Preventing ACL Injury: A Review of the NATA’s Position Statement

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May 3, 2018

By Elizabeth L. Augustine, MS, LAT, ATC

The National Athletic Trainers’ Association (NATA) has created a position statement to address how to aid in preventing the occurrence of anterior cruciate ligament (ACL) injuries in sport and physical activity. Injuries to the lower extremity make up 66% of all sport injuries and the knee is the most commonly injured joint. ACL injuries are expensive and there is a higher degree of long-term disability for patients, so prevention programs are important. The purpose of the new position statement is to provide Athletic Trainers (ATs) guidance on creating a prevention program, that is evidence based.

The 2 biggest benefits to an injury prevention program for ACLs is the decreased risk of ACL tears and other knee injuries and improved performance. The NATA makes the following recommendations about prevention training programs:

1. Prevention programs should be multi-faceted and include feedback about technique and at least 3 of the exercise categories. The categories are strength, plyometrics, agility, balance and flexibility. Table 3 in the statement shows exercises in each category that have been identified for an injury prevention program.

2. The exercises chosen should be progressively challenging and encourage quality of movement and technique.

3. Prevention programs should be completed during preseason and in-season.

4. Programs should be completed 2-3 times a week through preseason and in-season.

5. Exercises should be performed each year that the person is active or in sport.

NATA recommends the following, to implement ACL injury prevention programs:

1. The training programs should be supervised by individuals who are skilled at seeing faulty movement patterns.

2. Programs are most effective when completed as a dynamic warm-up or part of a strength and conditioning program.

3. Parents, coaches and administration should be educated on the benefits of the prevention program. The position statement includes these benefits, as well as how to encourage a program for children.

4. When creating a program, consideration should be given to the time required to complete, ensuring sport specific/functional movements and exercise variety.

NATA also addresses how to target patients/athletes who are more at risk for ACL injury and would be strong candidates for completing an injury prevention program:

1. High risk sports that involve landing, jumping and cutting tasks, like those in basketball, soccer and team handball are more prone to ACL injuries. Females who are in these sports are even more at risk.

2. Individuals who have previous history of ACL injury.

3. Children who participate in higher risk sports.

The statement provides evidence that multicomponent training programs can be effective in reducing the risk of ACL injuries. The statement does note there is more research to complete to further enhance these recommendations, especially focus on males in high risk sports, determining more specific ally which exercises are best, and in more detail, the underlying factors that predispose athletes for ACL injuries.


Padua, DA, DiStefano, LJ, Hewett, TE, et al.National Athletic Trainers’ Association Position Statement: Prevention of Anterior Cruciate Ligament Injury.Journal of Athletic Training.2018:53 (1): 5-19.


About the Author

Elizabeth augustine

Elizabeth L. Augustine, MS, LAT, ATC has been an Athletic Trainer since 2006 and lives in Claypool, Indiana. She graduated from Manchester College with degrees in Athletic Training and Exercise Science and a minor in Spanish in 2006. She received her Master’s in Organizational Leadership and Supervision for Indiana-Purdue Fort Wayne in 2009. She currently works as an Athletic Trainer for a Sports Medicine doctor in Warsaw, Indiana. Her athletic training interests include concussions, creating policies and procedures, and injury rehabilitation. In her spare time, she enjoys running, playing tennis, doing puzzles, and spending time with her husband and two young daughters.

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