Prevention and Treatment of Anterior Cruciate Ligament (ACL) Injury

acl injury treatment

ACL injury (sprain or tear) physiotherapy.

Article by Sydney sports physio, Chris El-Hayek.

The Anterior Cruciate Ligament (ACL) is one of the main stabilising ligaments of the knee. It is the most common knee ligament injury to occur, and is unfortunately associated with significant time out of sport/activity.

The injury generally occurs from sudden change of direction, an awkward landing (especially after being bumped mid air), or from direct contact at the front or side of the knee (e.g. in a rugby tackle). ¹

Because of the high recurrence rate of this injury, time out of sport/exercise, pain, and dysfunction, it is an injury that is commonly discussed, and heavily researched. This has led to a lot of research and time being spent on the best strategies to minimise the risk of the injury occurring in the first place. What is also of concern is the increasing number of ACL operations being done in Australia, particularly in adolescents, as well as the higher risk of females injuring their ACL compared to men.

This article will aim to discuss some of the risk factors for ACL injury, and potential exercise-based strategies that should be considered to mitigate some of the risks mentioned, which may reduce the chances of an ACL tear occurring.

Potential risk factors of an ACL sprain or tear

Intrinsic Risk Factors

  • Reduced fitness / conditioning
  • Fatigue/poor sleep
  • Lack of exposure to specific movements (e.g. landing, change of direction)
  • Reduced bilateral (2 legs) or unilateral (1 leg) strength
  • Poor movement technique for change of direction, deceleration, and landing
  • Graft failure from previous ACL operation
  • Premature return to sport following ACL injury or reconstruction
  • Ligament laxity due to estrogenic effects in females

Extrinsic Risk Factors

  • Poor field Surface (e.g. uneven, dry, bumpy grounds)
  • Type of studs you wear (e.g. Wearing metal studs on hard grass/artificial grass)

Exercises to reduce ACL injury risk

It is important that there is regular exposure to the movements listed below. With this, coaching/cueing should be given to correct poor technique which may increase risk of ACL injury.

As competency increases, progressions can be made to these exercises to increase the difficulty, and specificity of the movements to your specific activities/sport (e.g. 2 vs 1 leg landings, exposure to multi directional movements).

Landing Exercises

Shove from Behind – Jump off 2 legs, land on 1 (2 sets 5 reps each leg. Complete x3 a week)

ACL Injury 1

Important cues/coaching points:

  • Land on the balls of your feet ²
  • Absorb load through knee flexion ²

Both of the above points help reduce axial load on the acl which can reduce injury risk.

Change of Direction Exercises

Wide Cutting – (2 sets 5 reps each leg. Practice over 5-10 metre spaces. Complete x2 a week)

ACL Injury 2

Important cues/coaching points:

  • Laterally flexed hips to the intended cutting target can reduce load on the ACL.³
  • Landing with greater width relative to the hips can help increase change of direction speed/explosiveness.

How a physiotherapist can help prevent, manage and treat an ACL injury or tear

It’s clear that there are many factors involved in ACL injury. The exercises and movement patterns above are a few different strategies that can be implemented, but there are many other things to address from an exercise perspective. One key topic that will be the main focus of part 2 of my ACL articles will be strength and how this can reduce risk of ACL injury. Stay tuned for this article, and give us a ring, or send through an email if you are looking to reduce your injury risk, or rehabilitate your knee injuries to optimise your recovery and performance!

Do you need assistance managing or treating an ACL injury or tear? 

Sports physiotherapist Chris El-Hayek has extensive expertise in offering physiotherapy services to athletes in a range of high-performance sports. He has been able to assess and treat multiple athletes with a wide range of sport related injuries.  He can successfully implement programs that will minimise injury rates and enhance your athletic qualities.


  1. Evans J, Nielson Jl. Anterior Cruciate Ligament Knee Injuries. [Updated 2022 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  2. Mehl, J., Diermeier, T., Herbst, E., Imhoff, A., Stoffels, T., & Zantop, T. et al. (2017). Evidence-based concepts for prevention of knee and ACL injuries. 2017 guidelines of the ligament committee of the German Knee Society (DKG). Archives Of Orthopaedic And Trauma Surgery, 138(1), 51-61.
  3. Fox, A. (2018). Change-of-Direction Biomechanics: Is What’s Best for Anterior Cruciate Ligament Injury Prevention Also Best for Performance?. Sports Medicine, 48(8), 1799-1807.