Exercises To Decrease Risk Of Common Soccer Injuries: ACL Tears

What is the ACL?

The anterior cruciate ligament (ACL) is a ligament that connects the femur (thigh bone) to the tibia (shin bone).  It is one of several ligaments of the knee that helps provide stability to the knee joint during movement.  The ACL prevents the tibia from shifting forward relative to the femur and provides some rotational stability to the knee.

Injury to the ACL:

ACL sprains are a common sport injury of the lower extremity.  ACL sprains are graded on a scale from 1 to 3 based on the amount of damage the ligament has sustained, with a grade 3 ACL sprain indicating a complete tear of the ACL.

ACL injuries are typically described as contact or non-contact injuries.  A contact injury is when direct impact or contact is made against the knee, for instance during a football hit or soccer slide tackle.  A non-contact injury occurs when an athlete moves in a specific way that overloads their ACL, which may include pivoting, cutting, twisting, or landing awkwardly from a jump.  ACL injuries are often non-contact injuries.  An athlete may be at an increased risk of sustaining a non-contact ACL injury if they have poor strength and movement mechanics through their legs.

Ways to Decrease the Risk of a Non-Contact ACL Injury:

An athlete cannot plan for contact injuries; however, they may be able to decrease their risk of sustaining a non-contact knee injury.  Exercise-based knee injury prevention programs are a great way to decrease the risk of non-contact injuries during sports.

According to guidelines from the Journal of Orthopedic and Sports Physical Therapy, “there is strong evidence for the benefits of exercise-based knee injury prevention programs, including reduction in risk for all knee injuries and for ACL injuries specifically, with little risk of adverse events and minimal cost.”

It is recommended that all young athletes, particularly age 12-25 years of age in high risk sports (football, soccer, rugby, netball, basketball, and skiing) participate in a knee injury prevention program.  This is especially true for female athletes under the age of 18 due to the increased risk of sustaining a non-contact ACL injury in this group.

A comprehensive knee injury prevention program should include:

• Strength training

  • Strengthening exercises of the core, hips, and lower extremities.  Exercises to include in a strengthening program are double leg squats, single leg squats, lunges, Nordic hamstring curls, plank variations, and heel raises.

• Flexibility exercises

  • Addressing flexibility of the quads, hamstrings, hip adductors, hip flexors, and calf muscles.

• Plyometrics and agility

  • To improve jumping and landing mechanics with exercises that include single leg jumps (forward and backward), skater jumps, and squat jumps, as well as running and agility exercises in forward, backward, and lateral directions.

A knee injury prevention program should also:

• Be performed multiple times per week with training sessions that last longer than 20 minutes

• Be started in the pre-season and continued during the regular season.

Examples of Knee Injury Prevention Programs:

• FIFA 11+

  • The FIFA 11+ program is a soccer warm-up that was designed by international sports medicine experts to decrease injury risk in soccer players aged 14 or older.  It was designed to be a comprehensive warm-up that incorporates jogging/running, strengthening, balance, plyometric, and agility exercises to decrease risk of injury during practice and games. 

  • CLICK HERE to learn more about the FIFA 11+ program here:

• Journal of Orthopedic and Sports Physical Therapy (JOSPT) Knee Injury Prevention Program

  • The JOSPT has created a knee injury prevention program with comprehensive exercises to reduce the risk of knee injury with sports.

  • CLICK HERE to see a video of these exercises for field sports (soccer, football, etc).

  • CLICK HERE to see a video of these exercises for court sports (basketball, volleyball, etc).

Working with a Physical Therapist:

A physical therapist can help screen athletes for injury risk and help athletes develop a program to reduce injury risk.  A physical therapist can help develop an exercise program that addresses an athletes specific strength impairments or body mechanics with sport specific movements.  To schedule an appointment with one of our physical therapists, CLICK HERE.

-Sean Tyler, DPT

Exercises To Decrease Risk Of Common Soccer Injuries: Muscle Strains

Muscle and tendon injuries are some of the more common injuries sustained by soccer players.  Muscle and tendon injuries are more common in soccer players than joint and ligament injuries, including ACL injuries.   Common areas for muscle and tendon injuries in soccer players include the muscles of the thigh and groin, mainly the quadriceps, hamstring, and adductor muscles. 

