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PEP Program Seeks To Prevent ACL Injuries

As part of our continuing effort to service and educate our membership, each Thursday U.S. Soccer will provide an informative article from one of its departments. Once a week, we will bring you an article/paper/essay that will hopefully enhance your enjoyment and knowledge of the game of soccer - on and off the field. This month, we will look into the world of sports medicine and examine a program that is studying ACL injuries in soccer players.

PEP Program, Research Target ACL Injuries

It’s been more than 30 years since Title IX paved the way for many of the girls and women who are playing soccer and other sports today. In that time, there have been numerous studies showing the risk of anterior cruciate ligament (ACL) injuries in female athletes – particularly soccer players.

Research has shown that with specific training routines, the risk of a female athlete sustaining an ACL injury can be reduced. That’s where the Santa Monica Orthopedic and Sports Medicine Group enters the picture, with an ongoing study that began in 2000.

The Santa Monica ACL Prevention Project has developed a training session as a replacement for a team’s traditional warm up. The Prevent injury, Enhance Performance (PEP) Program, developed by a team of physicians, physical therapists, athletic trainers and coaches, is designed to integrate an injury prevention program into a team’s regular training routine.

The project has its own web site that explains the actual training program, as well as the overall goals of what is a two-pronged project. The first part is the “How to” of the training routine, and the second is the research that has been and will continued to be conducted.

Designed to be implemented two or three times per week as part of daily training, the program takes about 15 minutes and incorporates many activities and drills that are already a part of many practices. The PEP Program, however, takes some of these normal practice activities and turns them into more-effective injury prevention activities with specific attention to detail.

This prevention program consists of a warm-up, stretching, strengthening, plyometrics, and sport specific agilities to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint. It is important to use proper technique during all of the exercises. Coaches and trainers need to emphasize correct posture, straight jumps up-and-down without excessive side-to-side movement, and soft landings.

One of the catalysts for the project has been Holly Silvers, a PT ATC (Physical Theraphist, Athletic Trainer certified) from Santa Monica Orthopedic Group. She became more interested in ACL injuries after injury Tony Meola missed five months of action with the Kansas City Wizards and the U.S. Men’s National Team in 1999 with a torn ACL.

She said that the study focuses on non-contact injuries, which account for 70 percent of all ACL injuries, but that contact injuries are less likely to occur if the athlete has been training with this program.

“The feedback has been incredibly positive from everyone involved from coaches to players,” Silvers said.  “We have made some slight changes for the training to run more smoothly.”

The rest of the research team that developed and is studying the program includes Dr. Bert. R. Mandelbaum, Dr. William E. Garrett and Dr. Donald T. Kirkendall, who have all worked with the U.S. Soccer National Teams Programs recently.

The three doctors and their team developed the program, and it was first implemented in the summer of 2000 in the Coast Soccer League with girls’ teams from ages 14-18. The control group was other teams in the league, so that the data would reflect the same age group playing on the same fields with the same level of play.

In the first year of the study there was an 88-percent reduction in the occurrence of ACL injuries within the teams that were training with the PEP Program, according to Silvers. She also said that the second year showed a reduction rate of 74 percent.

Last fall, 65 NCAA Division I women’s soccer teams adopted the program and injuries were reduced three-fold compared to a control group, Silvers said. She added that ACL injury rates were significantly lower based on data collected by the NCAA over the last five to 10 years.

While the focus of the study is women, the program can also be beneficial to men, Silvers said. She pointed to U.S. Men’s National Team stars Clint Mathis, Josh Wolff and Chris Armas who have all recently missed time with ACL injuries. Silvers said that several MLS teams have contacted her about the program.

An additional benefit of implementing this program is that it is completed on the soccer field with no extra equipment other than cones and soccer balls.

The study will continue to gather data, and a pair of articles about the program are scheduled to appear shortly in the American Journal of Sports Medicine.

For more information on the program including a downloadable .pdf describing the program, visit the Web site at Questions about the program should be directed via e-mail to Holly Silvers, the program coordinator, at

For more information from U.S. Soccer’s Sports Medicine Department, please contact Hughie O’Malley, U.S. Soccer’s Manager of Sports Medicine Administration, at or 312.528.1225.