How to Protect Your Knees: An Eight-Point Checklist for Athletes

Dr Adam Walker (PhD) — Director and Head of Rehabilitation, Gold Coast Knee Group

Knee injuries in female athletes, ACL tears in particular, have become a genuine epidemic.

Women and girls face three to eight times the risk that males do — a gap driven by developmental, societal, biomechanical, hormonal and training factors rather than any single cause.

You see it at the elite level with players like Sam Kerr and Mary Fowler. Locally, I am seeing twelve and thirteen-year-olds with ACL injuries all the time. It is clearly a big issue and it is not getting smaller on its own.

This checklist comes from a talk I gave at the International Women’s Day Female Athlete Forum. Eight strategies, grounded in research and in what I see in the clinic, for reducing knee injury risk. They apply to male athletes too.

Work through it honestly. Can you say yes to each one? If not all of them, then the more the better.

✅ I do a periodised strength program designed by an expert

Strength training is the foundation of injury prevention, and women and girls have historically had far less access to it — a gender gap in gym access that is improving, particularly for teenagers, but has not closed.

A properly designed program builds the capacity of muscle, tendon and connective tissue to handle what sport asks of them: high jumps, sharp cuts, contact. Strong muscles act as body armour around the joint during explosive movement.

It also improves how the nervous system coordinates movement, which shows up as better technique.

The word doing the work here is specific. The program should target functional strength and the movement patterns your sport actually demands — not a popular fitness class, and not a bodybuilding split. Done well it reduces injury risk and makes you faster and more powerful at the same time.

✅ I have been taught how to jump and land, and I train plyometrics

Landing from a jump is one of the most common moments an injury happens — in AFL, netball, basketball and soccer especially.

Research shows females often land in riskier positions, with the knees collapsing inward. That position increases ACL tear risk substantially.

Learning to land properly — on one leg and two, in multiple directions including forward, sideways and rotational — builds the control that stops it. Plyometric work like hurdle jumps and reactive hops develops those skills further.

The detail that matters is practising it under conditions that resemble a game. Sticking a landing is one thing. Sticking a landing when someone pushes you mid-air is the skill you actually need on a Saturday.

✅ I have learnt how to run, change direction and decelerate

Change of direction is the number one cause of ACL injuries.

Here is the uncomfortable part: being strong and fast makes this worse if your mechanics are poor. More force into a bad position is a bigger problem, not a smaller one.

Deceleration is where it concentrates. The forces peak as you slow down to cut or to land, and that is the moment knees end up in awkward positions.

Learning to decelerate — lowering your centre of gravity, keeping the knee tracking over the foot — keeps you out of those positions. Training your running and cutting mechanics reduces injury risk and makes you more agile and more efficient while it does it.

✅ My team does a structured injury prevention warm-up at training

This one is the highest-leverage item on the list, and it is the one most often skipped.

A structured warm-up, done twice a week for fifteen minutes, can reduce ACL injuries by up to 50%.

These programs combine mobility, activation, strength, plyometrics and movement drills matched to the sport. The established ones include Prep to Play for AFLW, Perform+ for soccer, and TouchTime for touch football.

There are programs for most sports. The obstacle is not evidence, it is implementation — community clubs run on volunteers, and training and funding to deliver these consistently is genuinely hard to come by.

And consistency is the whole thing. Drop to once a week and the benefit disappears. If you coach or run a club, this is the single change most worth making, and we are happy to point you at the resources to get started.

✅ I recognise when I am rundown or carrying a high training load

Youth athletes carry schedules that would flatten most adults. School sport, club training, games, multi-day carnivals, and often more than one sport at once.

Add exams, or something difficult happening at home, and fatigue climbs — and fatigue raises injury risk.

A teenager training five nights a week and playing twice has very little recovery in the schedule anywhere.

The skill worth building is noticing it. Feeling sluggish, unusually sore, heavy-legged — and then actually telling a coach or a parent so the load can be adjusted. That conversation is uncomfortable for a lot of young athletes, and it prevents both burnout and injury.

✅ I prioritise sleep and nutrition

Recovery gadgets — compression boots and the rest of it — are close to worthless without these two.

Sleep. Youth athletes with high training loads need seven to ten hours a night, sometimes more, to repair tissue. Low sleep increases injury risk directly. Basic sleep hygiene does most of the work: limit screens before bed, avoid caffeine, and eat earlier in the evening.

Nutrition. Under-fuelling weakens tissue. Eating carbohydrate and protein before, during and after exercise fuels the performance and the repair that follows it, and keeps knees resilient.

If nutrition is a live issue for a young athlete, a sports dietitian is the right person to see. It is not something to guess at during growth.

✅ I play other sports and get free play in the off-season

Specialising in one sport before the age of fifteen raises injury risk, raises burnout risk, and limits athletic development.

Kids today also get far less unstructured free play than previous generations, which narrows the range of movement they are exposed to.

