Athletes train to get stronger, faster, and more explosive. But coaches often say that the best ability is availability. Accidents happen, but many sports injuries are more preventable than we assume. Let’s dig into the science on what specifically an athlete needs to do to reduce the most common high school football injuries. The upcoming offseason is the best time to build this resiliency and prevent injuries next season. The exercises described can be easily incorporated into warm ups for lifting or other workouts.
Which injuries are most common
A large High School RIO study of U.S. boys’ football during 2008–2009 through 2012–2013 provides a consistent ranking of injury diagnoses. Reportable injuries required medical attention and at least one day of missed participation. These are the injuries from most to least common. [1]
1 Ligament sprains
Ankle Sprains: Build Strength, Balance, and Control
Preventing ankle sprains takes more than stretching. Athletes need to control the foot and ankle when landing, cutting, or reacting to contact. Here are the exact exercises, sets and reps an athlete needs to protect their ankles. Youtube has videos of these if you don’t understand the movements.
1. Single-leg balance with Y reaches
Stand on one foot with a slight bend in the knee. Slowly reach the other foot forward, diagonally backward in a curtsy lung, and out to the side (the non weight bearing leg is touching down lightly in the points of a Y). Keep the standing foot planted and the knee controlled. Start with two rounds of 30–45 seconds per leg. Progress by reaching farther and then adding a ball toss to catch while holding the position.
2. Straight-knee and bent-knee calf raises
The calf muscles provide strength and control during running, landing, and changes of direction. Train both positions: straight-knee raises emphasize the gastrocnemius, while bent-knee raises place more emphasis on the soleus.
Perform two sets of 10–15 repetitions in each position. Start with both legs if necessary, then progress to single-leg raises and added resistance. Rise smoothly and lower under control, and watch the heel and ball of the foot, keeping pressure distributed across the forefoot rather than rolling onto the foot’s outside edge.
3. Resistance-band ankle eversion
The muscles along the outside of the lower leg help control inward rolling of the ankle. While seated, use a resistance band to resist moving the forefoot outward. Keep the knee still so the movement comes from the ankle.
Perform two sets of 12–20 controlled repetitions per side. Increase resistance gradually.
4. Single-leg hop and hold
Once the player can balance and perform calf raises comfortably, introduce small single-leg hops. Land softly and the ball of the foot with the heel slightly elevated, control the foot and knee, and hold the landing for two to three seconds. Begin hopping forward, then add sideways and diagonal directions.
Start with two sets of five landings per leg. Increase distance and speed only when landings remain stable. Faster repeated hops and reactive cutting come later.
Practice this routine two to three times weekly, adjusting the amount around football practices and games. The strongest evidence supports balance and neuromuscular programs as a whole; individual strengthening exercises have not each been proven to prevent sprains on their own.
Knees need strength and movement preparation
Knee sprains include MCL and ACL injuries. Some result from direct contact; others occur during cutting, stopping, or landing. Exercise cannot reliably protect a knee from every collision.
Multicomponent programs should combine strength, balance, jumping, landing, and agility. Recommendations support performing them at least two to three times weekly through preseason and the competitive season. [4]
Practical actions:
Build controlled squats, split squats, hip hinges, and hamstring work into supervised strength training. Include single leg work in every leg workout to prevent the development of hidden strength/stability imbalances from leg to leg.
Practice landing, braking, and changing direction with a coach who can give feedback.
Progress from planned movements at manageable speeds to faster, more reactive drills.
Make prevention a regular part of warmups rather than a preseason demonstration that disappears once games begin.
2 Concussions
Concussion prevention depends heavily on the environment in which athletes practice and compete.
A 2023 systematic review found that American football strategies limiting contact in practice were associated with a 64% lower practice-related concussion rate. [5]
Practical actions:
Ask how your team limits full-contact practice and unnecessary collision drills.
Expect coaching that keeps the head out of initial contact and enforcement against dangerous hits.
Check helmet fit and maintenance. No helmet can prevent every concussion.
Make symptom reporting routine. Headache, dizziness, confusion, balance changes, or visual symptoms after a hit warrant immediate attention.
Remove a player with a suspected concussion immediately. There is no same-day return; medical assessment and clearance are required. [6]
Neck strengthening could help and can be part of football preparation, but it should not be thought of as proven concussion protection. [5]
Parents have an important role here: reinforce that reporting symptoms protects the athlete’s health and ability to keep participating.
