The pattern behind most knee injuries
Almost all non-contact knee injuries follow the same sequence: the foot lands, the leg is nearly straight, the upper body tilts sideways, and the knee falls inward. The technical term is knee valgus. In training you spot it when the knee travels over the inside of the foot during a landing or a deceleration.
The cause is rarely a lack of strength. What is missing is control: hip, knee and foot are not working in one line. If the glutes do not hold the pelvis, the thigh rotates inward and the knee follows.
Two situations carry the most risk:
Landing after an aerial duel. One-legged, uncontrolled, often with rotation.
Decelerating at full speed. Especially when the direction changes at the same time and the eyes are somewhere else.
Both can be trained. What is actually supported by evidence and what gets over-quoted is covered in the evidence on injury prevention.
What is different for girls and women
A point missing from many prevention articles: female players suffer ACL tears considerably more often than male players. The reasons discussed include a different pelvic angle, different muscle recruitment on landing, and hormonal influences.
For you as a coach that does not change the drills, only the consequence: in girls' and women's football, landing technique is not an optional block but a fixed part of the programme. Twice a week, all year round. For context: girls' football and, on the cycle, the menstrual cycle and training in women's football.
Five drills against knee valgus
Übung 1: Single-leg stand with perturbation
Setup
One leg, knee slightly bent. A partner stands alongside.
How it runs
Hold for 30 seconds while the partner pushes irregularly against the shoulder or hip.
Coaching point
The knee stays over the second toe. If it drifts inward, the set is over.
Progression
Eyes closed, soft surface, or passing a ball at the same time.
Why
This comes closest to an uncontrolled landing in a match, and it makes the problem visible to the player.
Übung 2: Landing from a jump
Setup
No equipment, firm ground, enough space.
How it runs
Jump off two feet, land softly, hold the landing position for two seconds. Ten repetitions.
Coaching point
Land on the forefoot, then bend ankle, knee and hip. A loud landing is a hard landing.
Progression
Single-leg landing, later a landing with a quarter turn.
Why
Landing is the situation in which most ACLs tear. It is almost never practised.
Übung 3: Nordic hamstring
Setup
Kneeling, a partner holds the lower legs down. Soft surface.
How it runs
Lean forward slowly with a straight body, as far as stays controlled, catching yourself with the hands. Three sets of five.
Coaching point
The movement is braked, not dropped.
Careful
Muscle soreness after the first session is the rule, not the exception. Do not introduce it two days before a match.
Why
The hamstrings brake the forward movement of the shin — the exact movement that loads the ACL.
Übung 4: Lateral lunge
Setup
No equipment, two metres of space to the side.
How it runs
A big step sideways, sink into a squat, push back under control. Ten per side.
Coaching point
The loaded knee stays over the foot. If it tips inward, shorten the step rather than adding repetitions.
Progression
With added weight, or as a push-off out of the lateral step.
Why
It rehearses the change of direction without match speed.
Übung 5: Decelerating on a signal
Setup
A twenty-metre running lane, coach or partner at the side.
How it runs
Sprint, then brake and stop on a call or hand signal. Five to eight runs with full recovery.
Coaching point
Brake in short steps, hips low, knee over the foot. Do not stop with one big step.
Progression
Brake and change direction on a colour signal, so the decision comes in as well.
Why
It links the technique to perception. Nobody in a match brakes on cue.
How much and when
Twice a week, eight to twelve minutes. That is the dosage prevention programmes work with, and the lower limit below which the effect stays small.
In the warm-up. Tired legs land worse, and practising bad landings is worse than not practising at all. A ready-made version is in putting 11+ into your sessions.
All year, not just in pre-season. The protection builds over roughly ten to twelve weeks and fades again once you stop.
As a separate block from U13 upward. Before that, leg-axis control comes from variety: hopping, balancing, climbing, jumping on one leg.
What you cannot influence
Honesty belongs here. Prevention lowers the risk, it does not remove it.
Contact injuries remain. A kick against the standing leg is not preventable by any programme. Injury history, growth phases and match load all play their part; more on that in growth phases in training.
And: a player who has torn an ACL once carries a raised risk of a second one. The return to play therefore belongs in a structure rather than a gut feeling. More on that in return to play.
Takeaways
- Most serious knee injuries happen without contact, when landing or decelerating.
- The pattern is nearly always the same: the knee falls inward because the leg axis is not held.
- Five drills cover it: single-leg stand with perturbation, landing, Nordic hamstring, lateral lunge, decelerating on a signal.
- Twice a week in the warm-up, all year round. Ten to twelve weeks before anything shows.
- In girls' and women's football, landing technique is compulsory, not optional.