Playing the same sport year-round overuses the same patterns, and overuse injuries follow. Off-season activities that move the body differently build broader skills and different muscles, and keep training enjoyable.

There is an argument that has nothing to do with injury too: multi-sport athletes are more likely to be drafted, have longer and healthier careers, and are less likely to burn out mentally. Specialising early tends to cost the thing it was meant to buy.

✅ If I get injured, I will rehab it properly and get tested before returning

A previous injury is the single biggest risk factor for the next one.

Rushing back after a knee injury without completing rehabilitation is asking for trouble, and the reason is that feeling fine and being ready are different things.

An athlete who feels good after a few weeks off may still be carrying a 20 to 30% strength or power deficit — invisible without testing. They cannot feel it. Nobody watching can see it.

Comprehensive rehabilitation, guided by someone who does this often, restores strength, explosiveness and mechanics rather than just settling the pain. That is what breaks the reinjury cycle, and it is what prevents the long-term problems — the ankle that needs strapping forever because a sprain was never properly rehabilitated.

Return to sport testing is how you know rather than hope.

The Bottom Line

Eight things. Build strength with a tailored program. Learn to land. Learn to cut and decelerate. Do the injury prevention warm-up twice a week, every week. Notice when you are rundown and say so. Sleep and eat properly. Play other sports. And if you do get injured, rehabilitate it fully and get tested before you go back.

Tick off as many as you can. Nobody manages all eight all the time, and the point is not perfection — the point is that each one you add reduces the risk.

Protecting knees, particularly young female knees, takes deliberate effort from athletes, parents, coaches and clubs together. It does not happen by accident, and the current injury rates are what happens when it does not happen at all.

Want help putting this in place?

We work with athletes, parents, coaches and clubs across the Gold Coast on exactly this. Our Resilient Athlete Program is built around strength, landing mechanics and change of direction for athletes who want to stay in the game, and there is more on our approach on the injury prevention page.

We see athletes across the Gold Coast at Robina, Currumbin and Benowa. You can get in touch with our team or phone 0408 051 943.

FAQs about Knee Injury Prevention

❓ Why are female athletes more likely to tear an ACL?

Women and girls face three to eight times the risk of males. It is not one cause but several working together — developmental, societal, biomechanical, hormonal and training factors.

The societal and training factors are worth noting because they are the modifiable ones. Historically less access to strength training, and less exposure to landing and cutting coaching, are both fixable.

❓ Can ACL injuries actually be prevented?

Risk can be reduced substantially. A structured injury prevention warm-up done twice weekly for fifteen minutes can reduce ACL injuries by up to 50%.

No program eliminates risk entirely — sport involves contact and chaos. But a 50% reduction from fifteen minutes twice a week is a remarkable return on effort.

❓ What is the best injury prevention warm-up program?

The established ones are matched to the sport — Prep to Play for AFLW, Perform+ for soccer, TouchTime for touch football. Most sports have something.

The best one is whichever your team will actually do twice a week. Consistency is not a detail here: drop to once weekly and the benefit disappears.

❓ At what age should kids start strength training?

Earlier than most people assume, and with proper coaching rather than a generic gym program. The goal is building the capacity of muscle, tendon and connective tissue to handle what the sport demands.

What matters is that the program is designed by someone who knows what they are doing and is specific to the athlete’s sport — not a bodybuilding routine and not a general fitness class.

❓ Is it bad for kids to specialise in one sport?

Specialising before the age of fifteen raises injury and burnout risk and limits athletic development. Playing the same sport year-round overuses the same movement patterns.

Multi-sport athletes are more likely to be drafted, tend to have longer and healthier careers, and are less likely to burn out. Early specialisation often costs the thing it was meant to secure.

❓ How much sleep does a young athlete need?

Seven to ten hours a night, and sometimes more where training loads are high. Tissue repair happens during sleep, and low sleep increases injury risk directly.

Recovery equipment is close to worthless if sleep and nutrition are not sorted first. Screens, caffeine and late meals are the usual places to start.

❓ When is it safe to return to sport after a knee injury?

When you have been tested, not when you feel ready. An athlete who feels good after a few weeks off may still be carrying a 20 to 30% strength or power deficit that is invisible without measurement.

A previous injury is the biggest single risk factor for the next one, which is why completing rehabilitation and passing return to sport testing matters so much.

❓ Does being stronger and faster reduce injury risk?

Only if the mechanics are good. A strong, fast athlete with poor movement patterns brings more force into risky positions, which makes the problem worse rather than better.

That is why strength work and movement retraining belong together. Neither is much use on its own.

❓What can parents and coaches do?

The highest-value action is getting a structured injury prevention warm-up running twice a week at training and keeping it there.

After that: watch training load across all commitments rather than just your own team’s, make it easy for a young athlete to say they are rundown, and support off-season variety rather than year-round specialisation.