3 Muscle and tendon injuries including hamstring strains
A meta-analysis of 8,459 athletes found that programs containing the Nordic hamstring exercise roughly halved hamstring-injury risk. [7] Max velocity sprint work may also be helpful throughout the offseason. Sudden increases in high-speed running - such as at the beginning of season practices - have been associated with greater hamstring injury risk.
Practical actions:
Introduce hamstring curls or assisted Nordic hamstring exercises gradually under at the beginning of the offseason.
Include complementary exercises such as controlled hamstring sliders, curls, and hip hinges.
Build sprint exposure progressively, including preparation for the speeds the player will encounter in games.
Coordinate team practice, private speed sessions, and lifting. Additional work still counts when it happens with a different coach.
Exercise selection and dose should match the athlete’s training experience. A reasonable approach is to start with an amount the player tolerates well and build it over time.
4 Quad contusions and direct impact injuries
A deep thigh bruise or hip pointer can meaningfully limit running, even without a torn ligament. Direct blows can damage muscle and produce substantial swelling.
Practical actions: little can be done to prevent these. Wear correctly positioned protective padding, report significant pain and loss of movement, and protect an injured area from another blow during recovery. [8]
5 Fractures
It may seem like training strategies would be unlikely to reduce the risk of fractures, but that is not accurate. For overall bone health, I would emphasize progressive strength training plus running and jumping, adequate nutrition, and optimizing sleep and recovery.
Strength train two to three days weekly. Include squats, hip hinges, presses, and rows. Use controlled technique and increase resistance gradually under qualified supervision.
Include running and jumping. High impact exercise helps build bone.
Eat enough for training and growth. Avoid dieting. Eat regular meals and snacks with adequate protein and carbohydrates; chronic under-fueling can weaken bones. A good calorie target would be 16-20 calories per pound of body weight per day PLUS extra calories to account for more strenuous/lengthy exercise.
Get 1,300 mg of calcium daily. Choose milk, yogurt, cheese, calcium-fortified alternatives, or calcium-set tofu. Supplement only to fill dietary gaps.
Meet vitamin D needs. Teenagers generally need 600 IU daily from food and supplements combined. I would check a level and treat documented deficiency with clinician guidance.
Prioritize recovery. Aim for 10 hours of sleep, increase training gradually, and have persistent, localized bone pain evaluated.
6 Dislocations and hyperextension injuries
These injuries include problems such as a shoulder coming out of its socket or a joint being forced beyond its normal range. These are thankfully far less common injuries. Many of the methods discussed above will also reduce these risks.
What about cramps?
Cramps can knock a player from the game and can be very frustrating when they reoccur. Caution: Cramps should not automatically be blamed on low sodium, low potassium, or dehydration. Though we all have long assumed that hydration or electrolyte status must play a key role in muscle cramps, a 2026 systematic review found little evidence to support those assumptions. It found that previous cramping was the clearest predictor of future episodes. [9]
Practical actions:
Build conditioning and strength progressively and review workload when cramps occur.
Make a hydration plan, with access to fluids and appropriate replacement during prolonged, sweaty activity. Forcing excessive water is not a prevention strategy. [10]
Stop activity and gently stretch an actively cramping muscle. Assess the athlete before returning. Stretching can relieve an episode without being a proven way to prevent the next one. [11]
Include electrolytes in the plan, but do not assume that magnesium, bananas, salt tablets, or pickle juice will solve recurrent cramps.
Take home
The best ability is availability. While no program can eliminate football injuries, consistent strength training, balance and movement practice, progressive conditioning, a focus on nutrient intake, and adequate recovery can help players stay ready to compete. Combine those habits with your team’s safer contact practices and early reporting of symptoms to give athletes their best chance of staying healthy and crushing their athletic goals.
Sources
High School RIO — 2024–2025 national surveillance brief summary, prepared for the NFHS
McGuine and colleagues — Randomized trial of lace-up ankle braces in high school football
National Athletic Trainers’ Association — Prevention of Anterior Cruciate Ligament Injury
Eliason and colleagues, 2023 — Concussion prevention strategies and modifiable risk factors
CDC HEADS UP — Preventing Concussion and Responding to a Sports-related Concussion
van Dyk and colleagues, 2019 — Nordic hamstring exercise programs and injury risk
National Athletic Trainers’ Association — Fluid Replacement for the Physically Active
Miller and colleagues, 2022 — Exercise-associated muscle cramp mechanisms, treatment, and prevention
Roundtable on Preseason Heat Safety in Secondary School Athletics — Heat Acclimatization
