What do we do about ACL injuries?

Apr 27, 2022

Knee injuries in sport are on the rise.

Is there anything we can do to stop it?


Anterior Cruciate Ligament (ACL) injuries are often significant, life-affecting events for both children and adults. They can take young people out of sports for months during their critical development years, and they’ve ended the seasons of professional sports-people in moments. 

They’re severely debilitating, often require surgery to heal, and demand months of recovery time. Even then, we know that a significant proportion don’t make a full return to sports. Moreover, not only do ACL tears have serious implications – they’re worryingly common. They’ve drastically increased in frequency among adolescents in recent years. The impact of such an injury can be even more pronounced in younger people, who will often spend over a year away from sport. Many will even go on to suffer early-onset arthritis later in life.

Most people have heard about ACL injuries and the misery they can cause. However, very few seem to know that a practical solution has been around for years, just waiting to be implemented.


Kids soccer team

The impact of ACL injuries can be especially severe in children and adolescents.

How do ACL injuries happen?

Anterior Cruciate Ligament (ACL) injuries occur at the knee joint, typically during excessive twisting or hyper-extension movements.

Here’s a mind-boggling stat: ACL injuries in adolescents have seen a twenty-nine-fold increase in the last twenty years. That’s an astronomical rise for such a serious knee injury.

The exact explanation for the increase is not certain, but it’s most likely multi-factorial. The professionalisation of sport at younger ages, the loss of ’movement literacy’ with a decline in childhood outdoor play, and even the increasing hardness of sports pitches, are all factors being put forward in the debate on causation.


Can we stop ACL injuries from happening?

As is often the case, removing risk entirely is not possible in team sports.

However, pragmatic steps to reduce the chance of harm is something that we can all support. It would enable sport to be enjoyed more widely and allow its positive impacts to shine through, with less participators side-lined through injury. The childhood obesity, heart health and mental health challenges that our country faces are well-documented reasons for physical activity and sport to remain high on the public health agenda. So, if stopping sport isn’t the solution to the worrying trend in ACL injury rates, then what is?

As the old adage goes: ’prevention is better than cure’ – and it seems that ACL injury is no exception. Avoiding ACL tears, by reducing the chance they’ll occur in the first place, is now a well-researched strategy with a proven method.

Where does the prevention start? In the warm-up.

There is a sports preparation routine that can half the rate of ACL tears. A huge improvement, affected by only a small change to the warm-up regimen of a team. It’s seen wide adoption in professional sports across the globe, with hugely positive results. However, adoption in the UK has been lower than in many other countries – particularly at the amateur, grass-roots level where it’s not widely known about.


What’s the best solution to ACL injuries?

Introducing: the PEP programme.

The name stands for ‘Prevent [injury], Enhance Performance’. It’s a selection of warm-up exercises that takes roughly 12 minutes to perform in total. Conducting this programme before every sporting session has been shown to significantly reduce ACL injuries. It’s by far the most effective method of preventing ACL tears that we know. Consequently there’s a pressing need for sports coaches in schools and clubs across the country to get involved and begin incorporating the PEP programme into their sessions.

SKIPP is a charity committed to raising awareness about ACL injury prevention programmes, aiming to increase adoption of PEP and similar programmes across all levels of sport in the UK. Among other things, SKIPP Charity works with a ’train the trainer’ approach, running free workshops for coaches on how to carry out the warm-ups. Research has shown strong evidence for the effectiveness of this approach.


Why aren’t ACL injury prevention programmes more widely used?

As mentioned before, the UK is lagging behind its peers in adopting preventative programmes – but why? We wish we knew, as this isn’t exactly new information! To take football as an example: since 2005 the international research centre at FIFA (FMARC) has been encouraging national footballing bodies to implement large-scale adoption of these warm-up programmes at all levels. Some countries appear to have run with this more than others, and disappointingly the FA grass-roots coaching materials still make scant reference to injury prevention, if at all.

The statistics have repeatedly borne out the benefits of the PEP (and similar programmes) as the strongest weapon we have against ACL injury, and the programme itself is simple to perform. At the moment, it seems that awareness is our biggest obstacle. Unfortunately, the vast majority of sports coaches and players themselves don’t know that such programmes exist!

What can we do to increase adoption?

You might be wondering what you can do to help raise awareness. If you’re in contact with someone who works in sports coaching, approach them and show them the SKIPP website. There they can find useful resources regarding warm-ups targeting injury prevention. If you know anyone who plays sports regularly, you can recommend the PEP programme to them.

Coaches and members of sporting organisations who are interested in attending or organising an injury prevention workshop, please get in touch via: info@skippcharity.org

TOM JACOBS BSc; MCSP; MAACP Senior Physiotherapist


This article does not constitute medical advice; we would always recommend calling 111 or visiting the NHS 111 website if you have any specific concerns about your health. In the case of an emergency, call 999.


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