Knee prevention: the programme that has proven its worth

The neuromuscular programme that roughly halves the risk of an ACL rupture: the five building blocks, a dose you can sustain over a season, and the mistakes to avoid.

Thibaud C. · Fitness coach · Last updated: September 26, 2026

This is the most practical module of the course. Neuromuscular training programmes are among the rare interventions whose effect is solidly documented: the meta-analyses that have pooled them report a reduction in ACL rupture risk of around 50% in female athletes, with estimates ranging from 40 to 70% depending on the protocol.

The most studied programme in football is FIFA's "11+", and that's no accident: the trial that made its name was run precisely with young female footballers aged 13 to 17 (Soligard et al., BMJ, 2008, a cluster randomised trial). The result: around a third fewer injuries overall, and close to half as many severe injuries.

One crucial point, and it's the main message of this module: the factor that best explains the results isn't the content of the programme, it's consistency. A meta-analysis devoted to that question shows that the most regular teams achieve a markedly greater risk reduction than teams applying the programme irregularly (Sugimoto et al., 2012). An excellent protocol done three times in September protects nobody.

The five building blocks that count

Whether you use the "11+", a club protocol or your own template, you always find the same ingredients:

• Jump landings. Jump, land on two bent legs, knees over the feet, silently. Then on one leg. It's the exercise most directly linked to the injury mechanism.
• Decelerations and changes of direction. Run, brake decisively in three steps, set off in another direction. You correct the knee position first, the speed comes later.
• Hamstring strengthening, particularly eccentric (the Nordic exercise). They balance the action of the quadriceps, which pulls the shin forward.
• Hip and glute work, which control knee alignment: lunges, single-leg squats, bridges, lateral work with a band.
• Balance and proprioception, on one leg, first stable then disturbed by a ball or a team-mate.

A dose that survives a real season

• Twice a week, 15 to 20 minutes, at the start of the session, in place of the usual warm-up. It's the only way it survives past October.
• All season, not just in pre-season. The protective effect fades once you stop.
• Progressively: start with two-legged landings before single-leg, with planks before the full Nordic.
• With corrections. An exercise done with the knee falling inwards prevents nothing: five clean repetitions beat fifteen sloppy ones.

The three mistakes that cancel everything out

• Doing it only in pre-season. It's the most common mistake, and it drains the programme of its value.
• Tacking it onto the end of the session, when everyone is tired: execution quality collapses, and it's the first block sacrificed when the session overruns.
• Never explain why. Players who understand it's about protecting their knee do it seriously; otherwise it becomes a formality rushed through.