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

Tips For Training For Ski Season

With back-to-school just around the corner and summer coming to a close, here in the Pacific Northwest it’s time to start thinking about training for the upcoming ski season. As my inbox is flooded with emails about discounts on season passes and lodging at the local ski resorts, I cannot help but feel inspired to prepare for those long days in the backcountry or skiing laps on powder days inbounds. But what are some of the more important areas to focus on when building a ski conditioning program? While skiing can be a lifelong sport, it also carries with it high physical demands and risk of injury. Therefore, as with most sports-specific training programs, the key is including exercises that promote both injury prevention and performance enhancement. When it comes to skiing, exercises that improve strength, stability, and mobility are paramount. Here are a few examples:

• A retro floating lunge improves functional gluteal and quadriceps strength, while also promoting improved stability at the hip and knee joints, two prominent areas that can frequently be injured when skiing.

• Band-resisted side-stepping strengthens the gluteus medius, a muscle integral in controlling excessive rotation at the knee joint. Training this muscle is important in reducing the risk of ACL tears, an unfortunately common injury among skiers.

• Ankle dorsiflexion lunges help increase mobility at the ankle joint, allowing you sufficient range of motion to avoid back seat skiing.

• Lateral bounding facilitates improved stability at the hip and knee joints, while also strengthening the gluteals and quadriceps, helping you better hold your edge on more challenging terrain.

As with any training program, a slow and systematic progression is key to avoiding overuse injuries. Performing strengthening exercises such as these 2-3 days per week is enough to make improvements and more is not always better. Your program should be at least 8 weeks in length in order to provide adequate time for adaptive changes to take place to your musculoskeletal and cardiovascular systems. It takes time and consistency to make your muscles stronger and your joints more mobile! Finally, seek clearance from your physical therapist or primary care provider before initiating any new exercise program and stop if you find yourself limited by unrelenting aches and pains.

Fingers crossed for a big snow year. Hope to see you out there!

-Grant Hennington, DPT

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