The Feb. 26, 2026 NY Times Magazine article on the surge ACL tears in female athletes has generated a ton of buzz in the general media, youth sports community, and rehab/sports performance space recently.
This issue is undoubtedly complex and multi-factorial with no simple solution. The article goes on to detail multiple factors including early sports specialization and the commercialization of youth sports, lack of movement competency and movement literacy in our increasingly sedentary youth, anatomical and physiological differences in female athletes, and societal and cultural influences with gender-based stereotypes toward young female athlete strength and conditioning programs. These are just a few of the issues that may predispose female athletes to an increased risk of ACL injury.
ACL injuries and the subsequent rehab process following surgery can be physically, mentally, and emotionally grueling for young athletes, with rehab often lasting 6-12 months after surgery.1-3 The encouraging news for parents of young female athletes is that there is overwhelming evidence that the risk for non-contact ACL injury can be mitigated or reduced with specialized injury prevention programs.
The FIFA 11+ is a well-researched injury prevention warmup found to be effective in male and female athletes.4-7 While this program has been found to be effective, compliance rates with implementation of this program remain low for a variety of reasons. Time constraints, program monotony, lack of implementation knowledge, and other factors may all contribute to a lack of compliance with consistent performance of this program. The benefits of the FIFA 11+ or a similar injury prevention warmup program may be augmented or enhanced with a well-developed strength and conditioning program. These additive benefits may be compounded when the programs are overseen by professionals with knowledge of ACL injury mechanisms, common neuromuscular deficits and risk factors, and knee biomechanics.
Contact me to help design and implement a customizable injury prevention program that fits your athlete’s needs.
- Brinlee AW, Dickenson SB, Hunter-Giordano A, Snyder-Mackler L. ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline. Sports Health. 2022 Sep-Oct;14(5):770-779. doi: 10.1177/19417381211056873. Epub 2021 Dec 13. PMID: 34903114; PMCID: PMC9460090.
- Manoharan A, Fithian A, Xie V, Hartman K, Schairer W, Khan N. Return to Sports After Anterior Cruciate Ligament Reconstruction. Perm J. 2024 Jun 14;28(2):102-108. doi: 10.7812/TPP/23.132. Epub 2024 Apr 25. PMID: 38659351; PMCID: PMC11232915.
- Waldron K, Brown M, Calderon A, Feldman M. Anterior Cruciate Ligament Rehabilitation and Return to Sport: How Fast Is Too Fast? Arthrosc Sports Med Rehabil. 2022 Jan 28;4(1):e175-e179. doi: 10.1016/j.asmr.2021.10.027. PMID: 35141549; PMCID: PMC8811519.
- Nuhu A, Jelsma J, Dunleavy K, Burgess T. Effect of the FIFA 11+ soccer specific warm up programme on the incidence of injuries: A cluster-randomised controlled trial. PLoS One. 2021 May 24;16(5):e0251839. doi: 10.1371/journal.pone.0251839. PMID: 34029321; PMCID: PMC8143390.
- Bizzini M, Dvorak J. FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide-a narrative review. Br J Sports Med. 2015 May;49(9):577-9. doi: 10.1136/bjsports-2015-094765. PMID: 25878073; PMCID: PMC4413741.
- Steffen K, Emery CA, Romiti M, Kang J, Bizzini M, Dvorak J, Finch CF, Meeuwisse WH. High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. Br J Sports Med. 2013 Aug;47(12):794-802. doi: 10.1136/bjsports-2012-091886. Epub 2013 Apr 4. PMID: 23559666.
- Rössler R, Donath L, Bizzini M, Faude O. A new injury prevention programme for children’s football–FIFA 11+ Kids–can improve motor performance: a cluster-randomised controlled trial. J Sports Sci. 2016;34(6):549-56. doi: 10.1080/02640414.2015.1099715. Epub 2015 Oct 27. PMID: 26508531.