June 17th 2004

Basic Prevention Techniques to Reduce Soccer Injuries

By Rich Bomgardner, CSCS, ATC

Since 1999, the US Consumer Product Safety Commission has estimated that there have been approximately 876,364 soccer-related injuries reported in emergency rooms, hospitals, and physician offices or clinics1. Soccer is one of the fastest growing competitive sports today with age groups competing from youth to college and beyond. Along with this rapid growth comes an increase in injury potential, due to the greater number of participants.
Table 1. Common Soccer Injuries
Lower Leg Injuries Knee/Patella Injuries Muscle Injuries
Lateral Ankle Sprains Anterior Cruciate Ligament Quadricep Strain
Medial Ankle Sprains Medial Collateral Ligament Hamstring Strain
Syndesmotic Sprains Meniscus Groin Strain
Compartment Syndrome Chondromalacia Hip Flexor Strain
Shin Splints Patellofemoral Syndrome Contusions

The major areas of injury are centered on the lower extremity (see table 1). Injuries to the lower extremity occur through a variety of mechanisms, but are considered to be either acute or chronic. Most acute injuries result from joint rotation, twisting, direct impact, or dynamic overload of the muscle. These injuries are normally either related to the joint, such as ankle sprains, knee sprains, and meniscus injuries, or to the muscle in the form of strains and contusions.

Muscle strains are produced by a variety of reasons including forceful contractions, spontaneous contractions due to explosive movements, and improper warm-up of the body. Muscle strains are generally high during the first 2 – 3 weeks of the season. However, these numbers should decline as the season progresses. If the team is experiencing a high volume of strains after the initial period, the injury issues can often be attributed to improper warm-up, flexibility, and/or conditioning exercises.

Chronic injuries occur through stress or overuse in which there is a fatigue factor involved within the specific area. Chronic lower leg injuries can involve the shin, calf, and knee. The main focal point for prevention of soccer-related injuries must address both acute and chronic conditions. Obviously, conditioning has an influence on chronic injuries; however, chronic injuries do not develop when the athlete just gets tired. These chronic injuries occur as a result of muscle and joint stress and overuse.

The focus of injury prevention should be concentrated on developing flexibility and muscular strength, and performing functional movements. Inadequate flexibility usually results in a high volume of muscle strains. Muscle strains are due to a variety of reasons; however, most muscle strains occur during the initial pre-season training (e.g., two-a-day practices). Even though deficits in muscle strength predispose an athlete to muscle strains, joint sprains can transpire because the athlete does not have enough strength to withstand the induced trauma. Functional exercises enable the athlete to adjust to the agility stresses during activity. An athlete needs to have an awareness of the body in relation to uneven surfaces, changes in direction, and resistance against motion.
Flexibility and Warm-up

Perhaps one of the most important prevention techniques is directly related to warm-up and flexibility. Proper warm-up is essential to prevent muscular injury. The priority of the warm-up is to increase the body temperature, heart rate, blood flow, deep muscle temperature, respiration rate, and perspiration by way of light activity before beginning the flexibility period2.

The warm-up generally consists of two types: general and specific. The general warm-up period involves slow jogging, jumping rope, bicycle riding, etc. for 5 – 10 minutes. This period prepares the athlete for the flexibility session. The specific warm-up period involves movements that mimic the athleteÕs sport. Specific movements for soccer involve dribbling, passing, and shooting activities.

Flexibility concerns are related to general stretching of the individual muscles, or groups of muscles. Exercise needs to encourage increasing flexibility through either static (general) or dynamic (specific) stretches. Static stretching is a slow stretch that uses the body weight or light muscle tension to passively stretch the muscle. A slow stretch needs to be held for 20 – 30 seconds to maximize the full effect. Static stretching exercises should cover overall flexibility of the major muscle groups in the lower body. These include the quadriceps, hamstrings, gluteus maximus, calf, groin, and hip. This program should last approximately 10 – 15 minutes.

Dynamic stretching involves flexibility during sport-specific movements. The development of a solid flexibility and warm-up program begins with a basic progression to prepare for physical activity. These exercises should be a part of the daily pre-practice routine. Table 2 represents a basic flexibility and warm-up program.
Table 2. Warm-up and Flexibility Exercises
General Warm-up Static Stretching Dynamic Stretching Specific Warm-up
Jogging Quadriceps Long walking strides Shooting
Jump rope Hamstrings Long walking carioca strides Passing
Bicycle riding Groin High knee strides Dribbling
Hip High knee skips
Calf High knee w/leg extensions
Butt kicks
Squat weave

The warm-up period begins with a general warm-up session for 5 – 10 minutes. This is followed by static stretching to isolate the individual muscle or muscle groups for 10 – 15 minutes. Dynamic stretching exercises range from 20 – 30 yards, and should be repeated 2 – 3 times at a mild/moderate pace. Begin the exercises slowly, increasing intensity as the warm-up continues. The following are explanations of some dynamic stretching exercises:

