Why ACL Injuries Are Still So Common in Soccer (and What We Can Do About It)
- 2 days ago
- 6 min read
If you follow soccer at any level, you’ve likely heard about elite players suffering ACL tears–names like Alex Morgan, Christen Press, Alexia Putellas, and Beth Mead. These are world-class athletes with access to top training, coaching, and medical staff—so why are these injuries still happening?
The answer is important not just for professionals, but for young athletes as well. ACL injuries are increasingly common in youth sports, especially soccer. The good news: many of the risk factors are understood, and there are proven ways to reduce the risk.
Understand ACL Injuries
The anterior cruciate ligament (ACL) is one of the key stabilizing ligaments in the knee. Injuries to the ACL are among the most common serious injuries in sports that involve running, jumping, and quick changes of direction—like soccer.
Each year in the United States, approximately 250,000 ACL injuries occur. Most are non-contact injuries. Others typically occur during:
Landing from a jump
Sudden deceleration while running
Cutting or changing direction
Recovery is long and demanding. Athletes often require surgery followed by 6-12 months of rehabilitation, with a recommended return to play no earlier than 9 months post-surgery. Even then, only about 55% of athletes return to competitive sports at their previous level.
Why Youth Athletes Are at Risk
To understand how to protect young athletes, it helps to break risk factors into two categories: those we can’t change and those we can influence.
Non-Modifiable Risk Factors
These are factors we cannot control, but they explain why some athletes are more vulnerable.
ACL injury risk increases during adolescence. For females, this tends to occur in the early teen years, while for males it is often later. Notable, female athletes in college soccer experience ACL injuries at rates up to three times higher than males.
Female athletes face unique challenges due to:
Anatomical differences
Hormonal fluctuations
Changes in strength, coordination, and body control during puberty
Certain structural differences may increase risk, including:
A narrow space in the knee where the ACL sits
Smaller ligament size
Wider hips (leading to increased knee angle)
Greater ligament looseness
Previous Injury
A prior ACL tear significantly raises the risk of another. Up to 30% of athletes who suffer one ACL injury will experience a second. Risk can also increase when returning from other injuries.
Modifiable Risk Factors
This is where parents, coaches, and athletes can make a real difference.
Movement Mechanics
Poor movement patterns are one of the biggest contributors to ACL injuries. High-risk movements include:
Knees collapsing inward during landing or cutting
Stiff or straight-legged landings
Limited knee bend when changing direction
These are teachable and correctable with proper training.
Fatigue and Training Load
Sudden increases in training intensity or volume—especially without adequate rest—can increase injury risk. Fatigue affects coordination and control, making poor mechanics more likely.
Environment
Factors like playing surface and footwear can play a role, though research hasn’t definitively shown that turf is riskier than grass. Properly fitted cleats and awareness of field conditions still matter.
Psychological Readiness
Confidence, stress, levels, and overall mental readiness can influence how athletes move and perform. A supportive environment that encourages proper training—including strength and injury prevention work—can make a meaningful difference.
The Most Important Question: What Can Be Done?
Here’s the encouraging part: ACL injuries are not just “bad luck.”
Research shows that exercise-based injury prevention programs can reduce ACL injury risk by up to 45% in female athletes. These programs don’t just protect knees—they also:
Reduce overall injury rates
Improve strength and coordination
Enhance athletic performance
What These Programs Look Like
Most effective injury prevention programs are:
About 15-20 minutes long
Designed as a warm-up before training
Focused on strength, balance, and proper movement mechanics
Require little to no equipment
They typically include:
Dynamic warm-ups
Strength exercises (especially for hips and core)
Plyometrics (jump training)
Agility and cutting drills
Technique coaching (how to land, stop, and change direction safely)
When and How Often Should Athletes Do Them?
Consistency is key.
At least 2 times per week is recommended
Ideally performed before practices or games
Can be supplemented with strength work after training
Should be continued year-round, including the off-season
Starting in preseason may improve effectiveness
Even partial completion is better than none—something is always better than nothing.
