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: 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.

"Move Better" Series: Exercises To Improve Your Dynamic Leg Strength

Yesterday’s “Move Better” post presented the Y Balance Test as a way to test your dynamic balance, strength, and stability while moving in various directions.  The Y balance test is a good functional test to assess hip and knee strength in active individuals and is often used to determine an athlete’s risk of lower extremity injury during sport activities. 

Improving your dynamic lower extremity strength and balance can improve your sport performance and decrease your injury risk.  Several studies suggest impaired dynamic balance and hip strength are risk factors for lower extremity injury during activity (1,2).  Weakness in the hip musculature may lead to dynamic lower extremity valgus (the knee moving inward) during single leg squatting, jumping, and landing.  Dynamic lower extremity valgus has been correlated with an increased risk of several knee conditions, including ACL injury and patellofemoral pain. 

Hip strength and stability are important components of many athletic activities.  Strong hips are needed to transfer force from the lower body to the upper body in sports such as basketball, soccer, volleyball, football, and throwing in track and field.  Strong hips are also required for quick and powerful changes in direction, cutting, and lateral movements.  Dynamic hip strength and stability also plays an important role in daily activities, including walking with a normal gait pattern, standing on one leg, and ascending and descending stairs.  

Exercise to improve hip strength and dynamic balance are provided in the videos below.  The video below includes exercises to improve dynamic hip strength:

The next video includes exercises to improve dynamic balance of the lower extremities:

In summary, focusing on hip strengthening and dynamic balance exercises can improve your performance with sport and daily activities and may decrease your lower extremity injury risk.

Questions?  Contact sean@salmonbaypt.com.

-Brian Collins, DPT & Sean Tyler, DPT

References

1. Khayambashi K, Ghoddosi N, Straub RK, et al. Hip muscle strength predicts noncontact anterior cruciate ligament injury in male and female athletes: a prospective study. Am J Sports Med. 2016;44(2):355-361.

2. Plisky PJ, Rauh MJ, Kaminski TW, et al. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36(12):911-919