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.

Golf & Shoulder Pain

Shoulder injuries are common among golfers. The shoulder is an incredibly mobile joint that lacks a lot of inherent stability and is exposed to significant forces during the golf swing. When a shoulder is moving properly and has sufficient strength, there generally is not a problem during the golf swing. Conversely, if there is a deficit in shoulder mobility or strength in a golfer, there is a good chance of eventually experiencing some shoulder pain while golfing. Here are some ways to check your own shoulder for rotational mobility:

INTERNAL ROTATION

Reach your arm behind your back: how high can you reach your thumb? Is it between your shoulder blades? Those with good mobility will reach to the level of T9 (the 9th thoracic vertebra) or higher, which roughly equates to bra strap level, or near the bottom corner of the shoulder blade. If your motion only makes it to the region of your low back or hip, that is a sign of reduced internal rotation mobility, with the most likely culprit being a stiff posterior capsule.

The shoulder capsule is a set of ligaments that blend together to form sort of a protective shell surrounding the “ball and socket” part of the joint. Anatomically, the socket isn’t particularly deep, allowing for more mobility, but at the cost of less stability. This is why the capsule is important, as it provides some joint stability while still allowing it to move through a large range of motion. When part of the capsule becomes stiff, it can adversely affect the mechanics of the joint, potentially leading to pain. This could manifest at the site of restriction itself or in other areas.

To stretch the posterior capsule of your shoulder, try the “sleeper stretch”. To stretch your right shoulder, lie on your right side with your elbow raised to shoulder level. Then take your left hand, grasp your right wrist, and guide the right arm to rotate downward toward your feet. Hold for 30 seconds. Click on the link below for a photo and further instruction of the sleeper stretch:

Sleeper Stretch

If the sleeper stretch is painful to perform, an alternative exercise to similarly improve shoulder mobility is the cross-body shoulder adduction stretch. The key to this stretch is that it should be felt behind the shoulder, without any pinching or sharp pain experienced in the front of the shoulder. 

Cross-Body Shoulder Adduction Stretch

EXTERNAL ROTATION

To check external rotation of your shoulder, raise your hand up to a “high five” position. Can you do this without pain? When you look at your forearm in this position, ideally it would be vertical, indicating roughly 90 degrees of shoulder external rotation. Some can rotate beyond 90 degrees, which is okay for most people. But remember, excessive mobility can come at the cost of stability. In other words, those with more mobility may need to compensate with additional strength surrounding the joint in order to ensure pain-free shoulder function. External rotation stiffness may be capsular or muscular, and there are some simple ways to stretch both.

Shoulder External Rotation Stretches

It can be helpful to remember that ideal shoulder function involves balancing both mobility and stability. If either of those are compromised, it could affect not only your ability to golf without pain, but also result in pain with day-to-day activities.

-Matt Kooy, DPT

Golf & Low Back Pain

Does your low back hurt at the end of your round? Does it hurt with every swing? Do you have low back issues that prevent you from playing at all? Over 80% of adults experience an episode of low back pain in their lifetime, with low back pain being a major cause of disability across the globe. The low back is the leading site of injury in golfers and could have any number of causes: irritated disks, facet joints, muscles, ligaments, etc. While there are many potential causes for low back pain, it is often helpful to look at the low back’s neighbors (the hips and thoracic spine) for mobility restrictions that might relate to the painful tissues in the low back.  

HIPS

The hips are highly mobile joints and hip mobility is critically important for the golfer during both the backswing and follow through. For a right handed player, the right hip internally rotates on the backswing and externally rotates on the follow through. Conversely, the left hip externally rotates on the backswing and internally rotates on the follow through. For left handed players, it’s the reverse. For many individuals (especially those with aging hips), there is usually more of a limitation with internal rotation compared to external rotation. While there are some stance modifications that may help while playing golf, such as increasing the amount of “toe out” at address, a better approach may be to identify where you are stiff and improve your baseline mobility in order to improve not only your golf game, but potentially day-to-day activities as well. 

THORACIC SPINE 

The spine is divided into three sections: the cervical spine (neck), thoracic spine (mid-back), and lumbar spine (low back). There are some distinct anatomical differences in each section and the shape of the bones and their connections can affect how far they are able to move in a particular direction. The neck moves well in all directions. The thoracic spine is mobile with rotation, but not as mobile with side bending or backward bending. The lumbar spine is mobile with forward & backward bending, but less mobile with rotation. It’s more important that the lumbar spine provide a stable foundation around which to swing, than to provide the rotational motion itself.

Since rotation is such a critical component of the golf swing, it is important to maximize the available rotation from the hips and thoracic spine so that we don’t place too much rotational demand onto the lumbar spine. If the hips and thoracic spine won’t fully rotate, the body might make up for it at the lumbar spine, an area without much rotation to give. See the exercises below to work on improving your hip and thoracic mobility and hopefully your golf game at the same time.

Hip & Thoracic Spine Mobility Routine For Golfers

-Matt Kooy, DPT