Originally published in TrailblazeHERS in Sports, Issue 1 | August 31, 2025
Anya Dalal
Most coaches would never skip sprints, scrimmages, or technical drills. But ask them to spend an extra 10 minutes on injury prevention, and suddenly there’s “no time.” Across youth sports, prevention is treated as optional, something for the overachievers who show up early. While teams invest heavily in uniforms, travel, and competitions, they often overlook the one thing that keeps players on the field: structured injury prevention.
That mindset is outdated. Young female athletes face higher risks of ACL tears, ankle sprains, and stress fractures, all of which are largely preventable, according to Dr. Lyle Micheli, world-renowned orthopedic surgeon at Boston Children’s Hospital and Founder of the Micheli Center for Injury Prevention, and Dr. William Meehan, Director of the Micheli Center for Injury Prevention. Their clinical approach—pairing quadriceps work with hamstring strengthening to stabilize the knee, screening for back stress injuries, and layering proprioceptive training for ankles—aligns with a decade of literature on neuromuscular warm-ups and targeted conditioning to reduce injury rates. If the evidence for prevention is robust, why does the field still look like this?
Prevention, especially for female athletes, has been shown to reduce injury risk, yet it remains overlooked and undervalued. According to Dr. Meehan, programs like FIFA 11+—an injury prevention program developed by FIFA designed as a complete warm up—can significantly reduce injury risk: “Female soccer players are six times more likely to tear their ACL than male soccer players, but there's good data that programs that involve strengthening of particular muscle groups can decrease your risk of tearing your ACL” Developed through a randomized controlled study in 2006 and rolled out by FIFA in 2009, FIFA 11+ significantly reduced lower-extremity injuries in collegiate female soccer players by 66% after one year and by 83% when maintained over three.
One of the Micheli Center’s key programs is the ACL Injury Prevention Program. Dr. Meehan recalled an example of a local high school girls’ soccer team that used the Micheli Center’s ACL program; they had zero ACL tears for two straight seasons. Yet, when they stopped the program—because they thought things were good enough—the risk immediately returned, highlighting how prevention only works if it becomes a consistent habit, not a quick fix.
At the Micheli Center, injury prevention is the “focus of [the] entire program.” Dr. Meehan recalled how Dr. Micheli first asked, “Why are we waiting for [athletes] to get hurt? Why don’t we prevent them from getting hurt in the first place?” That question shaped their center’s entire philosophy. By identifying each athlete’s unique risk factors, such as muscle imbalances, limited flexibility, or overtraining, the team develops programs based on data that correct weaknesses before they become injuries. Every plan is personalized and is “based on the literature and the science.”
Dr. Micheli explained how “good hamstring strengthening, not just the quadriceps [strengthening],” is key. When he first started practicing medicine, quad strengthening was the major focus, but the “hamstring plays an important role in balancing the strength of the knee.” They also focus on back and core stability to reduce stress fractures from repetitive training. “We developed a whole stress strength program; therapists here at the hospital, that’s their focus.” For female athletes, the risk extends beyond the knees. Reviews of bone stress injuries, fractures, and RED-S (Relative Energy Deficiency in Sport) highlight a persistent pattern of overuse in sports that specialize early and repeat the same movement patterns year-round.
Propioceptive training—training the nerves and muscles surrounding a joint to react quickly—is another crucial piece, especially for ankle and knee sprains. When someone inverts their ankle, which typically occurs with an ankle sprain, proprioceptive training would enable “[the nerves to] fire a little quicker when the ligament starts to stretch, and therefore, you might be able to contract those muscles a little sooner. The faster the nerve fiber fires, the stronger the muscles are, the less likely you are to invert that ankle,” said Dr. Meehan.
Despite overwhelming evidence, injury prevention remains undervalued. Part of the problem is the modern schedule, which makes it hard for coaches to do what’s best for their players. Even at the professional level, fixture congestion and short recovery windows are associated with a higher risk of injury. Youth athletes now train more, recover less, and specialize, leading to more repetitive loading, resulting in more overuse injuries, burnout, and hospital visits.
The deeper issue, however, is the mindset. As Dr. Meehan put it, “We have a hard time convincing [coaches] to prevent something that hasn’t happened yet.” Success in prevention is invisible, making it easy to ignore. Coaches face pressure to optimize for the next match. Interventions that pay off throughout the season, such as an injury-prevention focused warm-up, are often outmatched by tactics that might lead to a goal over the weekend, like a scrimmage or shooting drill. But if athletes aren’t healthy to play, wins don’t matter.
Additionally, many programs equate “hard work” with more ball-centric reps and scrimmage time. Slower, neuromuscular work reads as less “sport-specific,” even when it’s protective. Dr. Meehan advises athletes to “not forget about general strength and conditioning”. He added, “What would be ideal is if athletes not just trained for their sport, but had a strength and conditioning program that developed them beyond what they need to do for their sport.” That way, they could strengthen “the muscles that [they] don't normally use during [their] sport, because [the muscles] might protect [them].”
He also warns against early specialization: athletes who play one sport year-round and train the same muscle groups continuously are setting themselves up for overuse injuries, which “could be avoided if [they] took a little more time off, or if [they] switched to a different sport that worked different muscle groups.” Thus, athletes should prioritize overall recovery and consider cross-training as an alternative to dedicating all their time to their sport.
Fifteen minutes of prevention can seem easy to cut, until the surgery bill arrives, a season is lost, or a college opportunity is gone. Ultimately, injuries adversely affect player confidence, identity, and sometimes entire careers. The costs of these biases are borne disproportionately by female athletes. Ongoing investigations in Europe have framed the surge in elite ACL cases as a problem tied to systems designed for men, from equipment and training schedules to recovery support.
The data are clear; structured prevention reduces injuries when implemented and maintained. That places the accountability beyond any single coach’s preference and into program policy: athletic directors who set practice templates, club directors who control coach education hours, and tournament schedulers who compress weekends until recovery is a theory.
Programs like FIFA 11+ or the Micheli Center’s routines can be incorporated into warm-ups in under 20 minutes, focusing on strengthening the hamstrings, core, and posterior chain, while also emphasizing recovery throughout the week. Back to back practices and games should also be avoided, as studies have shown that those consecutive activities can significantly increase injury risk.
Instead of treating injury prevention as an optional aspect in youth sports, it should be front and center, rethinking what player development entails. The biggest wins are often the ones we can’t see, and the Boston Children’s Micheli Center provides a playbook that can be modeled in the US and beyond.
Image Credit: https://www.themichelicenter.com/