ACL Injuries in Female Soccer Players: What Every Athlete and Parent Should Know
I've torn both of my ACLs.
I know what it feels like to be the athlete sitting in a doctor's office hearing that you tore your ACL.
I know what it feels like to wonder:
When can I play again?
Will my knee ever feel normal?
Will I tear it again?
Can I trust my knee?
But I've also been on the other side.
As a physical therapist, I've helped athletes work through ACL injuries and get back to the sports they love.
Going through two ACL injuries myself changed the way I think about ACL injuries.
Because an ACL tear is not always as simple as:
“She landed wrong.”
Or:
“She wasn't strong enough.”
There are many things that can play a role.
Strength.
How an athlete moves.
How much she is training.
How well she is recovering.
How much she is eating.
Hormones.
Past injuries.
How ready she is for her sport.
And the demands of the sport itself.
We cannot control everything.
But there is a lot we can control.
The goal is not to make female soccer players scared of tearing their ACL.
The goal is to help athletes become stronger and better prepared for the demands of their sport.
Why Are ACL Injuries So Common in Female Soccer Players?
Soccer is a demanding sport.
Players sprint.
They stop quickly.
They jump.
They land.
They cut.
They change direction.
They fight for the ball.
And they do all of this over and over again.
Many ACL injuries happen during these types of movements.
Research shows that female athletes in sports like soccer, basketball, and volleyball have a higher risk of ACL injury than male athletes. Female soccer players are one group that has received a lot of attention when it comes to ACL injury prevention.
But here is the good news:
An ACL injury is not always random.
We cannot prevent every ACL injury.
But we can work on many of the things that may increase an athlete's risk.
Research shows that programs that include strength, jumping, landing, balance, and cutting exercises can lower the risk of ACL injuries in female athletes. One recent expert review found that these types of programs can lower ACL injuries in female athletes by about 61%.
But there is an important part that often gets missed.
ACL prevention is about more than doing a few exercises before practice.
We need to ask:
Is this athlete ready for what we are asking her body to do?
1. Strength Matters
Being strong is important for soccer players.
But simply saying, “She's strong,” doesn't tell us enough.
Strong compared to what?
Is she strong enough for her sport?
Is one leg much stronger than the other?
Can she control her body when she lands?
Can she slow herself down?
Can she change direction?
Can she do these things when she is tired?
These are important questions.
Soccer is also a sport where athletes spend a lot of time using one leg at a time.
You run on one leg.
You push off one leg.
You land on one leg.
You change direction from one leg.
That means athletes need more than just strong legs.
They need to be able to control those legs.
A good strength program may include:
● Squats
● Lunges
● Single-leg exercises
● Hamstring exercises
● Hip exercises
● Calf exercises
● Jumping
● Landing
● Sprinting
● Slowing down
● Changing direction
The goal is not just to lift more weight.
The goal is to build a body that can handle the demands of soccer.
2. Your Athlete May Be Doing Too Much Soccer
This is a big one.
Many competitive athletes are doing more than one team sport schedule.
A soccer player may have:
● Club practice
● High school practice
● Games
● Private soccer lessons
● Speed training
● Strength training
● Conditioning
● Tournaments
● Camps
● Showcases
And sometimes they add even more because they want to get better.
But more is not always better.
Your body needs time to recover.
Training puts stress on your body.
Recovery gives your body time to rebuild and get stronger.
If an athlete keeps adding more and more training without enough recovery, she may start to feel tired, sore, or run down.
That doesn't mean hard training is bad.
Hard training is part of becoming a better athlete.
But the amount of training needs to match what the athlete is ready to handle.
Ask:
“How much is she doing?”
But also ask:
“Can her body handle that much right now?”
Those are two different questions.
3. Training Load Matters
“Training load” is just a fancy way of saying:
How much work is your body doing?
For example, imagine an athlete who normally practices soccer three days a week.
Then preseason starts.
Now she is practicing five days a week.
She has games on the weekend.
She adds private soccer training.
Then she adds extra conditioning.
And she still goes to the gym.
That's a big jump in how much work her body has to handle.
The body needs time to adjust to changes like this.
This is why we need to think about the athlete's total workload.
Not just soccer practice.
Not just games.
Everything.
And we also need to look at how the athlete feels.
Is she sleeping?
Is she eating enough?
Is she sore all the time?
Is she tired?
Is her performance getting worse?
Is she recovering between practices?