Evidence-Based Programs to Explore
Several well-research programs are available for free and can be implemented by coaches, teams, or even parents:
Perform+ (Football Australia)
FIFA 11+
PEP Program (Prevent Injury, Enhance Performance)
American Physical Therapy Association ACL Injury Prevention Playlist
These programs are widely used and adaptable for different ages and skill levels.
What Parents Should Take Away
If your child plays a sport that involves running, jumping, or cutting—like soccer, basketball, or lacrosse — ACL injury prevention should be part of their routine.
As a parent, you can:
Encourage teams to adopt prevention warm-ups
Support strength and conditioning outside of practice
Promote rest and recovery
Reinforce good movement habits
Help create a positive, supportive environment around training
The reality is simple: while ACL injuries can be serious and life-changing, many are preventable.
And for a young athlete, the difference between a 15-minute warm-up and a season-ending injury could be everything.
Take the Next Step
Knowing about injury prevention is important—but implementing it correctly and consistently is what truly makes the difference.
At CORE Physical Therapy and Performance, we specialize in working with athletes to:
Assess movement patterns and identify injury risk
Build strength, control, and confidence
Teach proper cutting, landing, and deceleration mechanics
Guide safe return-to-sport after injury
Whether you are looking to stay healthy, improve performance, or safely return from an injury, having expert guidance can be a game changer.
Visit coreptp.com to learn more or schedule an evaluation.
Non-modifiable Risk Factors:
Age: tend to increase in the early teens for females and late teens for males and female injury rates in college soccer are 3x more than males.
Sex: females have anatomical differences and hormonal fluctuations across the menstrual cycle, changes in the development of strength, power, and body control during and after puberty.
Anatomy: females have smaller intercondylar notch (the space where the ACL passes through), smaller ACL size, increased Q-angle (wider hips), increased posterior tibial slope (steep angle of top of tibia), and greater knee ligament laxity (looseness) compared to males.
History of injury: up to 30% of athletes who have an ACL injury will experience another one, the risk can also increase while recovering from other injuries.
Modifiable Risk Factors:
Movement patterns: high-risk movement patterns include letting the knee and leg collapse inwards, hyper-extending the knee, or having less knee bend when cutting, changing direction, decelerating, and landing from a jump or header.
Fatigue: sudden increases in training load without appropriate rest may increase overall injury risk for soccer players.
Environment: playing surface and cleat/shoe choice, but research studies have not shown a clear conclusion that turf causes a higher risk than grass.
Psychological Readiness: emotional and psychological support is less studied. Creating an environment that is supportive of participation in injury prevention components, like strength training, may have potential to indirectly reduce non-contact ACL injuries.
The Why
Regular use of an exercise-based injury prevention program can reduce risk of ACL injury in female athletes by up to 45%.
Also, it has been shown to reduce the incidence and severity of overall injury rates—not just ACL.
Can also improve overall team performance.
When to Implement
Most injury prevention programs are designed to be a pre-training warm-up in order to be time and socioeconomically friendly.
Ideal to complete the entire program prior to training, but some parts may be completed separately. For example, strengthening exercises can be completed after training and retain the injury reduction benefits of the program on days where completing the whole program before isn’t possible.
Should be used in the off-season too to avoid biomechanical decline or return of old movement patterns.
Initiating the program during pre-season may enhance its effectiveness.
Regular adherence to the program is important.
Most effective when completed at least twice a week. Ideally, these programs are 20 minutes or more in duration.
Evidence-based injury prevention programs:
Perform+
11+
PEP
American Physical Therapy ACL Injury Prevention Playlist
All of these programs require minimal equipment and can be conducted by coaches, staff, players, and even parents!
So, if you play a sport that involves jumping, sprinting, and cutting then one of these programs could be the difference between being healthy and playing the sport you love or suffering a season-ending injury and watching from the sideline.
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