Women are 3 times more likely to injure their anterior cruciate ligament (ACL) while playing soccer than men. ACL injury prevention programs (IPPs) involving stretching and strengthening drills can reduce the incidence of ACL injury when incorporated into routine training. The rate of implementation among coaches is largely unknown. The purpose of this study was to determine the rate of implementation of ACL IPP, to identify factors that influence implementation, and to acquire information to assist in design dissemination and implementation strategies. Study subjects were coaches of woman soccer players aged 11-22 years in Utah (n = 756). Data were gathered using a Web-based survey followed by a qualitative study in which "best practice coaches"-coaches who met criteria for successful implementation of ACL IPP-were interviewed via telephone. A minority of survey respondents, 19.8% (27/136), have implemented ACL IPP. Factors associated with successful implementation include length of coaching experience and presence of additional support staff such as a strength and conditioning coach or athletic trainer. Best practice coaches (14/136) unanimously agreed on the following: (a) there are performance-enhancing benefits of ACL IPP, (b) education on ACL injury prevention should be required for licensure, and (c) dissemination and implementation will require soccer associations to enact policies that require IPPs. In conclusion, a minority of girls soccer coaches have implemented ACL IPP and those that have do so because they believe that prevention improves performance and that soccer organizations should enact policies requiring ACL injury prevention education and implementation. Efforts to implement ACL IPP should be driven by soccer organizations, emphasize performance-enhancing benefits, and engage additional coaching staff.

A greater number of women are choosing to exercise in pregnancy as the recommendations by the American College of Obstetrics and Gynecology (ACOG) and other organizations have changed in recent years. Exercise during pregnancy can be beneficial to the health of the fetus and mother. Physicians should be aware of the contraindications to exercise, the warning signs to terminate exercise, and the latest recommendations by the ACOG. In the absence of contraindications, the authors believe that physicians should help to develop a reasonable exercise protocol for women based upon their previous activity levels. It is incumbent upon physicians to be aware of the unique physiologic factors present during pregnancy that may predispose women to injuries. Treatment of injuries sustained during pregnancy must balance the risks to both the mother and fetus.