22 Jul The Best Soccer Prehab Exercises For Injury Prevention
Soccer is the world’s most popular sport and demonstrates continued growth in the United States each year. Over 13 million Americans play soccer, and according to US Youth Soccer, there are over 3 million youth soccer players registered in the United States today. Although there are benefits to playing soccer such as improved cardiovascular health, strength, and self-esteem, there are also some inherent risks involved. One study found that there were over 2.4 million soccer-related injuries leading to an Emergency Room visit between the years 2000 and 2012. Another study showed that soccer is the high school sport with the highest risk of injury for female athletes (1-3). In this article, we will highlight the most common injuries seen in soccer and teach you research-based soccer prehab exercises to help prevent these injuries!
Why Soccer Prehab Exercises?
Unfortunately, injuries are a part of sports. When it comes to elite soccer players, the average time missed from playing is about 2 weeks while the burden of the injury can last up to 6 weeks (4)! As we like to say, the best rehab is [P]Rehab and if we can reduce the risk of common soccer injuries, then we are helping people by decreasing their risk of missing time from playing the sport they love. The most common exercise-based strategies at the elite level include eccentric exercise, neuromuscular training programs, strength and flexibility exercises, core exercises, and balance/proprioception exercises. We will outline all of these and much more but first, we need to educate you on the most common soccer injuries.
What Are The Most Common Soccer Muscle Injuries?
Muscle and tendon injuries are much more common in soccer compared to bone contusions and fractures or joint and ligament injuries (4). Because of this, there has been plenty of research conducted as well as a lot of emphases put on what are the best soccer prehab exercises for ‘injury prevention’ when it comes to muscle injuries. There is evidence to support specific exercises being helpful for the hamstring, adductor, and quadriceps muscle groups by improving eccentric muscle strength (we will dive into the specific evidence below)! However, as we will discuss later in the article, injury prevention may not be the best word as it could be interpreted incorrectly whereas risk reduction or risk mitigation would be more accurate.
Soccer Muscle ‘Injury Prevention’ Exercises
This is a great introduction to the most common soccer prehab exercises for muscle injuries. Craig not only takes Mike through different levels of adductor, quadriceps, and hamstring exercises, but he also reviews how to perform these exercises by yourself or with a partner!
Hamstring strains are the most common soccer muscle injury accounting for up to 50% of muscle injuries. They tend to be more common in males than females and the most common game situations in which a hamstring is injured is in high speed running activities during terminal swing phase and during a kicking motion when there is simultaneous hip flexion and knee extension. About a third of athletes who suffer a hamstring strain will experience a re-injury within a year of returning to their sport. The greatest risk of re-injury is in the first two weeks following return to play, and the second injury is usually more severe than the initial strain. Factors contributing to the high rate of recurring hamstring strain injuries include…
- Persistent weakness
- Reduced extensibility of the musculotendonous unit
- Compensatory movement patterns and biomechanics
- Improperly addressing the modifiable risk factors that led to the initial injury, and
- Returning to play prematurely.
The key to effective prevention of any injury is understanding its modifiable risk factors. For a hamstring strain, a case can be made for hamstring weakness, impaired flexibility of hamstrings and quads, strength and coordination deficits of pelvic and trunk muscles, and impaired lumbopelvic rhythm all playing a role in hamstring strain injury risk. However, the modifiable risk factor most supported by research is eccentric hamstring strength. When a player shoots the ball and is going into hip flexion and knee extension, the hamstrings must have enough eccentric strength to be able to control the rate of knee extension being produced concentrically by the quads. If the quads have significantly more concentric strength than the hamstrings do eccentric strength, then the knee will be extending too quickly for the hamstrings to control, leading to over-stretching of the hamstrings and subsequent injury. Soccer prehab exercises for hamstrings should include eccentric hamstring muscle action as well as core stability (5-8).
