Anterior Cruciate Ligament (ACL) Injury and Injury Prevention

The female footballer needs to pay particular attention to the prevention of injury to the Anterior Cruciate Ligament (a very important stability ligament in the knee).

Female players are 2-3 times more likely to rupture their ACL ligament than males (1) with this injury keeping players out of competitive matches for 12 months! Importantly, we know that programs like the Football Australia Perform+ are effective in reducing the risk of players rupturing their ACL by 45% (2) and all injuries by up to 68% in the young female footballer (3).

Coaching tips for females


Impact of Social Factors on Injury Risk for Female Players

The ACL injury rate disparity between male and female players highlights the need to consider multiple factors that may contribute to the increased injury risk. An example is the impact of social factors on injury risk (4). These factors include (but are not limited to):

  • a lack of resources
  • a lack of access to technical and strength & conditioning coaching
  • poor provision of equipment and facilities
  • low training access and exposure for female players
  • unsupportive societal attitude towards female participation in sport

As such, coaches should consider the training history of their players (i.e. how long have they been playing football), in addition to ensuring that resources are available for players to have access to injury risk reduction strategies. Furthermore, administrators should promote and ensure equal resource accessibility for male and female players.

Role of the Football Australia Perform+ and Fundamentals+

The Football Australia Perform+ has been specifically designed to reduce injury risk for the female player and considers the social factors that may contribute to injury risk. The Perform+ and Fundamentals+ program was designed to be:

  • simple to deliver by coaches of any level
  • suitable for all players regardless of training history or skill level
  • safe to perform from a young age and prepares players for the fundamental movements in football
  • can be performed as a home and school exercise program

It should also be noted that much more research is required in women’s football, especially in the area of injury risk reduction. As more detailed and female specific research is conducted, it is expected that further strategies to reduce injury risk will be developed (5).

Practical Tips:

  1. Start the Football Australia Perform+ from a young age. The peak incidence of ACL injury in female athletes is between 15-19 years of age, compared with 20-24 years for males, making it imperative that injury risk reduction strategies are introduced early and regularly from 10-11 years of age.

  2. Strength, power and change of direction training are all very important components for injury and ACL injury prevention for female players. It is important that these components of the Football Australia Perform+ are included in training and players are monitored for technique and movement quality.

  3. Focus on technique from a young age. How a player moves, especially preventing the knee from “buckling in”, is very important. Encouraging control of ankle – knee – hip alignment is a fundamental principle for injury prevention.

  4. Coaches and administrators should consider social factors that may influence the injury risk profile for their players. Ensuring that players have good access to resources, adequate exposure to the Football Australia Perform+, in addition to consideration of individual training history, may assist in further reducing injury risk for female players.


  1. Montalvo AM, Schneider DK, Yuk L, et al. “What’s my risk of sustaining an ACL injury while playing sports?” A systematic review with meta-analysis. Br J Sports Med 2019;53:1003-1012.
  2. Crossley KM, Patterson BE, Cluvenor AG et al. Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players. Br J Sports Med 2020;54:1089-1098.
  3. Soligard T, Myklebust G, Steffen K et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 2008;337:a2469.
  4. Parsons JL, Coen SE, Bekker S. Anterior cruciate ligament injury: towards a gendered environmental approach. Br J Sports Med E Pub ahead of print: 22 Feb 2021. doi: 10.1136/bjsports-2020-103173.
  5. Kryger KO, Wang A, Mehta R, et al. Research on women’s football: a scoping review. Science and Medicine in Football E Pub ahead of print: 8 Jan 2021. doi: 10.1080/24733939.2020.1868560.