Are knee injuries preventable?

by Physiotherapist Paul Heffernan

This is one joint that people dread injuring. It accounts for a high number of games missed from sport (AFL injury survey 2015) and has a predictable long-term cost to the individual and society (Roe, J et. al., 2016). The knee is something that has fascinated me throughout my physiotherapy career. I was lucky enough to start practice in Sydney at a centre of excellence with regards to knee injury management. I refined my University training in sound history taking skills, accurate examination techniques, comprehensive rehabilitation strategies and a number of validated outcome measures to confidently give our patients expert care regarding their knee injuries. It is something I pride myself on and have fostered amongst the team at Active Physiotherapy.

But are knee injuries inevitable with the high demand pivoting sports we put ourselves through and enrol our children in?

No! Knee injuries are not inevitable!

There is now a comprehensive body of evidence showing a significant reduction in knee injuries in various sports. Unfortunately, the message is not consistently reaching the grassroots and there has not been an uptake of the proven programs showing a significant reduction in injuries. Proven strategies that can reduce not only knee injuries, but all lower limb injuries! Armed with this knowledge we feel as physiotherapists we need to empower the community with this information to reduce injuries and the burden they have on people lives and society.

Injury prevention has followed the research journey over the late 90’s and into the noughties. By 2010 there was a pooled systematic review (Hubscher, et al., 2010), showing the efficacy of the programs. Unfortunately there have been problems with take up. However, a number of sporting organisations at the higher level have set out programs. The programs are warm up routines and they not only decrease injury risk, they aid in skill development and performance. Examples include: FIFA 11+; footy first (AFL); the PEP (Prevent injury and Enhance Performance Program) program; and more recently netball Australia's KNEE program. At Active Physiotherapy we have been incorporating the principles common to all the programs including strength, control, landing technique, load monitoring, neuromuscular control and general fitness, not only into rehabilitation programs but also into our education process for individuals and teams. We will be running free seminars/workshops again this year based around these topics. We have had good feedback in previous years and it fulfils Active Physiotherapy’s core focus areas of education, collaboration and achievement. We are looking forward to further getting  the  information to local coaches, sports trainers, teachers and participants alike!


We know for example that adolescent girls in particular are at 6-10 times the risk of an ACL injury than adolescent boys. Seeing this over the years as a physiotherapist and as a father of 5 girls I am highly motivated to stop this happening in Wagga and the Riverina! The early teenage years are the optimal target time for this skill development, but these principles should be an essential component of every sports participants experience.

The injury prevention exercises are performed as the warm up for training and sports participation. The knee program by Netball Australia takes exercises from 4 categories

  1. Warm up  2. Balance/Landing   3. Strength   4. Agility

With the key principles of good technique in: take off / landing/ deceleration / Change of direction.

With  these first class resources at your fingertips, including easy to follow video examples, there is no excuse for your children (or yourself) not to be doing them!! Ask yourself and your kids coaches - What are we doing to prevent injury?

Come along to our FREE Workshops:

ADEQUATE SPORTS WARMUP: 22nd February 2017, 7pm-8pm @ Active Physiotherapy, 1 Lewisham Ave, Wagga Wagga

INTRODUCTORY SPORTS TAPING: 8th March 2017, 7pm-8pm @ Xceler8

AUSTRALIAN NETBALL "KNEE" PROGRAM: 22nd March 2017, 7pm-8pm @ Wagga Netball Clubrooms

To book please contact the clinic 6925 7734 or


2015 AFL Injury Survey.

Roe, J., et al. (2016) Twenty-year comparison outcome data of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with either patellar tendon or hamstring autograft. DOI: 10.1016/j.asmart.2016.07.06

HÜBSCHER, M., et al., (2010). Neuromuscular Training for Sports Injury Prevention: A Systematic Review. Medicine & Science in Sports & Exercise:  Volume 42 - Issue 3 - pp 413-421 doi: 10.1249/MSS.0b013e3181b88d37


Cristy Houghton