This 2-year prospective nonrandomized cohort study tested whether the PEP Program — a 20-minute neuromuscular and proprioceptive warm-up replacement — reduces noncontact ACL injuries in competitive female soccer players ages 14–18. The program was evaluated over two consecutive seasons across more than 5,700 players and 205,000 athlete exposures. The primary question: can a structured team-level warm-up consistently cut ACL injury rates in a high-risk population?
Female soccer players tear their ACL at 2–8 times the rate of male players, yet before this study, no warm-up modification had been tested across multiple consecutive seasons in a large cohort with rigorous injury tracking.
When a club, school, or league asks what to do about ACL injuries in their girls' program, this is the evidence you cite: an 88% reduction in year one and 74% in year two, achieved with a 20-minute coach-led warm-up and an instructional videotape.
The program works by training feed-forward neuromuscular control. Athletes learn to pre-activate stabilizing muscles before landing and cutting loads arrive, using deep hip and knee flexion, avoiding knee valgus, and a 3-step deceleration pattern.
One practical caveat: intervention teams self-selected, so motivational bias cannot be excluded. With a relative risk of 0.18 across more than 200,000 exposures, however, the magnitude of effect is hard to dismiss on methodological grounds alone.
This 2-year prospective nonrandomized cohort study tested whether the PEP Program — a 20-minute neuromuscular and proprioceptive warm-up replacement — reduces noncontact ACL injuries in competitive female soccer players ages 14–18. The program was evaluated over two consecutive seasons across more than 5,700 players and 205,000 athlete exposures. The primary question: can a structured team-level warm-up consistently cut ACL injury rates in a high-risk population?
Female soccer players tear their ACL at 2–8 times the rate of male players, yet before this study, no warm-up modification had been tested across multiple consecutive seasons in a large cohort with rigorous injury tracking.
When a club, school, or league asks what to do about ACL injuries in their girls' program, this is the evidence you cite: an 88% reduction in year one and 74% in year two, achieved with a 20-minute coach-led warm-up and an instructional videotape.
The program works by training feed-forward neuromuscular control. Athletes learn to pre-activate stabilizing muscles before landing and cutting loads arrive, using deep hip and knee flexion, avoiding knee valgus, and a 3-step deceleration pattern.
One practical caveat: intervention teams self-selected, so motivational bias cannot be excluded. With a relative risk of 0.18 across more than 200,000 exposures, however, the magnitude of effect is hard to dismiss on methodological grounds alone.