Soccer [P]Rehab Exercises For The Hamstrings
The gold standard for the hamstrings is the Nordic Hamstring Exercise. Incorporating hamstring eccentric strengthening exercises has been found to be successful in helping to reduce the incidence of hamstring strain injuries up to 51% in soccer players (8). Eccentric exercises increase muscle fascicle length and improve eccentric strength, thereby addressing two of the modifiable risk factors associated with hamstring strain injuries. A comprehensive hamstring strain injury prevention program should include eccentric hamstring strengthening exercises, quad and hamstring flexibility, neuromuscular control of the lower extremities and lumbopelvic region, core stability, and sport-specific movement patterns. If these two variations are too hard for you, check out the read below to learn more Nordic Hamstring Curl Variations.
The adductor muscle group is made up of the adductor magnus, longus, and brevis. There are other muscles that contribute to hip adduction including the pectineus and gracilis. Due to the large adductor eccentric contraction demands in sports training and competition such as soccer, there is a high prevalence of adductor muscle injuries. From research, we understand contributing risk factors to adductor muscle strains include a muscle strength ratio imbalance between the hip adductors and hip abductors as well as lower adductor strength was found during the preseason when comparing players who sustained groin strains compared with injured players. However, there is evidence to suggest including eccentric adductor strengthening exercises can potentially reduce injuries in athletes, specifically soccer players (9)!
Soccer Prehab Exercises For The Adductors
The gold standard for the adductors is the Copenhagen Adductor as it demands high muscle activity of the adductor longus muscle and the abdominal muscles, both of which are protective against groin problems (9). However, this exercise is not easy for the first-timer! Below are some of our favorite alternatives and starters for those wanting to work up to the Copenhagen Adductor exercise! To learn more groin rehab exercises, click here.
Groin Injury From Soccer? Bulletproof It With Our Prehab Program!
The Groin [P]Rehab Program is the ultimate resource for those looking to recover from a groin injury, prevent a groin injury, or to reach new levels as a rotational athlete by addressing the workhorse of our movement system. No matter your fitness level or equipment restrictions, we have a carefully thought out plan developed for you that can be tailored to your needs! We are excited that you are taking control of your body, utilizing the right information at the right time to earn those groin grains through safe and effective programming!
The quadriceps muscle group is made up of the vastus intermedius, vastus lateralis, vatus medialis, and rectus femoris. Quad strains are another common soccer muscle injury due to its biarticular nature (the rectus femoris muscle crossing the hip and knee joint), which exposes it to a high risk of injury during fast movements such as repeated sprints, changes in direction, and kicking motions. Injury risk factors contributing to quad strains include…
- poor flexibility of the muscle
- poor eccentric strength
- previous quadriceps or hamstring injury
Again, the benefit of eccentric exercises is that they help with improving muscle architecture features, which include pennation angle, muscle thickness, and fascicle length. Improving these features can have a positive impact on muscle function as well as muscle injury risk. It is also worth noting eccentric exercises can increase muscle force and power values to a greater extent than concentric or isometric exercise! Improving eccentric quad strength is essential to reduce the risk of quad strains from occurring (10, 11)
Soccer Prehab Exercises For The Quadriceps
The gold standard for the quadriceps is the Reverse Nordic Hamstring Curl demonstrated above as it has been shown to improve the eccentric performance of the quadriceps muscles. What if you specifically have a hip flexor strain issue? Click here to learn how to manage a hip flexor strain.
Soccer [P]Rehab Program
Soccer to some, futbol to others, but to us it’s what got Arash & Craig into physical therapy in the first place! Just like any sport, soccer has physical requirements and demands a lot from your body. Prepare for the sport you love and protect your body from the most common soccer injuries with our Soccer [P]Rehab Program! You will train hard and expose your body to soccer-specific injury prevention (what we like to call risk-reduction) exercises so that you’ll be as ready as you can be to play! This program is rooted in scientific evidence, our clinical expertise as physical therapists, and of course our experience as soccer players!
