The nature of football can place increased risk on structures of the body. The anterior cruciate ligament (ACL) has a propensity towards injury in football and can be significant enough to keep a player sidelined for up to 9 months. There are 2 major issues which increase the likelihood of this type of injury occurring, however, these can be mitigated with a personalised corrective exercise programme.
Issue 1: Less than ideal biomechanics
The knee joint tends to adopt a bowing-in position when there is a lack of mobility and strength and stability at the ankle and hip joints. This position results from shallow flexion of the hip joint accompanied by the tibia (shin bone) turning outwards and the femur (thigh bone) turning inwards excessively (see image above). Studies by McLean et al. (2004) and Della-Villa et al. (2020) have noted that this position predisposes the knee to an increased risk of injury to the ACL and potentially the MCL and medial meniscus. Bowing in of the knee joint results from less-than-ideal function and range of motion of the ankle and/or the hip joint, as the optimal alignment of the knee joint depends on the ideal function and alignment of these other two joints.
Issue 2: Non-contact and indirect contact with the knee
Studies by Della Villa et al, (2020) and Walden et al (2015) noted that ACL injuries involving no direct contact to the knee and indirect contact (contact with the upper body causing indirect motion at the knee) made up for 88% and 85% of ACL injuries in their respective studies. These types of injuries are involved primarily from pressing an opponent in preparation to make a tackle and at initial contact when tackling an opponent (without direct knee contact). The authors noted that 90% of the observed ACL injuries occurred when the injured leg was weight-bearing. With these points in mind, we can understand how the following types of injury predispose players to ACL injury:
Major Causes for an ACL Injury in Football:
1: Unable to resist forces from In-direct contact.
ISSUE: 44% of ACL tears result from indirect contact with the knee, with 20% of these injuries occurring from being tackled by an opposing player. This typically involves contact from an opposing player on the upper body causing changes in alignment in the lower body, such as when an opposing player tries to use their upper body strength to knock a player off balance when tackling (see image ).
SOLUTION: A corrective mobility and strengthening programme can still make a profound difference in these situations. Players with greater mobility, strength, and coordination can better absorb and resist forces from contact. A player with considerable core and hip strength can remain on their feet following a tackle and maintain possession of the ball.
2: Non-contact forces
ISSUE: A further 44% of observed ACL injuries also accounted for non-contact incidents. Pressing and tackling an opponent with no contact had the highest prevalence of observed ACL injuries. The cause of this is due to the less-than-ideal biomechanics mentioned earlier in this article. The authors noted a higher incidence of ACL injury when the body was leaning over the affected knee, increasing the amount of load placed on the knee joint. This is accompanied by the bowing in the position of the knee caused by the tibia (shin bone) excessively turning outwards and the femur (thigh bone) excessively turning inwards over a planted foot (see image left of the position of the knee of the player in white as an example).
SOLUTION: This is where the need for athletes to have a personalised tailored corrective exercise programme becomes apparent. These programmes include specific exercises to develop body awareness, coordination, stability and optimal alignment of the joints of the lower body allowing athletes to distribute their weight better and accept forces from the ground. This quality is essential when a player presses an opponent, lands from jumping to head the ball, and regains balance after passing or shooting.
3: Lack of neuromuscular readiness
ISSUE: 62% of ACL injuries occurred in the first half of a match, with 25% of all ACL injuries occurring in the initial 15 minutes of a match. The authors hypothesised that a lack of neuromuscular readiness (lack of movement preparation) may be the reason why this is the case. This finding contradicts the more common assumption that ACL injuries are primarily the result of fatigue as only 33.4% of ACL injuries occurred in the second half, with only 8.5% of observed injuries occurring in the final 15 minutes of a match.
SOLUTION: A movement preparation programme in place before starting a match optimises the mobility and function of the joints of the lower body, thus reducing the risk of ACL injury.
How do we create a suite of ACL injury risk reduction for your players?
We take the time with each player to assess posture, quality of motion, strength and athletic quality. We offer free initial 15-minute screenings for under-18s and Personal Training sessions for adults. Our resident fitness and human movement and sport performance enhancement specialist Dan will use a series of assessments to highlight where your limitations in movement and strength reside and if you have an increased risk of injury to the knee and any other joints in the body. Dan will work with the player to create a tailored personalised programme aligned with the 3 key evidence-based factors in reducing the risk of ACL injury.
For more information on injury prevention and to make an appointment please contact us at:
Address: 10 Fawkon Walk, Hoddesdon EN11 8TJ
- Della Villa F, Buckthorpe M, Grassi A, Nabiuzzi A, Tosarelli F, Zaffagnini S, Della Villa S. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. Br J Sports Med. 2020 Dec;54(23):1423-1432. doi: 10.1136/bjsports-2019-101247. Epub 2020 Jun 19. PMID: 32561515.
- McLean SG , Huang X , Su A , et al. Sagittal plane biomechanics cannot injure the ACL during sidestep cutting. Clin Biomech 2004;19:828–38.doi:10.1016/j.clinbiomech.2004.06.006 pmid:http://www.ncbi.nlm.nih.gov/pubmed/15342155
- Waldén M , Krosshaug T , Bjørneboe J , et al. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. Br J Sports Med 2015;49:1452–60.doi:10.1136/bjsports-2014-094573 pmid:http://www.ncbi.nlm.nih.gov/pubmed/25907183