How to NOT rupture your ACL

Why is it that an athlete can perform the same change of direction and twisting type motion a thousand times during a season and then the thousand and first time they do that exact same motion, they rupture their ACL? 

Why is it that even with the best prevention programs in place in elite sports such as AFL, the incidence of ACL rupture is increasing (3 ruptures within Round 1 of the 2019 Mens AFL season)? 

Unfortunately, science does not yet have a solid answer. However, we do know that there are both modifiable and non-modifiable factors that can increase your risk of ACL rupture. Perhaps as health professionals we should be focusing our attention on how NOT to rupture your ACL instead of just rehabilitation after it has already happened. 

ACL injuries can be REDUCED by 50% with a 30-minute neuromuscular program per week (Finch et al. 2016). Even better, the 30 minutes can be broken down into 10-minute blocks before trainings and games and still have the same effect. At the end of the day what is 10 minutes compared to 12 months off? There are specific programs that have been developed for soccer, AFL and netball with free and easy to follow exercises: 

  • FIFA 11+ 
  • AFL Footy First 
  • Netball Knee 

Neuromuscular programs are programs designed to improve the strength, flexibility, control, balance and coordination of athletes and should include agility, balance and plyometrics based exercises (Ayala et al. 2017).  

This may include exercises such as: 

  • Planks and side-planks 
  • Nordic Hamstring curls 
  • Walking lunge with rotation
  • Stationary and dynamic ball passing/catching drills at different angles standing or landing on one leg 
  • Side-to-side and forwards-backwards hopping and jumping with focus on soft and controlled landings 
  • Zig-zag running and side-stepping 
  • Bounding 
  • Unanticipated change of direction with attacker/defender drills 
  • Jumping/hopping with partner push or bumps whilst in the air 

Not only do we know that these programs reduce the risk of ACL injury, they also reduce ankle injuries by 40% and all other lower limb injuries by 22% (Grimm et al. 2016). 

There are also some non-modifiable factors which place some athletes at high-risk of ACL rupture, and these individuals need to be identified during pre-season screening and be required to participate in such programs. This includes: 

  • 14-18 year olds and males 19-25 year old (Sanders et al. 2016) 
  • Players with a past history of ACL injury (Morgan et al. 2016) 
  • Those with a family history of ACL injury (mother or father) (Smith et al. 2012) 
  • Female athletes partly attributed to hormonal changes during the menstrual cycle as well as biomechanical differences due to wider hips compared to males (Park et al. 2009). 
  • Athletes with current or a past history of patellofemoral joint pain (Myer et al. 2015) 

ACL injury can be a sport or career-ending injury for some players, not to mention the physical, emotional and financial costs associated. Let’s focus on preventing them before it’s too late. 


Ayala, F., Pomares-Noguera, C., Robles-Palazon, F. J., Del Pilar Garcia-Vaquero, M., Ruiz-Perez, I., Hernandez-Sanchez, S., et al. (2017). Training effects of the FIFA 11+ and harmoknee on several neuromuscular parameters of physical performance measures. Int. J. Sports Med. 38, 278–289. doi: 10.1055/s-0042-121260

Finch CF, Twomey DM, Fortington LV, et alPreventing Australian football injuries with a targeted neuromuscular control exercise programme: comparative injury rates from a training intervention delivered in a clustered randomised controlled trialInjury Prevention 2016;22:123-128.

Grimm, N.L., Jacobs, J.C., Kim, J, Denney, B.S., Shea, K.G. 2016, ‘Anterior Cruciate Ligament and Knee Injury Prevention Programs for Soccer Players: A Systematic Review and Meta-analysis’, American Journal of Sports Medicine, Vol. 43, No. 8, pp 2049-56.

Morgan MD, Salmon LJ, Waller A, Roe JP, Pinczewski LA. Fifteen-Year Survival of Endoscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 18 Years and Younger. The American journal of sports medicine. 2016 Feb;44(2):384-92. PubMed PMID: 26759030. Epub 2016/01/14. eng.

Myer GD, Ford KR, Di Stasi SL, Foss KD, Micheli LJ, Hewett TE. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: is PFP itself a predictor for subsequent ACL injury? British journal of sports medicine. 2015 Jan;49(2):118-22. PubMed PMID: 24687011. Pubmed Central PMCID: PMC4182160. Epub 2014/04/02. Eng.

Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, et al. Incidence of Anterior Cruciate Ligament Tears and Reconstruction: A 21-Year Population-Based Study. The American journal of sports medicine. 2016 Jun;44(6):1502-7. PubMed PMID: 26920430. Epub 2016/02/28. Eng.

Smith HC, Vacek P, Johnson RJ, Slauterbeck JR, Hashemi J, Shultz S, et al. Risk factors for anterior cruciate ligament injury: a review of the literature-part 2: hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Sports health. 2012 Mar;4(2):155-61. PubMed PMID: 23016083. Pubmed Central PMCID: PMC3435909. Epub 2012/09/28. eng.

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Mana NankivellMana Nankivell
00:38 18 Apr 23
I highly recommend Trent and the Physio Fit team.I sustained a knee injury (fat pad impingement) in a half-marathon around 18 months ago, and after 12 months of seeing a (different) physio and sports doctors without any improvement, I was told by the doctor that I would "probably just have to put up with the pain".I booked in with the team at Physio Fit for another opinion, and it was the best decision I ever made. Trent put together a very manageable rehab plan for me and was quick to respond and adapt when something didn't work out. In the past 6 months, I've gone from not being able to walk without pain or even think about hiking, running or cycling without my knee flaring up, to running my first post-injury 5.5km trail run and hiking 10km with a 10kg pack!
Laura O'ConnorLaura O'Connor
08:47 05 Feb 23
This clinic is the pinnacle of physiotherapy in Adelaide. Ive seen a couple of different physios at physiofit over the years for different injuries and the experience has been absolutely amazing each time! Highly recommend seeing the team here for all your physio needs!
Ryen ArcherRyen Archer
02:50 03 Feb 23
Corey is absolutely fantastic, worked out my issues and we have been working to improve them for a few months now and all I can say is I am feeling a million times better! thanks physio fit! Keep up the great work!
Amy SzyndlerAmy Szyndler
02:44 03 Feb 23
I attended Physio Fit to get my tennis elbow treated. Always a friendly greeting from the lovely reception staff, and my physio, Corey, was fantastic; very friendly, knowledgeable and provided treatment that was personalised and holistic. Following Corey's advice and exercise regime helped me get back to the activities I enjoy, pain-free. Highly recommended.
Debbie MossDebbie Moss
07:21 02 Feb 23
Have been taking my daughter here for quite a few months now for ongoing back issues. The care that she has been given through her Physiotherapist Corey, has been fantastic. Everything has been explained and if exercises have needed to be modified he has. Would thoroughly recommend this place for any Physio needs. All staff that we have dealt with have been friendly and professional. A great team and environment.
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