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(PEP)ping Up the Step of Female Soccer Player ACL Injury Prevention


As of the writing of this blog, the FIFA Women’s World Cup is well underway. The strength and athleticism of these soccer athletes are matched equally by their hearts – for the game and their teammates, which is why it always breaks my heart when one of them is sidelined by an ACL injury. In fact, at this time, more than a dozen female professional soccer athletes have sustained an ACL injury over the past two years that has ruled them out of playing in the World Cup.

Throughout my career, I have studied, worked with esteemed colleagues, and written extensively about the preponderance of ACL injury in female athletes. It remains true that female athletes specifically have a more than three times higher risk of injuring their ACL than male athletes. And sadly, ACL tears can have more prolonged healing and rehabilitation times that are often “season-ending” injuries. Complete rehabilitation can take as long as 6-9 months. It may result in the athlete being unable to play at prior skill and intensity levels, which can also be psychologically challenging. Alongside developing gold standards for treating and rehabilitating ACL injuries, our orthopedic medical community focuses on preventing injuries before they occur.

It’s important to note here that a variety of factors have been deemed to make female athletes more susceptible to ACL injury than men – certain anatomical features, hormones, and typical female body mechanics have a role to play. But none of these precludes female athletes from working on ways to protect their knees and prevent injury.

My journey into preventive orthopedic medicine for female athletes is a long time in the making. More than 20 years ago, a team of orthopedic experts and I started to see a pattern in evaluating and treating ACL injuries in increasing numbers of young female athletes. We were increasingly fascinated that many of the ACL injuries we saw weren’t the result of a hard fall or other blunt-force trauma to the knee. Instead, they seemed to correlate with how the athlete would jump, land or decelerate. In athletes who also had hip and leg strength deficiencies, the upper legs would turn in. The movement would then cause too much strain on the ACL and sometimes would result in an ACL tear.

To address this pervasive ACL injury trend, I was part of an outstanding medical team that developed an ACL Injury-Prevention program. The program includes a knee-specific warm-up, as well as plyometric and agility training to combat the possible deficiencies in strength and coordination of the stabilizer muscles that surround the knee joint. We named the program “PEP” to Prevent Injury and Enhance Performance.

Now more than ever, scientific and rehabilitative medicine is showing us that paying attention to strengthening the hips, thighs, and hamstrings is strong protection for the knees. I’m here to tell you, with multiple years of study data to back up the claim, these programs work. A PEP training program promotes better strength, posture, and control for athletes. Even if you aren’t a professional soccer player, preventive training to reduce injury risk is a solid concept. Of course, it won’t prevent every single ACL tear in the sport, but it will absolutely prevent some – and that alone is worth the effort and attention.


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