ACL Injury Prevention: Physio’s Guide to the Program That Works

For physios working with sporting teams, injury prevention is always front of mind, and few injuries draw more attention than ACL injuries.

The good news? ACL prevention doesn’t need to be complex. Researchers and clinicians have spent years developing simple, effective programs to make injury prevention easier to implement across all sports and levels. These programs are built to be flexible, accessible, and require little-to-no resources to implement.

One standout is the Prep-to-Play program (1); it’s a program specifically designed to overcome common barriers to implementation in community sporting clubs. Its core aim is to reduce the burden of injury in sport. This blog discusses some components of the program and how you can apply them in the real world.

If you’d like to see exactly how expert physio Dr Brooke Patterson helps prepare her athletes for play to reduce the risk of injuries, watch her full Practical HERE. With Practicals, you can be a fly on the wall and see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster. Learn more HERE.

The warm-up

Brooke outlines the eight activities involved in this dynamic, flexible warm-up, which takes approximately 10-minutes to complete. While demonstrated in the context of Australian Rules Football (AFL), the program can be adapted to a range of different sports. The eight activities which should be incorporated into any injury prevention warm-up include:

1. Dynamic movements
2. Deceleration
3. Jumping/landing
4. Change of direction
5. Contact (sport-specific)
6. Speed
7. Single leg balance (e.g., handballing while standing on one leg)
8. Jumping/landing with contact

A key cue Brooke teaches her athletes in many of these activities is to avoid taking a large lunge, for example when changing direction or decelerating – as this can reduce your balance and control. Taking smaller steps when changing direction or decelerating means you keep your body over your feet and maintain more control.

If equipment is scarce, Brooke also demonstrates a minimal-equipment version of the warm-up, still hitting the same key movement patterns (like deceleration, balance and speed). So even if you’re coaching with cones made from water bottles, an effective injury prevention warm-up can still be done!

Training drills

Integrating prevention work into sport-specific drills is where it all comes together, especially for bridging the gap between rehab and full return to play.

One drill Brooke shares is the tackling grid: a simple, partner-based drill that replicates game scenarios. It’s adaptable across sports and a great way to layer contact and decision-making into your training while supporting injury resilience. See her demonstrate the drill in this clip from her Practical:

The “cool down” (A.K.A strength)

There are three strength categories as part of the Prep-to-Play program:

1. Quadriceps/lower-limb
2. Hamstrings/glutes
3. Trunk/hip exercises.

Each of the categories include three bodyweight exercises which don’t require a gym or any fancy equipment! Watch Brooke demonstrate the three quadriceps-based exercises in the below video from her Practical:

This part can be the hardest to implement. The common barriers? Players think they already do strength work outside of training. Coaches feel time-poor. Clubs think they don’t have the resources. But Brooke offers workarounds that make integration easier, think walking lunges to water bottles, or alternating ball drills and strength stations in small groups. Brooke also highlights performance tests to track progress, keep players motivated, and collect useful pre-injury data if an athlete gets injured later on.

If the club, coach or player you’re working with still doesn’t want to make the change, then maybe they just don’t know the numbers – these programs can reduce injuries by 40–60%. That’s too large a number to ignore. Putting a program such as Prep-to-Play in place can have lasting benefits for all parties involved, so it should be a no-brainer when it comes to ACL injury prevention.

Wrapping up

As physios, we’re lucky to have structured, evidence-based tools like Prep-to-Play at our fingertips. These programs are built with real-world challenges in mind to make our jobs easier – they don’t take much time, they don’t require fancy equipment, they’re highly adaptable and they can be applied by coaches, players and parents. There will always be barriers, but it’s our role to advocate for simple, effective strategies that make a difference. Prep-to-Play isn’t just research-backed, it’s ready to be applied today.

If you want to see how expert physio Dr Brooke implements the program herself, watch her full Practical HERE.