Lateral Ankle Sprains
Lateral ankle sprains are one of the most commonly diagnosed injuries in soccer, accounting for anywhere from 15 to 20 percent of all injuries. Lateral ankle sprains occur when the ankle is plantarflexed and inverted and can happen when a player is cutting, changing speed or direction, or landing from a jump. Soccer players typically have tight calves, which may predispose them to lateral ankle sprains due to the relative position of plantar flexion caused by calf tightness. Soccer players may also be susceptible to this type of injury due to the specific demands and movement patterns associated with the sport.
An ankle sprain with no loss of function and no ligamentous laxity is classified as a grade 1 injury, and the athlete will typically return to sport in 5-9 days. In a grade 2 injury, there is some loss of function with anterior talofibular ligament (ATFL) involvement. With a grade 3 injury, there is almost complete loss of function of the ATFL and calcaneofibular ligament (CFL) involvement. In a grade 3 injury, athletes may require up to 55 days of recovery. It is important to address the athlete’s specific impairments that led to his or her initial injury that may be putting them at an increased risk of reinjury.
Research shows that there can be balance impairments and compensatory movement patterns in both the involved and uninvolved ankle for up to 6 months post-injury. In fact, up to 34% of athletes who sprain their ankle will experience continued pain, swelling, re-injury, instability, or limitations in physical activity (12-15).
Single-Leg Stability – Volleys, Skater Hops Passing, SL RDL to Volley, SL Passing
Video by contributing author Nicole Surdyka
Studies have shown a decrease in the recurrence of ankle sprains when a proprioceptive training program has been implemented. Exercises such as the Star Excursion Balance Test can be initiated immediately following an injury on the uninvolved side since studies have shown that usually, both ankles have balance and movement impairments in athletes who suffer a lateral ankle sprain. Once the athlete is full weight-bearing, they can begin the balance training on the injured side. It is also advised to address the underlying strength, mobility, and movement impairments that may have predisposed the athlete to an ankle sprain in the first place. Lengthening and strengthening the calves, as well as training single-leg stability should all be utilized as a part of a comprehensive prevention program. Some recommended soccer prehab exercises are inch worms, calf eccentrics, star excursion, and single-leg stability activities. Click here to learn more about how to prehab and manage ankle sprains.
Soccer Prehab Exercises For Lateral Ankle Sprain
Ankle Sprain [P]Rehab Program
Lateral ankle sprains can be challenging and frustrating due to having the highest injury AND reinjury rate amongst any lower-body injury. The high reinjury rates are likely because most ankle sprains aren’t properly managed in the first place. It’s time to change the narrative with [P]Rehab – we’ve designed a solution for you to get back to normal life while protecting your ankles into the future! Learn more HERE!
ACL Injuries are one of the most well-known and feared injuries a soccer player can sustain. Over 200,000 ACL injuries occur each year and are more common in female soccer players. Some studies suggest that up to 80% of ACL injuries are non-contact in nature. The most common mechanism of injury is a deceleration task with the foot planted flat into the ground, bodyweight shifted over the injured side, and a high knee internal extension torque coupled with dynamic valgus forces. Some typical playing situations that lead to noncontact ACL injuries are a change of direction or cutting combined with deceleration, landing from a jump in or near full extension, and pivoting on a planted foot with the knee near full extension. The forces on the ACL are the highest when the knee is flexed to about 20-30 degrees. Studies have shown that female soccer players demonstrate decreased knee flexion during landing, cutting, and deceleration tasks, typically staying between 0-30 degrees of knee flexion (16-24). You can learn more about the ACL here and ACL graft options for surgery if you injured your ACL.