* Long walking strides—long walking strides to emphasize stretching the hip and groin
* Long carioca strides—long carioca strides to emphasize stretching the hip and groin
* High knee strides—emphasize elevating knee up while walking
* High knee skips—emphasize elevating knee while skipping
* High knee with leg extension—emphasize extending the leg while elevating knee
* Heel kicks—alternate kicking heel to the gluteus maximus in rapid succession
* Squat weave—squat low and move side to side to emphasize the groin, hamstring, and hip movements

Finally, specific warm-up exercises include shooting, passing, and dribbling skills associated with soccer. With a little imagination, these exercises can provide a comprehensive warm-up for the lower body.
Muscular Strength

Muscular strength can be divided into three areas: lower leg, knee, and hip. Lower leg exercises concentrate on developing the muscular strength to support the ankle joint as well as the general strength of the lower leg. Muscular strength to support the knee and hip joints needs to concentrate on the quadriceps and hamstrings, with particular attention to the hamstrings. Hamstring strength should be approximately 70% of the strength of the quadriceps. The hamstring/quadriceps ratio is an important factor in injury prevention. Functional exercises employ the use of the entire lower extremity as a single unit. These exercises develop the functional aspects of the hip, knee, and ankle.

The emphasis is to increase muscular strength, not muscle size. Soccer athletes do not need to possess great muscular size to be effective. Furthermore, too much muscular size can predispose an athlete to injury due to inflexibility, limited range of motion, or decreased functional agility.

Table 3 outlines exercises for the lower leg, knee/hip, functional, and multi-joint exercises. Lower leg, knee, and hip exercises isolate each specific region respectively. Functional exercises assist to expand on the functional aspect of the lower body. Multi-joint exercises incorporate the actions of the large lower extremity muscle groups.
Table 3. Strength Training Exercises
Lower Leg Knee/Hip Functional Multi-Joint
Calf raises Leg curl Step-ups forward Dead lift
Single leg squat Leg extension Step-ups lateral crossover Hang clean
Ankle inversion Hip flexion Reach lunge Push press
Ankle eversion Hip extension Side step shuffle Squat
Ankle dorsiflexion Hip abduction Single leg squat
Ankle plantarflexion Hip adduction Co-contractions
An explanation of the strength and functional exercises are as follows:

Lower Leg: 2 – 3 sets, 12 – 15 repetitions, 2 – 3 minutes recovery between sets

* Calf raises—seated or standing. (figure 1)
* Single leg squat—dumbbell squat with single leg. (figure 2)
* Ankle exercises (inversion, eversion, dorsiflexion, and plantar flexion)—resistance bands or cuff weights. (figures 3, 4, 5, & 6)

Knee/Hip: 2 – 3 sets, 12 – 15 repetitions, 2 – 3 minutes recovery between sets

* Leg curl—lying position.
* Leg extension—seated position.
* Hip exercises (flexion, extension, abduction, and adduction)—resistance bands or cuff weights (figures 7, 8, 9, & 10)

Functional Exercises: 2 – 3 sets, 12 – 15 reps, 3 – 5 minutes recovery between sets

* Step-ups forward—Step up onto a box 10 – 15 inches in height, alternate lead foot each repetition.(figure 11)
* Step-ups lateral cross over—Standing beside the box, step up and cross over with outside leg. Alternate lead foot each repetition. (figure 12)
* Reach lunge—Lunge forward while reaching with a medicine ball. Alternate lead foot and lunge angle with each repetition. (figure 13)
* Side shuffle—resistance bands around both legs and shuffle in lateral direction. (figure 14)
* Co-contraction—resistance band around waist and shuffle, cross step, or carioca in half circle. (figure 15)

Multi-joint: 2 – 3 sets, 12 – 15 reps, 3 – 5 minutes recovery between sets

* Dead lift—holding weight at hip level, bend at the waist and lower weight until it almost touches the floor, then return the weight to hip level.
* Hang clean—holding weight at hip level in front of the body, squat a few degrees, then pull weight to chin and rotate hands from top of weight to bottom of weight (now weight rests at shoulder level). Return to starting position.
* Push press—hold weight at shoulder level, squat down a few degrees, then explode up with the legs (like a jump) and push the weight over the shoulders (like a shoulder press).
* Squat—regular back squat procedure.

Prevention of soccer injuries begins with a comprehensive strength and conditioning program. The emphasis is to increase the strength and functional capacities of the lower extremity, not to develop muscle girth. Prevention must continually be addressed within the strength and conditioning program. The main objective is to decrease the number of injuries from reoccurring year after year. Therefore, a comprehensive program needs to be incorporated to develop all aspects that serve as prevention components.
References

1. U.S. Consumer Product Safety Commission. (2004). National Electronic Injury Surveillance System. Washington, DC: National Injury information Clearing House.
2. Baechle TR, Earle RW (Eds.). (2004). Essentials of Strength Training and Conditioning (2nd ed.). Champaign, IL: Human Kinetics.

"This article originally appeared in NSCA's Performance Training Journal, a publication of the National Strength and Conditioning Association. For a free subscription to the journal, browse to www.nsca-lift.org/perform."

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