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Injury Prevention

ACL injury prevention for high school athletes: the warm-up that lowers the risk

An ACL tear is about the worst news you can hand a high school athlete: surgery, the better part of a year gone, and a knee they never fully stop thinking about. The good news is real, though. Most of these tears happen with nobody else involved, which means we can actually train to lower the odds.

Michael Gordon, ATC, CSCS · Head Athletic Trainer, 20+ years on the sideline · Founder of Strata

Start with the one fact that should change how you warm up your teams: most ACL tears in sport are non-contact. No collision, no dirty tackle. The athlete plants, cuts, or comes down from a jump, and the knee goes on its own. That word, non-contact, is the one that matters here, because an injury the body causes is one the body can be trained to avoid.

Why the ACL is the injury you most want to prevent

This is not a sprain you tape up and send back out. If the athlete wants to get back to a sport that cuts and jumps, an ACL tear usually means reconstructive surgery with a long rehab behind it. Plan on 9 to 12 months from surgery to a real return to play, and often longer before they stop thinking about the knee on every cut. That is most of a season gone, sometimes two of them.

And it does not fully reset even when the surgery goes well and the rehab is done right. A young athlete who goes back to pivoting sports carries a higher chance of tearing again, the same knee or the other one. The long game matters too: a torn ACL raises the lifetime risk of early arthritis in that knee, repaired or not. This is an injury with a tail that runs for decades, which is exactly why ten minutes of prevention is worth the trouble.

Who is most at risk

Any athlete in a sport that cuts, pivots, and jumps is exposed: soccer, basketball, volleyball, lacrosse, football, gymnastics. But it is not spread evenly. Female athletes tear their ACLs at much higher rates than male athletes in the same cutting and jumping sports. It comes down to a mix of movement mechanics, strength patterns, and anatomy, and here is the part you can actually use: your girls' soccer, basketball, and volleyball teams are the highest-value place to start a prevention program.

That said, boys tear ACLs too, and the training that protects one protects the other. This is not something you run for one team and skip for the rest.

Most tears are non-contact, so most are trainable

Watch the film on non-contact ACL injuries and the same picture keeps showing up. The knee caves inward over the foot. The athlete lands stiff and upright instead of hips-back and soft. Or they slam on the brakes off one leg with the trunk out over the knee. These are movement habits, and movement habits respond to coaching. That is the whole idea behind prevention: you cannot coach away a defender's cleat, but you absolutely can train the landing and cutting that wreck knees with nobody else involved.

The single most useful thing you can teach: land soft, land bent.

Hips back, knees bent, knees tracking out over the toes instead of caving in, and the whole landing quiet. The one to fix is the loud, stiff, straight-legged landing.

What the evidence supports: neuromuscular training

The best-studied way to lower ACL risk is a structured neuromuscular training program. That is a mouthful, so think of it as a prevention warm-up. It is not one exercise or one machine you buy. It puts four things together:

Done consistently, two to three times a week through the season, that combination meaningfully lowers ACL injury rates, and it does the most for the non-contact tears we care about most. The catch is that it has to be coached, not just performed. An athlete going through the motions of a jump drill with sloppy landings gets a fraction of the benefit.

How to build it into your week

  1. Replace the warm-up, do not bolt it onSwap the static-stretch jog for the prevention program. Ten to fifteen minutes before practice, so it never fights for time and never gets cut when practice runs long.
  2. Coach the mechanics out loudWatch the landings and cuts and fix them on the spot. "Softer." "Knees out." "Hips back." The program is only as good as the reps done right.
  3. Run it 2 to 3 times a week, all seasonThis is a dose, not a preseason clinic. The protection fades when the program stops, so it has to live in the weekly routine from the first week to the last.
  4. Track who is actually doing itA program on paper protects nobody. Know which teams ran it this week and which ones quietly let it slide.

Doing it right, and doing it often, is the whole game

This is the part that gets lost. The programs that actually cut injuries are the ones done the way they were designed and done often, not the ones that start hot in August and are gone by October. Two things decide whether it works: doing the drills correctly, with good landing and cutting form, and doing them two to three times a week, every week. Run it twice in preseason and forget about it, and you do not have a prevention program. You have a memory of one.

The head coach is what makes or breaks it, because athletes take it exactly as seriously as their coach does. Sell it as performance too, and you will not be stretching the truth: the same soft landings and strong cuts that save knees also make athletes more explosive and better balanced.

When to refer a suspected ACL injury

Prevention lowers the odds. It does not erase them. So know what a fresh ACL injury looks like. Any athlete showing these signs needs a same-day look from your Athletic Trainer or a physician, and should not go back on the field that day.

Red flags after a knee gives way:

A pop, or a feeling of the knee shifting, right at the moment of injury. Swelling that comes up fast in the first few hours. A knee that feels unstable or gives out under them. Trouble staying in the game, or not being able to at all.

Diagnosis comes from a clinical exam and usually imaging. A knee that swelled fast and felt unstable belongs in a physician's hands, not an Athletic Training Room guess. When in doubt, refer. That has never once been the wrong call.

Program it once, run it all season

Strata lets you build your prevention warm-up as a real program, push it to every team that needs it, and see at a glance who ran it this week and who let it slide. The training that only works when it is consistent finally has something keeping it honest.

See it with your school's branding →

Frequently asked

Do ACL prevention programs actually work?

Yes. Done consistently, structured neuromuscular training meaningfully lowers ACL injury rates, especially the non-contact tears, and the payoff is biggest for female athletes in cutting and jumping sports. The catch is the same one every time: it only works when it is done right and done often, two to three times a week through the season.

How often does the program need to be done?

Two to three times a week, in-season, from the first week to the last. It is a dose, not a one-time clinic. The protective effect fades once the program stops, so it has to stay in the weekly warm-up instead of living only in preseason.

Which athletes need it most?

Anyone in a cutting or jumping sport, and at the top of the list, female athletes in soccer, basketball, and volleyball, who tear ACLs at higher rates. The same training protects the boys too, so the honest answer is every team that plants, pivots, and lands.

Sources & further reading