Want to avoid serious knee injury playing football this year? Then get smart with your preseason training.

By far the biggest scourge of the keen footballer is the dreaded ACL tear. The Anterior Cruciate Ligament (ACL) is a strong ligament inside your knee that runs from the front of the shin bone to the back of the thigh bone. It works in conjunction with the posterior cruciate, the collateral ligaments, and the musculature and joint capsule to keep your shin bone from sliding off your thigh bone during the tremendously large forces produced at the knee during running sports.

Football has relatively high rates of ACL injuries due to the nature of the game. Running and fast changes in direction are risks for ACL tears and the fact that football is played with the feet, meaning that the player is often negotiating these activities whilst weight bearing on one leg only.

I hate seeing ACL ruptures in footballers because I know how long it will take them to get back to full fitness. The surgery and early rehab is usually painful and then there is a long road of graded exercises to get back to full ability. It takes a lot of commitment and good help from trained specialists, therapists, and fitness trainers.  I know more than a few park and semi-professional footballers who have given up the game after a cruciate ligament rupture.

So obviously the best strategy regarding ACL injuries is to not get one in the first place.

Luckily there has been a concerted research effort over the last 15 years to work out what is the best way to reduce the chance of athletes and players suffering an ACL tear. There are a bunch of training programs that have been designed, which vary in length and design, to reduce the incidence of ACL tears by 20% to 80%, depending upon the study.

Most of the prevention training programs are 4 to 6 weeks in length. They are designed for preseason use, but don’t fret if you’ve missed the deadline. Better late than never- and the effects probably start as soon as you start on a program like this.

These ACL injury prevention programs are known by a few names but the PEP Programs short for prevent injury – enhance performance – program are the most well known. There is some variety in what’s been studied but they follow a similar routine.  No one program is considered the best.

Below I am going to give you a brief run-down of a general program. Get in touch with the clinic if you want any more info or some help in putting one of these together for your club/team/player. Find our contact details at the bottom of the page.

A good PEP program is divided into 5 sections. Do the program before training commences. It should take about 20 minutes to complete.

The Preamble:

  • This is probably the most important part of incorporating this whole program in a training routine. The athlete must understand the reason for having to do another drill and how to get the most out of it. This program is meant to be done with a real focus on FORM, rather than on speed. Just going through the motions won’t ensure the result. The athlete needs to pay attention to quality of movement, over quantity. Focusing on technique and proper execution of the movements should increase its effectiveness. If you are a couch, communicating this clearly should help achieve good athlete compliance with the program and get the best results.

The Warm Up:

  • This section involves a series of slow and deliberate shuttle runs over 15 meters to prime the body. The players should focus on soft landing and good running form. Shuttle run is initially done forward, then sideways, then backwards.

Strengthening Portion:

  • Begin with a walking lunge over the same distance. Bring the same deliberate focus on good technique to all these strength exercises. In the walking lunge pay particular attention to not allow the knee to deviate from proper positing over the forward foot- especially not allowing it to collapse inward- the direction or knee rotation that precedes most ACL injuries.
  • “Russian” Hamstring Curls: Athletes will need a partner for this exercise- One athlete will need to kneel with both shins flat on the ground. Have the partner clasp the ankles firmly to the floor so the athlete can control a bend forward from the knees. This is an exceptionally hard exercise to perform anywhere near full range, so make sure they only go as far forward as they can control. And no bending at the hip.
  • Single Toe Rises: Stand on one leg with the other knee up. Slowly rise up on the standing foot to tip-toe, control and lower back down. Remember the focus should be on balance, control and stability. Repeat each leg.

Plyometric Portion:

Plyometric is a form of exercise involving fast, explosive movements like sprints, jumps, etc. This program works through a number of jumping drills:

  • Lateral hops over a line. Encourage the athletes to focus on a soft, quiet landing and allowing themselves to land in a semi-squat position. This should encourage the athlete to use their ankles, knees, hips and back to absorb the force.
  • The next exercise is forward/backward hops over the line. Repeat as above.
  • Single leg hops are more difficult, and the athlete should be encouraged to build their ability to “stick” the landing and not to need a secondary hop for balance.
    • With single leg hops, go through lateral hops and forward/backward hops for both legs singly.
  • Finally put the athletes through a scissor jump drill and a vertical jump drill.


There are 3 drills in the agility section.

  • 3 step stop: Perform over the same area as for the shuttles, except get the athlete to focus on a deliberate 3 step stop, counting out the steps as they do. They should fully stop before they continue on again. Alternate stopping foot.
  • Bounding run: Over the same distance get the athletes to perform a bounding run, which preferences hip motion rather than knee. I’ve also heard this called “ice skating” running.
  • “Z” running drills with deliberate outside foot planting: Set up cones in a zig-zag pattern over about 20 meters. Run each athlete through in-sequence and get them to practice planting the outside foot at the cone and deliberately pivoting off this foot as they change direction. Once again, form is essential in this exercise, not speed.

5 Stretches to finish.

Athlete’s should finish with calf stretches, quad stretches, figure ‘4’ seated hamstring stretches, a seated ‘V’ groin stretch and a hip flexor lunge stretch.

Women vs Men.

Finally there is convincing evidence that women are at a significantly higher risk of injuring their ACL in sports like football than men. There are a number of suspected reasons like leg builds, muscle strength and proprioception differences, but we don’t really know for sure why. Suffice to say that if your team does not have a program in place for the adolescent girls and all age woman’s teams, you probably should consider it.


Edward Clark

B. App. Sci, M. Ost.

Registered Osteopath.


Get in touch regarding PEP programs for professional or amateur sports teams by contacting us at the clinic.


Phone: 9553 9823



Number 8, Belgrave Street, Kogarah. NSW.