Preventing ACL Injuries in Soccer Players

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Written by: Dr. Julia Callaghan, BSc (Hons), DC, ART® / Contemporary Medical Acupuncture

According to FIFA’s most recent ‘big count survey’ an estimated 265 million people play soccer worldwide! In my opinion, the beautiful game is the BEST sport in the world. That being said, the incidence of injury is quite high among soccer players, in particular lower extremity injuries such as ankle sprains, hamstring and groin strains, and of course ligament injuries in the knee (Junge, A. et al., 2010). Further, 70% of these injuries occur without contact to another player (Junge, A. et al., 2010).

There are both internal and external risk factors for ACL injuries. External risk factors include the level of competition, footwear and playing surface, as well as weather (Mandelbaum B et al., 2005). Internal risk factors include hormones, anatomical variations and neuromuscular patterns (Mandelbaum B et al., 2005). Of these risk factors, there is evidence to support and resources in place to make changes to neuromuscular patterning that can help decrease and prevent ACL injuries. In May of 2014, the Canadian Academy of Sport and Exercise Medicine (CASEM) released a position statement illustrating the importance of neuromuscular training programs in reducing anterior cruciate ligament (ACL) injuries among youth soccer players (Campbell, C. et al., 2014).

In order to reduce and prevent injuries incurred on the pitch, specifically non-contact injuries, our main focus must be improving awareness and neuromuscular control during standing, running, planting, jumping, and landing (Sorgard, T. et al., 2008). By adding an injury preventing warm up designed specifically to reduce the risk of ACL injuries twice per week and prior to games, starting with young players, we can hope to achieve improved strength, awareness, and neuromuscular control throughout static and dynamic movements and therefore decrease and prevent injury among our athletes (Sorgard, T., et al., 2008). There are a number of such warm ups available including the FIFA 11+ and GRSM’s Knee Fit program.

For those athletes who are unfortunate enough to experience an ACL injury, or any knee injury for that matter, the proper treatment and rehabilitation can make the difference in reducing the risk of re-injury or injuring the other knee, and can help you safely return to the sport you love. Treatment to ensure full range of motion and tissue compliance has returned and rehabilitation to build strength, endurance and restore or correct faulty neuromuscular patterning is essential. Such treatments can include ART®, acupuncture and/or electro-acupuncture, instrument assisted soft tissue therapy, and joint mobilization or manipulation. Active rehabilitation programs will focus on strength, agility, explosive power, and lower extremity kinematics.

Here are some examples of exercise training that your chiropractor may include in your rehabilitation:


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A stretch for gluteus medius – this muscle is extremely important for proper form when landing.

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Banded single leg supine bridge – this is a preliminary exercise used to create glute function and endurance prior to moving on to more complex movements such as squatting.

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A stretch for the hip flexors – it is important to maintain mobility in the hips to ensure proper form and function throughout the pelvis.

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Bird Dog – this is an early phase of the bird dog exercise, a spine safe core exercise. It is essential for athletes to be able to create a strong abdominal brace with good endurance. This is the foundation off of which explosive power through our limbs is created.


Campbell, C., et al. (2014). Canadian Academy of Sport and Exercise Medicine Position Statement: Neuromuscular Training Programs Can Decrease Anterior Cruciate Ligament Injuries in Youth Soccer Players.  Clinical Journal of Sports Medicine, 24, 263-267.

FIFA. (2011). FIFA 11+ a complete warm up programme. Retrieved from:

Junge, A. et al. (2010). Countrywide Campaign to Prevent Soccer Injuries in Swiss Amateur Players. American Journal of Sports Medicine, XX, (X, XXXX). Retrieved from:

Soligard, T. et al. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomized controlled trial. British Medical Journal, 337, (a2469). Retrieved from:

Soligard, T. et al. (2010). Compliance with a comprehensive warm-up programme to prevent injuries in youth football. British Journal of Sports Medicine. Retrieved from:

Steffen, K. et al. (2013). High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. British Journal of Sports Medicine 00. Retrieved from: adherence to 11 improves functional balance and reduces injury risk in Canadian youth football players.pdf

Spindler K et al. Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med 2004; 32: 1986-1995.

Mandelbaum B et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes. 2-year follow-up. Am J Sports Med 2005; 33:1003-1010.

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