How Do Neuromuscular Training Programs Prevent ACL Tears?

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The anterior cruciate ligament, or ACL, is one of four major ligaments of the knee. Injuries to the ACL are a common sports injury and can be season-ending injuries. New research is investigating ways to prevent ACL injuries in an effort to avoid lost time from sports and competition.

Stability of the knee is dependent on different factors. The two most important are the static and the dynamic stabilizers of the knee.

  • Static Stabilizers
    The static stabilizers are the four major ligaments of the knee: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL).
  • Dynamic Stabilizers
    The dynamic stabilizers of the knee are the muscles and tendons that surround the joint. These muscles and tendons are controlled by what's known as neuromuscular input, the unconscious activation of these structures to control the position of the joint.

Neuromuscular training is used to teach your body better habits for knee stability. By training how your knee moves, especially when jumping, landing and pivoting, you can maintain a more stable position of the knee joint. Several studies have shown that neuromuscular training programs can reduce the chance of an ACL injury.

Studies found that comprehensive programs that include plyometrics, strengthening, stretching and balance training were the best at preventing ACL injuries, especially in young women athletes.

Plyometrics include repetitive jumping exercises that build both strength and power.

American Academy of Pediatrics Recommends Neuromuscular Training Programs

With more children participating in organized sports and undergoing more intense training for longer periods, ACL injuries have become more common.

These are especially on the rise of girls playing soccer, volleyball, basketball, and gymnastics. Sports that involve running, pivoting and jumping are especially risky for young joints. The American Academy of Pediatrics (AAP) recommends neuromuscular training programs to reduce the risk of ACL injury, citing research that it can reduce the risk by as much as 72 percent in young women.

The AAP lists training programs they recommend to coaches and school sports programs. These include plyometric and strengthening exercises.

Neuromuscular Training Programs

PEP Program: One of the better-known neuromuscular training programs, the Prevent Injury, and Enhance Performance program (commonly known as the PEP program) was developed at the Santa Monica Orthopaedics and Sports Medicine Research Foundation. It is available as a free PDF download and a video is available for a donation. It can be set up on a field with lines or cones. The program takes about 15-20 minutes to complete and should be done three times per week. It includes warm-up, stretching, strengthening, plyometrics and sport-specific agility exercises.

KIPP for Coaches: This is a free online instruction with slides and videos of exercises for young female athletes.

It is used as a 15-minute neuromuscular warm-up routine with exercises for strengthening, plyometrics, balance, agility, and stretching. It was developed for the Chicago public high schools in 2006 by the Ann & Robert H. Lurie Children's Hospital of Chicago Institute for Sports Medicine.


Griffin LY, et al. "Noncontact Anterior Cruciate Ligament Injuries: Risk Factors and Prevention Strategies" J. Am. Acad. Ortho. Surg., May/June 2000; 8: 141 - 150.

Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, Cugat R. "Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates." Knee Surg Sports Traumatol Arthrosc. 2009 Aug;17(8):859-79. doi: 10.1007/s00167-009-0823-z. Epub 2009 Jun 9.

Cynthia R. LaBella, William Hennrikus, Timothy E. Hewett, COUNCIL ON SPORTS MEDICINE AND FITNESS, and SECTION ON ORTHOPAEDICS. "Clinical Report: Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention," Pediatrics May 2014, VOLUME 133 / ISSUE 5