These are all important clues.
4. Recovery Is Training Too
A lot of athletes think that getting better means doing more.
But recovery is part of getting better.
Sleep
Sleep is one of the best recovery tools an athlete has.
And it doesn't cost anything.
Still, sleep is often the first thing to get pushed aside when athletes have school, sports, homework, travel, and other activities.
A tired athlete may not move or perform the same way as a well-rested athlete.
Food
Your athlete needs enough food to fuel her training and help her body recover.
Think about it this way:
Your body needs fuel to train.
It also needs fuel to repair itself.
If an athlete is not eating enough to match how much she is training, her body may not have what it needs to perform and recover well.
Not eating enough can also affect bone health, hormones, energy, and performance.
This is one reason nutrition is an important part of taking care of a female athlete.
Rest
Rest does not mean an athlete is lazy.
Rest is part of the plan.
A good training program should include hard days, easier days, and days where the body gets a chance to recover.
Sometimes the best thing an athlete can do is not add another workout.
5. What About Hormones?
This is a topic that gets talked about a lot when we discuss ACL injuries in female athletes.
You may have heard that hormones can make female athletes more likely to tear their ACL at certain times during their menstrual cycle.
The truth is more complicated.
Researchers have found that hormones can affect things like the looseness of the knee and the tissues around the knee.
But we do not have enough evidence to say:
“You are in this part of your cycle, so you are going to tear your ACL.”
It doesn't work that simply.
Instead, we should look at the whole athlete.
For example:
● Is she getting regular periods?
● Is she eating enough?
● Is she sleeping enough?
● Is she always tired?
● Has her performance changed?
● Is she getting hurt more often?
● Is she training more than she can recover from?
These questions can tell us much more about an athlete than simply looking at where she is in her menstrual cycle.
Hormones may be one piece of the puzzle.
But they are not the whole puzzle.
6. Don't Skip the Warm-Up
You may have heard of ACL prevention programs like FIFA 11+.
These programs can be very helpful.
Research shows that programs that include exercises for strength, balance, jumping, landing, and changing direction can lower ACL injury risk in female athletes.
So yes:
Do the warm-up.
But there is a problem.
The best program in the world does not help if the athlete doesn't do it.
Research shows that getting athletes to consistently perform injury-prevention programs can be difficult. Having coaches and medical professionals support the program can help athletes stick with it.
And doing the exercises correctly matters too.
It is one thing to tell an athlete:
“Land with your knees in a good position.”
It is another thing to figure out why she struggles with landing and then train that weakness.
That's the difference between simply giving someone exercises and creating an individualized plan.
7. What If Your Athlete Already Tore Her ACL?
This is where my story becomes personal.
I've torn both of my ACLs.
So I know what it feels like to go through surgery and rehab.
I also know what it feels like to wonder if your knee is ready again.
And now, as a physical therapist, I've helped athletes through that same process.
One of the biggest mistakes we can make is thinking that an athlete is ready to play just because enough time has passed.
Six months have passed.
Nine months have passed.
A year has passed.
But time alone does not tell us if an athlete is ready.
We need to ask:
Is her body ready?
Is her knee ready?
Is she strong enough?
Can she jump and land?
Can she stop quickly?
Can she change direction?
Can she do those things when she is tired?
Does she trust her knee?
Is she mentally ready to compete again?
Return to sport should look at more than just the calendar. Experts recommend looking at physical testing, movement, the athlete's confidence, her recovery, and the demands of her sport.
8. Being Cleared Doesn't Always Mean You're Ready
This is a very important difference.
An athlete can be medically cleared to play and still not feel ready.
Maybe she is afraid to cut.
Maybe she doesn't trust her knee.
Maybe she is afraid of landing.
Maybe she thinks about her ACL every time someone comes toward her.
Those feelings matter.
Your brain remembers an injury.
That's normal.
After an ACL injury, rebuilding confidence is part of the process.
Research has found that how ready an athlete feels mentally can be related to the risk of another ACL injury after returning to sport.
That's why we should not only ask:
“Can you play?”
We should also ask:
“Do you trust your body enough to play?”
9. So What Should an ACL Assessment Look Like?
There is no single test that can tell us:
“You will not tear your ACL.”
If someone tells you they can guarantee that, be careful.
Instead, we want to look at the whole athlete.
That may include:
Strength
Are both legs strong?
Are the muscles around the knee and hip strong enough?