Soccer Prehab Specific Plyometrics
Studies have shown that approximately 1 in 3 athletes who return to their sport after sustaining an ACL injury will either injure the same ACL again or injure the contralateral side. It is easy to see why preventing an ACL injury in the first place is a high priority. The intrinsic modifiable risk factors associated with an ACL tear are BMI, neuromuscular and biomechanical deficits, hormonal status, and fatigue. There are several ACL injury prevention/prehab programs out there, but the successful ones have some common elements: running warm-up, dynamic stretching, plyometrics, lower extremity strengthening, core control, and dynamic balance with an emphasis on correct mechanics. The best results have been demonstrated when the prevention program is implemented during pre-season and maintained throughout the season. Soccer-specific activities that utilize a soccer ball might help encourage implementation and promote compliance, especially among youth soccer teams (25-27).
Soccer Prehab Exercise Specific To Core Stability
Trunk position can largely influence knee position, which you know by now matters with ACL injuries. Don’t forget to include core stability soccer prehab exercises, you can make them fun with soccer included!
Can We Prevent All Soccer Injuries? Closing Thoughts
No, unfortunately, we cannot prevent all soccer injuries from occurring. That is the nature of sports, there is an inherent risk of getting injured. However, that doesn’t mean we throw away soccer prehab exercises! The goal of [P]Rehab is to mitigate the level of risk, we want to change the narrative from injury prevention to risk reduction as this is a more accurate statement! That is why being a pro soccer player is a full-time job year-round. Players have to take care of their bodies, they train in order to expose their body to the demands of their sport in efforts to be prepared to perform at the highest level with the lowest risk of injury!
But, some scientific research suggests otherwise. Recent evidence suggests there is no high-level scientific evidence to support the effectiveness of exercise strategies to prevent muscle injuries in elite footballers (4). However, the systematic review (a type of literature review that critically appraises other research studies) heavily weighted the risk of bias. What the study deemed to increase the risk of bias included blinding, exposure to training and competitions, training and match loads, type of training, and more. What is important to note is the study only looked at elite soccer players in the top 3 divisions, whereas there is plenty of evidence in other soccer demographics to support soccer ‘injury prevention’ exercises. We also have to take into consideration what affected the risk of bias in regards to the studies they appraised.
At the elite level, no professional organization is going to blind their fitness coaches and physiotherapists to the research being conducted on their squad. Also, teams are less inclined to report the details of their proprietary training methods or their player’s training loads as this could risk the competitive edge one club has on another. In our opinion and likely the opinion of many others, soccer prehab exercises still have tremendous value!
Looking For The Ultimate Guide With Soccer Prehab Exercises?
The thought of creating and designing a 3-month program can sound overwhelming for soccer athletes. That isn’t your expertise, you just want to play! However, in order to play and practice, your body needs to be able to handle the demands of the sport. Let us help you play the sport you love and make sure your body is as ready as it can be with our Soccer [P]Rehab Program. We have taken the guesswork out for you and have designed programming based on our experiences playing the sport growing up and working alongside D1 soccer programs. We have already taken into account the needs analysis for soccer and have put together the best programming specific to soccer players!
- Esquivel AO et al. Soccer-related injuries in children and adults aged 5 to 49 years in US emergency departments from 2000 to 2012. Sports Health. 2015; 7(4):366-370.
- Le Gall F, Carling C, Reilly T. Injuries in young elite female soccer players an 8-season prospective study. Am J Sports Med. 2008; 36(2):276-284.
- Clausen MB et al. High injury incidence in adolescent female soccer. Am J Sports Med. 2014; 42(10):2487-2494.
- Fanchini M, Steendahl IB, Impellizzeri FM, et al. Exercise-Based Strategies to Prevent Muscle Injury in Elite Footballers: A Systematic Review and Best Evidence Synthesis. Sports Med 2020. doi:10.1007/s40279-020-01282-z.
- Van Der Horst N et al. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players a randomized controlled trial. Am J Sports Med. 2015; 43(6): 1316-1323.
- Heiderscheit BC et al. Hamstring strain injuries: recommendations for diagnosis, rehabilitation and injury prevention. J Orthop Sports Phys Ther. 2010; 40(2):67-81.