Soccer players may have an increased risk of injury to these muscles and tendons if they have any of the following:

• Poor muscle strength

• Poor muscle flexibility

• Hip and core weakness

• A previous muscle or tendon injury in these areas

• Too quick of a return to sport following an injury

Research studies suggest that regular participation in a lower extremity strengthening program may help decrease the risk of sustaining a muscle or tendon injury during soccer activities.  A comprehensive strengthening program for a soccer play should include specific exercises that target these areas.  Specific exercises for each muscle group will be provided in the sections below.  

QUADRICEPS MUSCLE STRAINS

The quadriceps muscle group (“quads”) includes the rectus femoris, vastus lateralis, intermedius, and vastus medialis.  These muscles are on the front of the thigh and are responsible for flexing (raising) the thigh and straightening the knee.  The quadriceps are a common area for strain during soccer due to the knee and hip forces generated with kicking and sprinting.  An exercise program that includes quad strengthening exercises, specifically eccentric quadriceps strengthening, can increase muscle strength and may reduce the risk of quad strains during sport activities.

See the Videos Below for Quadriceps Eccentric Strengthening Exercises

HAMSTRING MUSCLE STRAINS

The hamstring muscle group includes the biceps femoris, semitendinosus, and semimembranosus.  The hamstrings are on the back of the thigh and are responsible for extending the thigh behind the body and bending the knee.  Hamstring strains are the most common soccer muscle injury and often occur during high speed running, sprinting, and kicking motions.

During an explosive kicking movement, the hamstring muscles have to be strong enough to control the quick straightening of the knee and forward movement of the thigh.  A comprehensive exercise program to decrease hamstring muscle strain risk should include strengthening of the glutes, strengthening of the abdominals and trunk muscles, and improving eccentric hamstring strength. 

See the Videos Below for Hamstring Eccentric Strengthening Exercises:

(Exercise at 0:48 in this video)

ADDUCTOR MUSCLE STRAINS

An adductor, or groin strain is an injury to the muscles on the inside of the thigh.  The adductor muscles most commonly strained include the adductor magnus, adductor longus, adductor brevis and gracilis muscles.  The adductors are a common location for a strain to occur in soccer due to the high amount of eccentric loading with cutting, kicking, and planting movements.  A strain can happen in the muscle belly, where the muscle meets the tendon, or where the tendon attaches to bone.  Research suggests that including eccentric adductor strengthening exercises in a strengthening program may reduce the risk of groin injuries in soccer players.   

See the Videos Below for Adductor Eccentric Strengthening Exercises:

Questions? CLICK HERE to contact the author of this blog, Sean Tyler, DPT.

Exercises To Decrease Risk Of Common Soccer Injuries: Ankle Sprains

An ankle sprain occurs when the ligaments of the ankle are overstretched as the ankle is rolled, twisted, or turned in an awkward or unexpected way.  Ligaments are connective tissue of the body that connect one bone to another bone and provide support through a joint.  Lateral ankle sprains, or sprains to the outer ligaments of the ankle, are the most common forms of ankle sprains in soccer players due to the movements required of the sport.

Ankle sprains are assigned a grade (grade 1, 2, or 3) based on the extent of injury to the ligaments.  The recovery time from an ankle sprain is typically longer with higher grade sprains.

Soccer players may have an increased risk of ankle injury if they have any of the following:

• Weakness through the muscles of the calf and ankle 

• Poor balance and control of the ankle or foot with dynamic activities

• Tight calf muscles

• A history of previous ankle sprain or injury 

Our joints and tendons contain sensory receptors called proprioceptors that respond to the movement and position of the body.  Proprioceptors communicate information to our brain and muscles and help us maintain or change our body position.

Research studies suggest that regular participation in a lower extremity strengthening program that includes proprioceptive training may help decrease the risk of having an ankle injury during soccer activities.  A lower extremity strengthening program should also include exercises that address strength and mobility impairments in the ankle in addition to building proprioception. 

Check out the video below for dynamic balance exercises to improve ankle proprioception:

Questions? CLICK HERE to contact the author of this article, Sean Tyler, DPT.

FIFA 11+ : A Warm-Up Program for Soccer Players to Decrease Injury Risk

Soccer is one of the most popular sports in the world and in the city of Seattle.  Like most sports, participation in soccer comes with an increased risk of sport-related injury.  Most soccer injuries occur in the legs, especially the ankle, knee, and thigh.  These injuries might include sprains, strains, and contusions.  Soccer players may be at an increased risk of injury when they have not warmed up properly, are fatigued, and have strength imbalances (1).

