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Health & Exercise Forum

ACL injury prevention for female athletes: Part 2 of 2

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Sep 12, 2016


Danielle Maurice, SPT

Danielle Maurice, SPT

Guest Contributor: Danielle Maurice, SPT

Various studies have shown that female athletes are on average four times more likely than males to tear their anterior cruciate ligament (ACL) of the knee. Susceptibility for female athletes to an ACL injury is a multifaceted problem; anatomical, mechanical, physiological factors and landing technique are all involved. Studies done involving the Prevent Injury and Enhance Performance (PEP) program developed by the Santa Monica Sports Medicine Research Foundation has demonstrated a decrease in ACL injuries for those athletes that adopted the program, compared to those that did not engage in a prevention program. Usually, athletes first get exposed to such programs once they get to the college level, mostly being applied at the Division I level. As the coach of the Pocono Snow Junior’s U13 Girls Team and as an Pre- Physical Therapy/Exercise Science student at the University of Scranton, I have become very interested in applying an injury prevention program to the regular practice routine for the girls I coach sooner than the collegiate level. With the help of Dr. Paul Mackarey and University of Scranton Assistant Coach Sarah Jerome, we created an ACL prevention program, based off of the PEP program, to tend to the needs of these girls. Last week we discussed the anatomy and mechanism of the ACL injuries in female athletes and the prevention program weeks 1 and 2. This week we will continue with the ACL prevention program for weeks 3-4 and 5-6.

Weeks 3-4

As in Weeks 1 and 2, start with one lap around the field, followed by the dynamic warm up and hops. New to Weeks 3 and 4 are agility exercises. Agility exercises can be modified to be sport specific. With the intent of increasing balance and strength for the athletes, proper body positioning and landing techniques are important here. A good sport specific agility exercise is Figure 8’s (Photo 13—Figure 8’s), or use of an agility ladder (Photo 14).

Weeks 5-6

The last two weeks of the program begin with the warmup lap around the field and the dynamic warmup (the same as Weeks 1-4). Here, it is the coach’s choice for either hops or agility/ladder work. New to Weeks 5 and 6 are advanced plyometrics and resistance exercises.

Reminder: Plyometrics are meant to be explosive and build strength, speed, and power. However, technique is still important! Remind athletes to land softly on the balls of their feet with bent knees—never landing on heels or hyperextended knees.

Examples of advanced plyometric exercises include: Jump squats (Photo 15), knee-to-chest (Photo 16), single leg lateral hops (Photo 17), and mountain climbers (Photo 18). These exercises should be done for 10 yards, then athletes should accelerate for another 10 yards.

A great resistance exercise is sports cord with a partner (Photo 19). By having one athlete running forward while attached to a band, and another athlete holding it behind them, both athletes are working on improving strength and balance.


For several reasons, including anatomy and bio mechanics, female athletes have four times the risk of ACL injuries. Studies have shown that a multifaceted ACL injury prevention program can significantly reduce the risk for an ACL injury in this population. A multifaceted program includes education in anatomy, biomechanics, and physiology, along with concentration on lower extremity strength, flexibility, agility, balance and proprioception with emphasis on proper landing techniques.

Coaches, athletic trainers, athletic directors, school boards, parents and players would be well advised to incorporate a mandatory ACL injury prevention program such as the one described in part I and II of this column in order to prevent ACL injuries in all athletes, most especially the female athlete.

Guest Contributor: Danielle Maurice, SPT, University of Scranton, Pre- Doctor of Physical Therapy/Exercise Science Student 2020. Dani a native of Long Island, NY is an intern at Mackarey & Mackarey Physical Therapy Consultants, LCC

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.