and found that poor frontal plane control of the lower limb and pelvis is associated with increased knee loading and higher occurrence of ACL injury. The implication is clear: how your body moves and absorbs force matters enormously — and it can be trained.
A Structured Way to Start: The FIFA 11+
One of the most well-studied injury prevention programmes for athletes is the FIFA 11+, developed by FIFA's Medical Assessment and Research Centre. Research has shown that it can meaningfully reduce the risk of knee injuries when performed consistently before training sessions and matches.
The programme takes around 20 minutes and requires no special equipment — just a ball and space to move. It covers running mechanics, strength, balance, and landing technique, all in a structured sequence.
Athletes in team sports should be doing the FIFA 11+ warm-up before every training session and competition.
- Official FIFA 11+ website: inside.fifa.com/health-and-medical/injury-prevention
- Official FIFA 11+ PDF Downloads
- Fit to Play app (iOS/Android): fittoplay.org
The Concept of Prehabilitation
Prehabilitation — or prehab — means strengthening the body before an injury occurs, rather than after. It is a proactive approach: building resilience into the system God has given us, so that when demands on the knee are high, the entire stabilising network can cope.
If you are an active individual or competitive athlete, prehab should be a regular part of your training — not an afterthought.
Important Note
Prevention reduces risk, but does not eliminate it entirely. ACL injuries can still occur even in well-conditioned athletes, particularly in contact situations or at high speeds. If you have suffered an ACL injury or are concerned about your knee, a formal assessment with a sports surgeon is the right next step.
References
Della Villa F, Di Paolo S, et al. Kinematics of 90° change of direction in young football players: Insights for ACL injury prevention from the CUTtheACL study on 6008 trials. Knee Surgery, Sports Traumatology, Arthroscopy. 2024;32:2666–2678.
