"We must teach our soccer players the techniques of how to run,
jump, land, and move prior to teaching endless
numbers of drills and exercises."
Swanson McArthur Physical Therapy (SMPT) has been providing pre-season and in-season soccer conditioning programs to athletes from Roseville Youth Soccer Club (RYSC), San Juan Soccer Club, Cal Blues, Placer United Soccer Club, and Woodcreek HS since 2006. The program focuses on cardiovascular conditioning, flexibility, and strengthening...all in a soccer-specific environment.
2008 marked the start of the SMPT ACL Injury Prevention Program. Developed and directed by Quinn A. McArthur, PT, OCS, the program focuses on Select and Competitive female soccer players and includes educational seminars for coaches, parents, and athletes as well as on-field training. This soccer-specific program is designed to reduce the risks of ACL injuries utilizing education, exercises, and techniques to improve flexibility, strength, endurance, agility, power, and neuromuscular control.
Coordinator, and Woodcreek High School's Soccer Program as
Sportsmedicine Director, Quinn has established an injury prevention
philosophy within the clubs and is applying the
SMPT ACL Injury Prevention Program to aggressively address
the epidemic of ACL tears in female soccer players.
SMPT also provides return to sport rehabilitation for athletes, especially
female soccer players, who are recovering from knee surgery and
preparing to return to the field. The program assesses functional strength,
flexibility, landing and positional change dynamics, and the quality of the
athlete's ability to decelerate and control the lower extremities and
trunk during athletic movements. This program consists of
ACL Injury Prevention Program
An estimated 80,000 ACL tears occur annually in the United States, with the higher incidence in individuals 15 to 25 years of age who participate in pivoting sports. Soccer, volleyball, and basketball represent the three sports where the majority of ACL injuries occur in females. ACL injury results in instability of the knee and is associated with meniscal tear in up to 77% of cases and chondral (cartilage) injury in up to 23% of cases.
Reconstructive surgery is often utilized to restore an athlete's function and stability. Unfortunately, the reinjury rate following surgery has been reported as high as 11%. Furthermore, a recent study following athletes after 5 years post-surgery reported the presence of degenerative changes within the repaired knee joint to be 31%.
Soccer-Specific Movement Science
Running, cutting, and jumping are movements vital to the game of soccer. Inherent within these movements is the potential for injury if they are performed incorrectly. Noncontact ACL injuries often occur with the knee slightly bent and in a valgus position. With highly skilled athletes playing longer seasons at a higher competitive level, the stresses at the knee can be significant. The research indicates that differences exist between boys and girls in the way they run, cut, jump/land, and decelerate. In assessing electrical muscle activity, force plate values, and video analysis, girls have been found to:
- run both forward and backward in a more upright position
- cut, standing more upright with the outside/planted leg, in valgus (caving in)
- land firmly from a jump more flat-footed, with less knee flexion (bend), and
less hip flexion (bend)
- over utilize the quads when squatting and running
- underutilize the hamstrings when running, cutting, and decelerating
- decelerate more with dominate quads in a more upright trunk position
- have weaker hamstrings in the non-dominant leg
Putting It Together
If one reviews the biomechanics we see that the combination of muscular weakness in the hamstrings and gluteals with the over utilization of the quads puts girls at risk. The hamstrings are unable to counteract the quads forward pull on the tibia. Since the hamstrings and gluteals are weak they don’t support a softer landing or a safer cutting motion. As a result the athlete is more upright and in a knock-knee position…further putting her at risk. When these are combined with the anatomical disadvantages described previously, as well as the potential hormonal issues, one begins to understand the high incidence of ACL tears in female athletes.
What Can Be Done to Reduce the Risks Inherent in Girls Competitive Soccer?
The research points to 4 potential reasons for ACL failure
Since we have no control over anatomical or hormonal factors, our focus must be on re-educating the most important structures in and around the knee. This can be achieved through neuromuscular and proprioceptive training.
A recent study found specific neuromuscular and proprioceptive training exercises reduced
non-contact ACL injuries by 74%. This “prevent injury and enhance performance” program teaches proper running, jumping, and stopping. The 12-week program focuses on injury awareness and avoidance techniques, lower extremity and trunk strength/stability, flexibility, progressive plyometrics, and sports-specific agilities.
Proprioception is our ability to sense where we are in space. We rely on our inner ear for equilibrium, our eyes for visual awareness, and our muscles and joints for limb position and effort. We can, with proper training, use these systems to learn how to properly move, balance, and coordinate actions.
Neuromuscular training is our ability to consciously choose to move in a specific way. We teach our muscles and joints how to perform an activity or movement pattern through biofeedback or instruction. We rely on proprioception (where we are in space) to perform new movements/skills or relearn old, poorly performed movements/skills. Basically, we can train ourselves how to move…properly.
We must teach our soccer players the techniques of how to run, jump, land, and move prior to teaching endless numbers of drills and exercises.
Soccer Training Implications
The research indicates it is essential that girls land from a jump softly on the balls of their feet, then fall to the mid-foot, and then heel. They must bend their knees and maintain a knee position in line with their ankles and second toes. The knees must never extend over the foot, never hyperextend, and the hips should flex to further absorb shock. The knees must not come together.
Cutting and Pivoting
These soccer-specific motions must occur with flexed knees, while maintaining knees over the ankles and avoiding a “caving in” of the knees or the tendency toward knock-knee positioning. Flexing the knees properly teaches the hamstrings and gluteals to assist the action, counteracting the forward pull of the dominant quads, and reducing ACL stresses.
Girls must run less upright with slightly bent knees, avoid the knock knee position, and stay flat-footed. They should be on their toes when sprinting. Backward running must occur with bent knees while the athlete stays on her toes and leans forward (while maintaining a straight back). She will be better balanced and able to change directions safely. Keeping the knees bent and maintaining a lower position will reduce ACL stresses.
The athlete must stay low with the knees over the ankles (not caving in) and the weight off the heels.
Girls can, with the help of a trainer or coach, learn through neuromuscular re-education techniques how to move more effectively, more safely, and more appropriately. This will reinforce proper movements in a game situation, and reduce the risk of ACL injury.
Since girls possess a tendency to overuse their quads when landing and decelerating, we must teach through neuromuscular re-education, how to use alternative and more supportive muscles. In essence, female athletes must learn to move in a way that will reduce the risk of injury. Studies have shown that adding proprioceptive and neuromuscular training exercises to the training regimen can reduce the number of ACL injuries by 2-4 times.
The SMPT ACL Injury Prevention Program has been adapted from the Santa Monica ACL Prevention Project. It has been established to reduce the risks previously described. It has been designed as a warm-up, should take only 15-20 minutes, and has been proven, in one study, to reduce ACL injuries by 74%. It should be performed 2-3 times per week during the season and modified by the coach, a trainer, or Quinn as needed. Proper form must be emphasized and corrected if needed. Please contact SMPT for details regarding the program and how to have it implemented for your team or club.
Swanson McArthur Physical Therapy
Provides Strength, Conditioning and ACL Injury Prevention Programs For The Following Organizations:
Additional Program Information
If you are interested in learning more about the Conditioning or ACL Injury Prevention Programs offered by SMPT, please call (916) 965-8900 or e-mail firstname.lastname@example.org.
"Restoring function, maximizing performance."
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- Diplomats, American Board of Physical Therapy Specialties -