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. The most commonly injured areas are the ankle and knee, and the most common injuries are sprains and strains. In this article I will highlight the most common injuries seen in soccer, and demonstrate research based soccer prehab exercises to prevent these injuries while employing soccer-specific activities.
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 plantarflexion 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 and 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 activity.
Single Leg Stability – Volleys, Skater Hops Passing, SL RDL to Volley, SL Passing
Studies have shown a decrease in 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 part of a comprehensive prevention program. Some recommended soccer prehab exercises are inch worms, calf eccentrics, star excursion, and single leg stability activities. (READ: Top 6 Ankle Sprain Prehab Exercises)
Ankle Sprain Return to Sport Exercises
Hamstring strains are the most common injuries among male soccer players. 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 reinjury 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.
Nordic Hamstring Curl Variations
Incorporation of eccentric hamstring exercises – such as the Nordic Hamstring Exercise – have been found to be successful in helping to reduce the incidence of hamstring strain injuries. Eccentric exercises increase muscle fascicle length and improve 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. (READ: 4 Reasons “Tight” Hamstrings Lead to Hamstring Strains)
Soccer Prehab Exercise Specific Core Stability
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, body weight 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 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.
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. Here’s an example of one of my favorite soccer prehab exercises.
Soccer Specific Strengthening Prehab Exercises
About the Author: Dr. Nicole Canning
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. She is currently taking courses to become Certified in Applied Functional Sciences (CAFS) through The Gray Institute and is planning on taking the Sports Certified Specialist (SCS) Exam in March 2018.
Prior to Physical Therapy School, she was a Division-1 Soccer Player at St. John’s University in Queens, NY. There, she was awarded the National Strength and Conditioning Association’s All-American Award, and helped her team to become the first in program history to reach the NCAA Tournament. She also worked as a Personal Trainer and Strength and Conditioning Coach in a Mixed Martial Arts Gym, and as a Youth Soccer Coach. When not treating patients, reading research, or writing, she enjoys working out with her fiancee, Dr. Marc Surdyka who is also a Physical Therapist, and being outdoors with their dog, Rosie.