- Schuermans J, Van Tiggelen D, Danneels L, Witvrouw E. Susceptibility to hamstring injuries in soccer. Am J Sports Med. 2016; 44(5): 1276-1285.
- Al Attar WSA, Soomro N, Sinclair PJ, et al. Effect of injury prevention programs that include the nordic hamstring exercise on hamstring injury rates in soccer players: a systematic review and meta-analysis. Sports Med 2017;47:A35.2–A35.
- Haroy J, Clarsen B, Wiger EG, et al. The adductor strengthening programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med.
- Alonso-Fernandez D, et al. Effects of eccentric exercise on the quadriceps architecture. Sci sports (2020), https://doi.org/10.1016/j.scispo.2019.11.006
- Alonso-Fernandez D, et al. Changes in rectus femoris architecture induced by the reverse nordic hamstring exercises. J Sports Med Phys Fitness. 2019.
- Kobayashi T, Tanaka M, Shida M. Intrinsic risk factors of lateral ankle sprain: a systematic review and meta-analysis. Sports Health. 2016; 8(2):190-193.
- Van Ochten JM et al. Chronic complaints after ankle sprains: a systematic review on effectiveness of treatments. J Orthop Sports Phys Ther. 2014; 44(11):862-C23.
- Cleland JA et al. Manual therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2013;43(7):443-455.
- Doherty C et al. Dynamic balance deficits 6 months following first-time acute lateral ankle sprain: a laboratory analysis. J Orthop Sports Phys Ther. 2015;43(8):626-633.
- Grooms DR, Onate JA. Neuroscience application to noncontact anterior cruciate ligament injury prevention. Sports Health. 2016; 8(2):190-193.
- Alentorn-Geli E et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanism of injury and underlying risk factors. Knee Surg Sports Traum Arthrosc. 2009; 17(7):705-729.
- Alentorn-Geli E et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates. Knee Surg Sports Traumatol Arthroscop. 2009; 17(8):859-879.
- Blackburn JT, Padua DA. Influence of trunk flexion on hip and knee joint kinematics during a controlled drop landing. Clin Biomech. 2008; 23(3):313–319.
- Brophy RH, Wright RW, Matava MJ. Cost analysis of converting from single-bundle to double-bundle anterior cruciate ligament reconstruction. Am J Sports Med. 2009; 37(4):683-687.
- Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes, part 1: mechanisms and risk factors. Am J Sports Med. 2006; 34(2):299–311.
- Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007; 42(2):311–319.
- Landry SC, McKean KA, Hubley-Kozey CL, Stanish WD, Deluzio KJ. Neuromuscular and lower limb biomechanical differences exist between male and female elite adolescent soccer players during an unanticipated side-cut maneuver. Am J Sports Med. 2007; 35(11):1888–1900.
- Mather RC et al. Societal and economic impact of anterior cruciate ligament tears. J Bone Jt Surg Am. 2013; 95(19):1751-1759.
- Myklebust G et al. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med. 2003; 13(2):71–78.
- Noyes FR, Barber-Westin SD. Neuromuscular retraining intervention programs: do they reduce noncontact anterior cruciate ligament injury rates in adolescent female athletes? Arthroscopy: Journal of Arth and Related Surgery. 2014; 30(2): 245-255.
- Perrier ET, Pavol MJ, Hoffman MA. The acute effects of a warm-up including static or dynamic stretching on counter-movement jump height, reaction time, and flexibility. J Strength and Cond Res. 2011; 25(7):1925-1931.
Contributing Author: Dr. Nicole Surdyka
Dr. Nicole Canning is a Physical Therapist from Monmouth County, New Jersey. She received her Doctor of Physical Therapy Degree from Emory University in Atlanta, Georgia where she was honored with the Susan J. Herdman Award for Excellence in Clinical Practice. She has experience working with youth, collegiate, and professional athletes in the prevention and rehabilitation of sports injuries. She has also given presentations at both the local and national level on injury prevention for athletes, specifically on programs that help reduce the risk of ACL Injuries.
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