Dynamic Warmups: Exercise-Based Knee and ACL Injury Prevention

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Dynamic Warmups:
Exercise-Based Knee and ACL Injury Prevention

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Prevalence of Knee and ACL Injuries in Soccer Players

  • Knee and ACL injuries typically occur due to the dynamic valgus position of the knee pictured above.
    Can occur due to contact or while planting and cutting.

  • Soccer is the leading sport for knee injuries for girls and is the second leading sport for boys behind football.

  • Female soccer players are 3-5x more likely to have a significant knee injury when compared to male players.

  • The knee is the most common site for sport-related surgeries.

  • Nearly 350,000 ACL reconstructions performed each year in the United States.

  • 25% of all athletes who have an ACL reconstruction will suffer another ACL tear at some point in their athletic career.

How Much do Exercise-based Injury Prevention Programs Really Help?

  • Caraffa et al studied 600 semi-pro and amateur soccer teams. Teams that completed an injury prevention program were over 7x less likely to sustain ACL injuries.

  • Waldén et al studied over 4,000 13-17 y/o female soccer players and found an 83% reduction of ACL injuries.

  • Mandelbaum et al studied 14-18 y/o female soccer teams for 2 years and found an 89% reduction in ACL injuries the first year and 74% reduction the second year.

  • Hewett et al found female athletes who completed injury prevention programs no longer had increased risk/incidence of severe knee injury relative to men.

In Summary

  1. All athletes age 12-25 shown to benefit from knee injury prevention programs.

  2. Female athletes benefit the most from knee injury prevention programs.

  3. Clinicians, coaches, parents, and athletes should support implementation of exercise-based knee injury prevention programs led by either coaches or a group of coaches and medical professionals.

  4. Compliance and correct form are KEY for success.

Components of an Exercise-based Injury Prevention Program

Prevention programs require only 20 minutes prior to practices or games, performed 2x per week.

Prevention programs are completed during warm ups before practice or games and include Dynamic stretching, Strengthening, and Plyometrics.

Dynamic stretching: Active warm-up completed between 6 cones, spaced 2 meters apart. Includes forwards/backwards jogging, lateral shuffle, and active/dynamic stretching for the calf, hamstring, groin, quadriceps, and hip flexor muscles (not static stretching).

Strengthening: Focuses on proximal control of the hips and core to allow for normal alignment of the lower extremities. Exercises include planks, side planks, squats, bridges, multi-directional lunges, and single leg balance with soccer skills. Each exercise includes 4 tiers of difficulty to progress as athletes get stronger.

Plyometrics and Movement Coordination: Soccer specific movements to improve cutting, foot speed, alignment, and reaction time. Includes multi-directional single/double leg hops, skater hops, 1 and 3 step decelerations, 1 and 3 step change of direction, jumping with contact. Includes multiple tiers to progress difficulty.

Video demonstration of Sample Exercise-based Knee and ACL Injury Prevention Program from the Journal of Sports and Orthopedic Therapy:

Completing exercises with good form and proper alignment is KEY.
BE Fit Physical Therapists would be happy to instruct players, parents, and coaches regarding proper form of injury prevention programs.

Now you can visit BE Fit Physical Therapy in TWO locations:

Upper Valley Aquatic Center:
100 Arboretum Lane, White River Jct., VT 05001 | 802.359.7400 (ph)

45 Lyme Road, Suite 101
Hanover, NH 03755 | 603.653.0040 (ph) | 603.653.0041 (fax)


  1. Nessler T, Denney L, Sampley J. (2017) ACL injury prevention: What does research tell us?. Curr Rev Musculoskelet Med. 10(3):281-288.

  2. Edward M. Wojtys and Ashley M. Brower (2010) Anterior Cruciate Ligament Injuries in the Prepubescent and Adolescent Athlete: Clinical and Research Considerations. Journal of Athletic Training: Sep/Oct 2010, Vol. 45, No. 5, pp. 509-512.

  3. Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention Arundale AJH, Bizzini M, Giordano A, Hewett TE, Logerstedt DS, Mandelbaum B, Scalzitti DA, Silvers-Granelli H, Snyder-Mackler L. J Orthop Sports Phys Ther. 2018 Sep;48(9):A1-A42. doi: 10.2519/jospt.2018.0303.

  4. Travis S. Roth, T.S., Osbahr, D.C., (2018). Knee injuries in elite level soccer players. American journal of orthopedics, https://www.amjorthopedics.com/article/knee-injuries-elite-level-soccer-players.