The FIFA 11+ program is a soccer warm-up that was designed by international sports medicine experts to decrease injury risk in soccer players aged 14 or older.  It was designed to be a comprehensive warm-up that incorporates jogging/running, strengthening, balance, plyometric, and agility exercises to decrease risk of injury during practice and games.    

Scientific studies have shown that youth soccer teams who used the FIFA 11+ program had lower rates of injury compared to teams using normal warm-ups (2).  

In fact, regular weekly performance of the FIFA 11+ warm-up program over a 2-3 month time span reduced the risk of injury in soccer players by 30% (2).   

Performing the FIFA 11+

The FIFA 11+ program should be performed on a soccer field with 6 cones, placed 5-6 meters apart.  The program consists of three parts: 

Part 1 - Warm-up running and active stretching exercises - approximately 8 minutes

• Running straight ahead

• Running, hip out 

• Running, hip in 

• Running, circling partner/cones

• Running, shoulder contact 

• Running, quick forward and backward 

Part 2 - Core and leg strengthening, balance, plyometrics, and agility exercises - approximately 10 minutes 

The exercises in Part 2 are broken into three categories: Level 1 (Beginner), Level 2 (Intermediate), and Level 3 (Advanced) based on athletes strength and conditioning, form, and comfort with the exercises.

• The Bench/Plank: Level 1, 2, or 3 

• The Sideways Bench/Plank: Level 1, 2, or 3 

• Hamstring Exercise: Level 1, 2, or 3

• Single Leg Stance: level 1, 2, or 3 

• Squats: Level 1, 2, or 3 

• Jumping: Level 1, 2, or 3 

Part 3 - Higher speed running, cutting, and pivoting exercises - approximately 2 minutes 

• Running, across the pitch 

• Running, bounding 

• Running, plant and cut 

Click here to download a print copy of the FIFA 11+

It is important to maintain proper form when completing the warm-up exercises.  Athletes should focus on good posture and body control, proper leg alignment, and soft landings with jumping. 

The FIFA 11+ warm-up program is a great warm-up program for organized soccer teams and recreational soccer players alike.  Coaches and trainers of organized teams who understand and utilize the FIFA 11+ program exercises can help decrease risk of injury in their soccer athletes.        

-Sean Tyler, DPT & Brian Collins, DPT

References:

1. Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011 Jun;45(7):553–8.

2. Sadigursky, D., Braid, J.A., De Lira, D.N.L. et al. The FIFA 11+ injury prevention program for soccer players: a systematic review. BMC Sports Sci Med Rehabil 9, 18 (2017). https://doi.org/10.1186/s13102-017-0083-z
   
   
   
   

Preventing ACL Tears In Soccer Players

With the World Cup currently in full force, it is difficult for physical therapists everywhere to not think about ACL tears when soccer is at the forefront of our attention. ACL tears are alarmingly prevalent in soccer players, particularly in females. In fact, female soccer players are near the top of the charts when it comes to athletes most at risk of ACL tears. But what, if anything, can be done to prevent this? While the risk of ACL tears can never be eliminated, the evidence suggests the risk can be reduced via targeted injury-prevention programs. Injury-prevention programs designed for ACL health should focus on improving lower extremity biomechanics via functional strength and stability exercises, particularly targeting the quadriceps, gluteals, hamstrings, and core musculature. Here are some common therapeutic exercises to consider:

• The TRX Retro Floating Lunge is a great way to improve dynamic knee control while strengthening the quadriceps, hamstrings, and gluteals. Perform 3 sets of 10-20 repetitions per leg, every other day.

• Band-resisted side-stepping helps to strengthen the gluteus medius, a muscle critical in controlling excessive rotational forces at the knee, which can be implemented in ACL tears. Perform 3 sets of 10-20 steps each direction, every other day.

• Lateral bounding is a common plyomteric exercise that can help to improve dynamic knee control and hip stability, while also increasing power in the leg musculature. Perform 3 sets of 10 jumps in each direction, every other day.

• An agility ladder stepping series creates a functional opportunity to improve coordination and dynamic knee control, translating to more efficient footwork on the soccer field. Perform a routine similar to this every other day.

Programs to reduce the risk of ACL tears should incorporate training multiple days per week and contain workouts that are at least 20 minutes in duration. With any injury-prevention program, compliance is key, as you only will see a benefit if these exercises are performed with regularity. Finally, when considering any new training program, please consult with your physical therapist or sports medicine provider before moving forward. Play on!

-Grant Hennington, DPT