One ACL in Four Years

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Forty-plus tournaments. A World Championship. An Olympic silver medal. The most dominant women’s rugby sevens program in the world, built from the ground up across four years of relentless preparation in one of the highest-risk environments in sport: ground-based, high-speed, collision-heavy, with athletes transferring in from across disciplines chasing a brand-new Olympic program and bringing movement histories that had never been tested in that environment.

One blown knee. And it happened because a tackler drove low into an athlete mid-cut at a speed and angle that created a torque no preparation could fully protect against. Contact-forced. Not a failure of readiness.

I attended the 2026 Project Play Summit in Boston. I sat in a session on the ACL pledge and left more committed to its purpose than I arrived, and more concerned than ever about the gap between what the pledge means and what most programs actually do about it.

The pledge matters because ACL injuries shouldn’t be treated as a cost of playing sports or as a reason to restrict them. Prevention should be the natural result of developing athletes well. I have 25 years of experience building athlete development systems for 30+ ground and water-based sports that have worked. What I want to raise is what “developing athletes well” actually requires, because the current consensus undersells it badly.

From 2012 to 2016, with the Black Ferns Sevens, we recorded one ACL rupture across four international seasons and forty-plus tournaments, and that single case came from a low-tackle contact mechanism. In published studies of elite women’s rugby, knee injuries account for roughly 20 percent of all match injuries in international sevens, and ligament sprains are the most common injury type overall. Prospective data from elite women’s rugby union report ACL injury rates around 0.4 per 1,000 match-hours, placing ACL tears among the leading serious knee injuries in the sport. That contrast isn’t a controlled trial. It doesn’t prove causation. But it does show what becomes possible when athlete readiness, training load, and daily health are treated as central performance variables rather than problems you address after someone gets hurt.

That number didn’t happen because of a warm-up protocol.

Twelve weeks before Olympic team selection, one of our athletes blew her knee. Not a mild sprain. ACL, MCL, PCL, cartilage damage. A catastrophic contact injury by any clinical measure. The standard read: she was done.

She chose a nonoperative path.

What followed was the most complete integration of athlete development I’ve been part of. Her physiotherapist, sports doctor, nutritionist, mental performance professional, and I built a program around her specific readiness, not a generic recovery timeline. We measured what she could do. We loaded what she could handle. We progressed her when the evidence said she was ready. Twelve weeks later, she was selectable. Ten weeks after that, she was a silver medalist.

That story is in my book, The Art of Ready.

The reason I’m telling it here is this: what made that recovery possible was the same thing that produced one ACL across four years of an elite program. It wasn’t a handful of exercises done before training. It was a shared understanding of what readiness actually means, consistently applied to every decision made about that athlete.

That’s the gap I want to name.

Programs like FIFA 11+ are not without value. The intention is right. But the way they’re positioned and applied carries a fundamental problem. The message becomes: do these exercises before training, and you’ve addressed your injury risk. That’s a symptom-level response framed as a solution.

Injuries occur when demand exceeds capacity. That is the whole equation. ACL injuries happen most often when an athlete is in a compromised position, and the soft tissue is asked to absorb a force beyond what it can manage. You can have athletes with genuinely strong connective tissue and still watch them rupture a knee if their body is in the wrong position at the wrong moment.

Picture this physically. A player cuts hard, and their trunk is upright. Shoulders back, knee tracking well forward of the foot, load concentrated at the front of the joint. Now picture the same cut with the trunk inclined forward at roughly forty-five degrees, hips loaded back, the force distributed through the posterior chain toward the hip rather than shearing forward through the knee. The second position doesn’t eliminate risk. It distributes it. The athlete’s own musculature absorbs what the ligament would otherwise have to manage on its own.

That’s not a warm-up problem. It’s a movement competency problem. And those are not the same thing.

Think of the knee as the hinge on a door. When you’re building or renovating, you don’t spend much time selecting the hinges. The hinge just swings. What matters is the framing around it, the quality of the structure the hinge is mounted in, and whether the joints above and below are doing their job. The knee is the same. It’s designed to hinge. When ACLs rupture, the fault is rarely in the hinge itself. It’s in the hip that didn’t load and the ankle that didn’t support the foot, which together put the hinge into a position it couldn’t tolerate.