Is one leg much weaker than the other?
Jumping and landing
Can the athlete control her body when she lands?
Can she absorb force?
Single-leg control
Can she control one leg when she is running, jumping, or landing?
Speed and power
Can she produce force quickly?
Can she accelerate?
Stopping
Can she slow herself down safely?
This is important because soccer isn't just about running fast.
You also have to stop fast.
Cutting and changing direction
Can she change direction while maintaining control?
Fatigue
Does her movement change when she gets tired?
This matters because soccer players don't only make decisions when they are fresh.
Training
How much soccer is she doing each week?
Recovery
Is she sleeping and recovering enough?
Nutrition
Is she eating enough to support her training?
Previous injuries
Has she had an ACL injury before?
What about ankle, knee, hip, or hamstring injuries?
Confidence
Does she trust her body?
Sport
What position does she play?
How competitive is her level?
How often does she practice and play?
These questions help us understand the athlete as a whole.
10. The Goal Isn't Just to Prevent an ACL Tear
This may be the most important part.
I don't want athletes thinking:
“I need to do these exercises so I don't tear my ACL.”
I want them thinking:
“I want to build a body that is ready for my sport.”
That's a much better goal.
Because the same things that can help lower injury risk can also help an athlete:
● Get stronger
● Run faster
● Jump higher
● Stop better
● Change direction better
● Feel more confident
● Handle more training
● Recover better
● Perform better
Injury prevention and performance training can work together.
The goal is to build a better athlete—not just protect a knee.
A Message to Athletes
If you are a competitive soccer player, you don't have to wait until something hurts to get help.
You don't need to have an injury.
You don't need to have torn your ACL.
You don't need to be coming back from surgery.
You can get checked when you are healthy.
That's often the best time to find problems.
Maybe one leg is weaker.
Maybe you don't control your landing as well as you think.
Maybe you're doing too much training.
Maybe you're not recovering enough.
Maybe you are ready for more.
You won't know until someone looks.
And if you're coming back from an ACL injury, don't make your only goal:
“I want to get cleared.”
Make your goal:
“I want to be ready.”
Ready physically.
Ready mentally
Ready for the demands of your sport.
A Message to Parents
If you are the parent of a competitive female athlete, you don't need to become a physical therapist or sports medicine expert.
But you should ask questions.
Is she sleeping enough?
Is she eating enough?
Is she always tired?
Is she getting stronger?
Is she doing more and more soccer without enough recovery?
Does she have a good strength program?
Has anyone checked her strength and movement?
If she has had an ACL injury, has anyone tested whether she is actually ready for the demands of soccer?
You don't have to wait for another injury before asking these questions.
Your Athlete Doesn't Need Another Generic Workout
There are plenty of ACL exercises online.
You can find them in seconds.
But a list of exercises doesn't tell you:
Which exercises does your athlete actually need?
It doesn't tell you:
● What is weak?
● What needs to improve?
● What should be trained more?
● What should be trained less?
● How much soccer is too much?
● Is she recovering enough?
● Is she ready to return?
● What does she need to be ready for her specific position and level?
That's where an individualized assessment can help.
Your athlete is not a generic program.
Her training shouldn't be either.
Is Your Athlete Ready for What Comes Next?
If you've been wondering:
“Is my daughter doing enough to lower her risk of an ACL injury?”
Or:
“Is she doing too much?”
Or:
“Is she actually ready to return to soccer?”
Or even:
“I just want someone to take a closer look at her.”
Let's talk.
Start With a Free Consultation
A free consultation gives us a chance to learn more about your athlete.
We'll talk about:
● Her sport
● Her goals
● Her training
● Her injury history
● Her current concerns
● Where she wants to go next
From there, we can decide if an ACL / Injury-Risk Assessment makes sense.
You don't have to wait until she tears her ACL to find out if her body is prepared for soccer.
The best time to prepare an athlete is before the injury happens.
Book your free consultation today.
About the Clinician
I've been on both sides of an ACL injury.
I've torn both of my ACLs.
I've gone through the rehab.
I've experienced the physical challenges.
I've experienced the mental challenges.
And as a physical therapist, I've helped athletes work through their own injuries and return to the sports they love.
Those experiences changed how I treat athletes.
I don't want to simply help an athlete feel better.
I want to help athletes become stronger, more confident, and better prepared for their sport.
Because getting back to sport is one thing.
Being ready for sport is another.
