The pattern behind most knee injuries
Almost all non-contact knee injuries follow the same sequence: the foot plants, the leg is almost fully extended, the upper body tilts sideways, and the knee collapses inwards. In clinical terms, this is called knee valgus; on the pitch, you will spot it when the knee drifts inside the line of the foot during landing or decelerating.
A lack of strength is rarely the main culprit. What is missing is control: hip, knee, and foot are not working in alignment. When the gluteal muscles fail to stabilise the pelvis, the thigh rotates inwards, and the knee collapses with it.
Two situations carry particular risk:
The landing after an aerial duel. Single-legged, uncontrolled, often with rotation.
Decelerating from full pace. Especially when changing direction simultaneously while your focus is elsewhere.
Both can be trained. What is scientifically proven to work and what is exaggerated is covered in the scientific evidence on injury prevention.
What differs for girls and women
One point missing in many prevention articles: female players suffer ACL tears significantly more frequently than male players. Potential reasons discussed include a different pelvic angle, differences in neuromuscular recruitment during landing, and hormonal influences.
For you as a coach, this does not change the drills, but the consequence: in girls' and women's football, landing mechanics are not an optional extra, but an absolute must. Two sessions per week, all year round. For context: girls' football and, regarding the menstrual cycle, menstrual cycle and training in women's football.
Five drills against knee valgus
Drill 1: Single-leg balance with perturbation
Setup
Stand on one leg, knee slightly flexed. A partner stands alongside.
Procedure
Hold your balance for 30 seconds while your partner applies unpredictable nudges to your shoulder or hip.
Coaching point
The knee remains aligned over the second toe. If it drifts inwards, the set is over.
Progression
Eyes closed, an unstable surface, or receiving and returning passes simultaneously.
Why
Closely replicates an uncontrolled landing in a match and makes the issue visible to the player.
Drill 2: Jump landing
Setup
No equipment, firm surface, adequate space.
Procedure
Jump up off both feet, land softly, and hold the landing position for two seconds. Ten repetitions.
Coaching point
Land on the balls of your feet, then flex ankles, knees, and hips. A loud landing is a hard landing.
Progression
Single-leg landing, later landing with a quarter turn.
Why
Landing is the moment when most ACL tears occur. It is almost never practised.
Drill 3: Nordic hamstring curl
Setup
Kneeling position, a partner secures the lower legs. Soft surface.
Procedure
Lower the body forwards slowly with a straight torso, as far as you can with control, catching yourself with your hands. Three sets of five.
Coaching point
Decelerate the movement, do not simply drop.
Caution
Muscle soreness after the first session is practically guaranteed. Do not introduce this two days before a match.
Why
The hamstrings decelerate the anterior translation of the shinbone — the exact movement that puts stress on the anterior cruciate ligament.
Drill 4: Lateral lunge
Setup
No equipment, two metres of clearance to the side.
Procedure
Take a large step to the side, drop into a squat, and push back up with control. Ten repetitions per side.
Coaching point
The loaded knee stays aligned over the foot. If it buckles inwards, reduce the step length rather than pushing for more repetitions.
Progression
With additional weight, or as an explosive push-off from the lateral step.
Why
Simulates a change of direction without match speed.
Drill 5: Deceleration on cue
Setup
A twenty-metre running distance, coach or partner on the touchline.
Procedure
Sprint forward, decelerate and come to a dead stop upon a call or hand signal. Five to eight repetitions with full recovery.
Coaching point
Decelerate in short, choppy steps, drop your hips low, knee over the foot. Do not stop in a single long stride.
Progression
Decelerate and change direction based on a colour signal, adding a decision-making element.
Why
Combines mechanics with perception. In a match, you never decelerate on a planned schedule.
How much and when
Twice per week, eight to twelve minutes. That is the volume prevention programmes use, and the lower threshold below which the effect remains negligible.
Part of the warm-up. Fatigued legs land worse, and practising poor landings is worse than not practising at all. For a complete routine, check out integrating FIFA 11+ into training.
All year round, not just in pre-season. The protection builds over ten to twelve weeks and degrades once you stop.
From U13 as a dedicated block. Prior to that, leg alignment control develops through varied movement: hopping, balancing, climbing, and single-leg jumping.
What you cannot influence
Honesty is essential. Prevention reduces risk; it does not eliminate it.
Contact injuries will always happen. A kick to the standing leg cannot be prevented by any programme. Prior injuries, growth spurts, and match loads also play a role; find out more in growth spurts in youth training.
Moreover: a player who has suffered an ACL tear carries an increased risk of a second one. Returning to play must therefore follow a structured protocol rather than gut feeling. See: Return to Play.
Conclusion
- Most serious knee injuries happen without opponent contact, during landings or decelerations.
- The pattern is almost always the same: the knee collapses inwards because leg axis alignment is lost.
- Five drills cover it: single-leg balance with perturbation, jump landing, Nordic hamstring curl, lateral lunge, and deceleration on cue.
- Twice a week in the warm-up, all year round. Ten to twelve weeks before results become visible.
- In girls' and women's football, landing mechanics are mandatory, not an optional bonus.