My PhD research on movement competency screening gave me a prognostic tool, not a diagnostic one. The goal wasn’t identifying injury after the fact. It was identifying the movement strategies that made injury more likely before anything happened, and then building training that progressively addressed those strategies, in the gym and on the field, with clear continuity between the two.

That continuity is what’s missing from most prevention conversations. You can run athletes through excellent pre-training exercises with solid positions and clear coaching, and then watch those same positions disappear the moment they step into a sport-specific drill. Speed, decision load, fatigue, competition pressure: all of it erodes what the body learned in isolation. The exercises didn’t transfer. Nobody taught the transfer. General movement competency and specific movement competency are not the same thing, and the bridge between them requires deliberate coaching, not just deliberate exercise selection.

What made the difference with the Black Ferns Sevens wasn’t a protocol. It was a system built on shared accountability. Our physiotherapist and I had genuine mutual professional respect, which meant we planned together rather than in parallel. We were in the training sessions. We understood what the coaches were building that week, that month, that cycle. When a high-intensity tackling drill was on the program, we knew which athletes were ready to run it at full urgency and which needed it at reduced exposure. The coaches understood why. They bought in. Everybody was invested in the same outcome: to win and keep every athlete on the field.

That’s the real prevention model. Not ten exercises before practice. An integrated approach where movement competency shapes load decisions, where coaches can read their athletes well enough to adjust demand in real time, and where every professional around the child shares accountability for development rather than just their own domain.

Here’s the objection I expect. That worked because you had resources most programs never see. A physiotherapist, a performance specialist, a sports doctor, a nutritionist, a mental performance professional, and a coaching staff are all working with the same ethos, ‘one athlete - one program’. Most under-10 soccer coaches are volunteers running a few practices a week under constraints.

It’s a fair point. And it misses the most important part of the story.

Every national program on that World Series circuit had the same resources. Every one of them had strength coaches, physiotherapists, team doctors, and the equipment to match. They were sustaining injuries at a far greater rate than we were. Resources weren’t the differentiator. Integration was.

The table we built for the program’s leadership was round on purpose. Every professional sat at equal standing, with equal accountability for the outcome. In most high-performance programs and most youth programs, that table is rectangular. The coach sits at the head. Performance and medical staff learn to defer, not because their judgment is wrong, but because the culture rewards deference over honest collaboration. That dynamic has its own consequences and deserves an article of its own. But it’s worth naming here.

For the coach reading this who runs an age-group program: your village already exists. Youth programs don’t operate in isolation. They sit inside communities with university programs full of students in sports science, physical therapy, exercise physiology, and psychology who need practical hours and want to contribute. There are qualified professionals in every community who got into this field because they care about kids and aren’t reaching them.

Youth sports costs have risen 46 percent since the pandemic, and most clubs are watching their registration fees climb while their operating margins disappear. Adding support staff feels out of reach. But the people aren’t absent. They’re just not talking to each other. The village exists. It doesn’t have a round table. It doesn’t have a shared language. It doesn’t have a system to anchor the conversation and hold each person accountable to the whole.

That’s what’s missing. Not the people. The infrastructure.

The problem is that infrastructure doesn’t build itself, and good intentions don’t replace it. A coach managing thirty youth athletes across multiple age groups doesn’t have a physiotherapist and a performance specialist co-designing training with them. A parent watching their kid at practice doesn’t have the vocabulary to ask the right questions. A club director trying to reduce injury rates across hundreds of athletes doesn’t have a way to measure what’s actually driving them.

That’s the problem Ready First is built to solve. Not at the elite level. At every level. R1 continuously measures readiness across Mind, Body, and Energy, classifies each athlete as Rebuilding, Rising, or Ready, and returns that picture to the coach, parent, and athlete in language they can act on. The body domain is built specifically around movement competency assessment, so the adults around a child have something concrete to work with rather than a generic checklist. It translates general movement competency into sport-specific risk and develops the general into sport-specific resilience.

The ACL pledge is a commitment to do better. Ready First is a system that makes it operationally possible to do better in the communities where kids actually play.