Your 12-year-old plays in a junior representative side. On Saturday a girl in her team planted her right foot, twisted at the knee, and went down. By Saturday night it was confirmed: torn anterior cruciate ligament. Surgery, six to twelve months out of football, and a different shape to her playing future.
It is midnight on Sunday. You have been reading the internet for two hours. You have seen the 4-to-6-times-higher-rate-for-girls statistic in several versions. You have seen the FIFA 11+ mentioned somewhere. You do not know whether your daughter's team does any of this, what to ask, who to ask, or whether you are being a worried parent or a sensible one.
You are being a sensible one. The rate gap is real. Girls have three to six times the non-contact ACL injury rate of boys at the same age in the same sport, and the rate climbs sharply from age 12 to 13. The fix is not a long list of exercises this article gives you. The fix is one short conversation with your club. Three questions, one email. You ask whether the team runs Football Australia's Perform+ program or an equivalent. You ask who is trained to deliver it. You ask when they last ran a complete session. The exercises are the coach's job. This article tells you what to ask, what numbers to know, and what a good answer sounds like.
The honest risk picture
In sports where boys and girls play side by side, girls have between three and six times the non-contact ACL injury rate of boys. The figure varies by study, age range, and sport. The clearest evidence in football: a Joseph and colleagues analysis of US high school athletics, published in the Journal of Athletic Training in 2013, found that girls' soccer had the highest ACL injury rate of the nine sports studied, at 11.7 to 12.2 injuries per 100,000 athlete exposures. An athlete exposure is one player at one practice or one game.
That rate matters because 76.6 per cent of ACL injuries in that data set required surgery. Recovery is nine to twelve months minimum at the community level, often longer. A torn ACL increases the risk of early-onset osteoarthritis later in life by a significant factor, independent of how good the surgery is.
The rate climbs sharply for girls from 12 to 13. For boys the climb starts later, at 14 to 15. The segment of the population that accounts for the highest number of ACL injuries is female athletes aged 15 to 19. Your 12-year-old is on the upslope of that curve.
Important clarification. The three-to-six-times rate is for non-contact ACL injuries. These are the ones that happen with a plant, a cut, a sudden deceleration, or an awkward landing, with nobody else involved. For contact ACL injuries, where someone runs into the knee, the gap between boys and girls is much smaller. Almost everything in this article is about reducing the non-contact mechanism, because that is the one prevention programs can affect.
Why the gap exists
Multiple factors, none of them simple, none of them the parent's lever.
Anatomical: girls have a wider Q-angle at the hip than boys, narrower intercondylar notch width in the knee, and ligament differences. These are not modifiable.
Biomechanical: female athletes tend to land with greater knee valgus, which is the knee collapsing inward, and with less sustained hip flexion. They tend to absorb landing force through the knee rather than through the hip and ankle. This is partly anatomy and partly habit. It is what neuromuscular training programs work on.
Hormonal: oestrogen affects ligament laxity across the cycle. Some research has suggested ACL injuries cluster in particular cycle phases. The evidence is real, the size of the effect is unclear, and there is nothing to do about it in a community setting at age 12.
Neuromuscular: the gap that opens at puberty. Boys gain explosive strength and neuromuscular coordination through that period. Girls gain coordination, but the strength curve is flatter without specific training. The result is a gap in the body's ability to control rapid changes of direction. This is the gap prevention programs are designed to close.
The parent's lever is the last one. Anatomy is fixed. Hormones are not something anyone is going to schedule a 12-year-old's training around. Biomechanics and neuromuscular control are trainable. That is what comes next.
What the research says actually works
Neuromuscular training programs reduce non-contact ACL injury risk by 50 to 65 per cent in published meta-analyses. The most-cited foundational studies are Hewett (1999, Cincinnati cohort, 1,263 athletes, a 2.4 to 3.6 times lower injury rate in the trained group) and Caraffa (1996, Italian semi-professional and amateur soccer, 600 players, an 87 per cent reduction in ACL injuries in the intervention group across three seasons).
The Crossley and Patterson 2020 meta-analysis in the British Journal of Sports Medicine pooled 11,773 female football players across multiple injury prevention program studies and found significant overall injury reduction.
These are not small studies and they are not new. The evidence has been clear for over twenty years that structured neuromuscular warm-ups reduce ACL injury risk substantially. The problem in the community game is not the evidence. It is the implementation.
