ACL Injury Prevention Programs, Soccer Conditioning
& Rehabilitation
"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 Rush, and Placer United Soccer Club 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.
Currently working with Placer United Soccer Club as Injury Education 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 on-field training.
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
- Anatomical
- Hormonal
- Proprioceptive
- Neuromuscular
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
Jumping/Landing
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.
Running
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.
Decelerating
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.
Training
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:
"To Inspire Young People to be Extraordinary Through Soccer"
Roseville Youth Soccer Club Home of the "World's Game" in Roseville Additional Program Information
ACL Injury Prevention Seminar For RYSC Coaches - please download the following: ACL Injury Prevention Program - RYSC - 2012
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 smpt@att.net.
"Restoring function, maximizing performance."
- Members, American Physical Therapy Association -
- Diplomats, American Board of Physical Therapy Specialties -
This information tells us that girls are more susceptible to ACL tears due to a number of potential causes. To avoid re-injury after surgery, the athlete needs to overcome not only post-operative issues of pain, swelling, ROM and strength loss, and functional/sports-specific limitations, but also the existing issues that lead to the tear initally. Assessing these factors requires careful evaluation, correction, re-assessment, and
repetition. The following information is designed to give the reader a basic understanding of the current ACL injury epidemic that is plaguing female athletics. The information is evidence-based and taken from peer-reviewed journals
Statistics
Over the past two decades the number of soccer related ACL injuries has risen significantly in girls. Due in large part to Title IX, which gave girls equal opportunity to academic and sports programs, exposure to the recreational activities once dominated by boys changed. As a result, a progressive increase in serious injuries has occurred. When comparing boys with girls in the same sport (soccer) girls have a far greater number of knee injuries and are 3 to 9 times more likely to sustain a non-contact ACL injury. In fact, 70% of all ACL injuries in girls are non-contact…the ligament tears due to the compromised position the athlete puts it in.
Research directed at this issue is extensive and has helped explain why the disparity between the sexes exists. Anatomical, hormonal, and neuromuscular differences have been studied and the results have been both interesting and helpful.
"Thank you Quinn. Elle really enjoyed physical therapy because you made it fun and she can see the results. She played a great indoor game last Saturday -- Dave and I both commented that she looked even stronger than before the ankle injury.
Hopefully, we won't
need your services
again soon, but it's
nice to know we
have a great place
to go if and when we
do!"
T. Harlow
"Quinn McArthur has been a huge asset to the Placer United Soccer Club. Having a Physical Therapist in our soccer community has been a blessing as Quinn has worked a number of our players back into form after injury.
As the Injury Education Coordinator, Quinn has established a program educating coaches, players, and parents with techniques for reducing the risk of ACL injury. If an injury does occur, he serves as a consultant with the player and family to help them through the initial injury or pre-operative phase.
Quinn also serves as a consultant in returning the athlete to the field after any kind of injury/surgery - working with the player, parents, coach, and physician.
Lastly, Quinn provides PUSC with educational info on common soccer injuries - per the website in the fitness and video gallery sections. www.placerunited.com
We are very appreciative to Quinn and his dedication to our student/athletes ensuring their health and well being."
Ron Benjamin and Paul O'Brien
Placer United Soccer Club
Directors of Coaching
"After our 12 year old daughter suffered a torn meniscus playing soccer, we were referred to Quinn McArthur for physical therapy/rehab. Quinn offered a wealth of experience and knowledge with regards to her injury, rehabilitation and future injury prevention. His expertise and guidance during her 6 weeks of rehabilitation were instrumental in her recovery.
Quinn offered on-field training to Jordan, which led to a confident recovery. Our experience working with Quinn went far beyond our expectations. We are grateful for his efforts in getting our daughter back on the field and for helping her develop proper techniques to prevent future injury."
Warren and Deidre Holt
"Quinn McArthur provided our daughter’s PT for an ACL injury before and after surgery in 2008. We spent 4-6 hours per week in his clinic for 4 weeks prior to surgery and 16 weeks post surgery. This traditional PT was followed by 16 weeks of soccer-specific training and injury prevention training.
Quinn has the unique ability to provide technical expertise in orthopedic rehabilitation and the unfailing personality to motivate young adults to reach their goals. Teen sports related injuries are a growing reality and Quinn’s technical skills and his own athletic experience provides for an unbelievable combination for rehabilitation. His “preventative” program is a must for all preteen and teenage athletes, especially girls. He breaks down running and jumping form and teaches teen’s proper body mechanics and balance while improving overall strength and speed.
Our daughter has better balance and technical form post surgery because of Quinn’s program. We would highly recommend Swanson McArthur Physical Therapy for complete sports medicine care."
Kelli Teeter
"An ACL injury is obviously a hard, stressful thing to recover from. Quinn immediately warned me of the obstacles I must overcome in order to heal and play the sports I loved. He was with me through thick & thin and always pushed me just enough to keep me focused and motivated. I was always comfortable asking him anything I did not understand.
Being hurt and having surgery is horrible but Quinn helped me get through it and now I can play all the sports I love in high school."
Megan Teeter
