A Promising Way to Prevent ACL Injuries

The warm-up program known as PEP is designed to prevent damage to the vulnerable ligament.

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The PEP (Prevent Injury, Enhance Performance) program is a formal, 15-minute warm-up for female soccer players that encompasses stretching, strengthening, agility, and plyometrics. (Plyometrics involve jumping and other exercises designed to increase muscles' explosive power.) A recent study published in the American Journal of Sports Medicine found that NCAA Division I players who were asked to perform the program three times a week had an overall ACL injury rate 41 percent lower than a group of female athletes who did their regular warm-up.

"We developed the program to address the deficits that we see in females, especially weakness in the lateral hip muscles, the glutes, and the core muscles," says Holly Silvers, a physical therapist at the Santa Monica (Calif.) Orthopedic and Sports Medicine Group and one of the developers of the PEP program. The details of the program (which is meant to be done in order and in full) can be found here. Some sample exercises, as described in the program:

• Diagonal plyometrics: Stand with a small, flat cone (2" in height) in front of you to your right. Hop over cone in a diagonal fashion landing on the ball of your foot while bending at the hip and knee. Now, hop backwards and to the left over the cone to return to your starting position. Repeat 20 times and then step to the left and repeat the exercise in the opposite diagonal.

• Jump and tuck. Jump up bringing knees towards chest tuck position. Land on your toes with hips and knees bent and quickly repeat exercise. Repeat 20 times and rest.

• Bridging with hip extension: Lying on your back with knees bent, place both feet on top of the soccer ball. Lift hips off the ground so your shoulders, hips, and knees are in a straight line. Slowly lift one foot off the ball and straighten the knee without dipping the hip down. Return foot back to the ball and repeat on the opposite leg. Repeat 30 times and rest.

This addresses the ACL issues of female athletes in general but also includes soccer-specific exercises; Silvers says her group is also designing injury-prevention programs for basketball and other sports. Michael Sokolove, author of Warrior Girls, says he's impressed. "If it's half as good as they say it is, it's worth doing," he says. But his own list of remedies also includes changes to the youth sports culture that would involve fewer games and less intensity and specialization.