The Australian answer: Perform+
In 2020, Football Australia, working with its Medical and Sports Science Departments and a group of Australian injury researchers and physiotherapists, released the Football Australia Perform+ program. Perform+ is the Australian update of the FIFA 11+ injury prevention program. It is free. It is hosted at footballaustralia.com.au with downloadable A3 posters, instructional videos, and a full session guide. It is the primary injury prevention program for football in Australia.
The numbers Football Australia publishes on its own page: Perform+ reduces injury incidence by around 40 per cent when delivered properly. "Delivered properly" matters. Programs of this kind are dose-dependent. Two complete deliveries per week is the floor. Three is better. Players who get the program once a fortnight do not get the benefit.
Football NSW echoes the recommendation. The state body's Injury Prevention page names Perform+ as the primary injury prevention program for football in NSW. The state body's January 2025 Member Protection and Insurance Update reinforces it. If your club is in NSW, this is the program the state body has told them to run.
For younger players, ages 5 to 13, Football Australia has a parallel program called Fundamentals+. This focuses on fundamental movement and coordination rather than injury prevention specifically, but it lays the groundwork. The full Perform+ program is designed for ages 10 and up.
The shape of Perform+, not the exercises
This article does not list the exercises. That is on purpose. The exercises are at the Football Australia link, with videos, with instructions, and with an A3 wallchart your coach can stick on the wall of the change room. Listing the exercises in a parent article would imply that running the program is a parent's job, which it is not. It would also imply that a parent who reads this article and does the exercises with their kid in the backyard is helping, which is more likely to be the opposite. The exercises are coordination work and they need a trained eye.
What you should know about the shape:
Two main components. A warm-up that takes 8 to 10 minutes at the start of training. A performance block of around 5 minutes that can sit at the end of training, in the middle, or be done at home.
The warm-up has running and movement drills, plus partner work for balance and proprioception. It does not require equipment.
The performance block includes the Nordic Hamstring Exercise, which on its own reduces hamstring injuries by up to 51 per cent in published meta-analyses, the Copenhagen Adductor Exercise for hip and groin, single-leg balance, and plyometric landing drills focused on knee position.
It is designed to be delivered by coaches and parents who have no specific injury prevention or performance training. You do not need a physio degree to run it. You need to read the manual and run it consistently.
You will know your club is running it well when the warm-up looks similar each week, when the coach uses cues like "soft knees" and "do not let the knee collapse in", and when there is a clear five minutes of strength and balance work somewhere in the session.
The three-question email
This is the part where parents act. One email, three questions, sent to the club secretary or to the coach directly through the club's official channels.
"Does the U13s team currently run Football Australia's Perform+ injury prevention program or an equivalent?
Who on the coaching staff is trained to deliver Perform+?
When did the team last run a complete Perform+ session?"
That is it. Send it on Monday morning. Wait two business days for a reply. The shape of a good reply: yes the team runs it, the head coach and assistant are trained, it was run last training and is run twice a week. The shape of a less-good reply: yes we do warm-ups but not the specific program, or no one in particular is trained, or it was last run two weeks ago.
If you get the less-good reply, you have your next move. You forward the email chain to the Coach Development team at your state body and you ask the same question of them. You are not in the wrong for asking. You are using a lever the state body has explicitly given you.
What you do not do is suggest your coach is failing your kid by not running Perform+. Uptake of injury prevention programs in community sport is poor across every sport in Australia. Football is not worse than other sports here. Many community coaches have never been told the program exists. Your job is to ask, not to blame.
What this article is not
It is not an exercise list. The exercise list is at footballaustralia.com.au and is the coach's job to use, not yours.
It is not a guarantee. Perform+ reduces non-contact ACL injury risk substantially. It does not eliminate it. Some ACL tears will happen even on teams running the best program in the world.
It is not a prescription to keep your daughter from playing high-intensity football. The whole point of doing this work is to keep her playing.
The boring close
On Monday morning, open your email, write three sentences to your club secretary, and send. The questions are above. Use the wording. Wait two business days.
If you get the clean answer, you have what you needed. You go back to watching her play with one less thing in your head.
If you do not get the clean answer, you have your next move and you make it without escalating. The state body has named the program. The numbers are on the page. You are asking a question the system has already answered. You are just checking that the answer reached your kid.