Your average soccer player spends hours honing their craft on the field, developing their touch, bending free kicks into the upper 90 and running more than they ever want to admit.
To cancel all that work in one instant with a knee injury is a soul-crushing blow. Instead of racing down the sideline with your teammates, you’re spending days in physical therapy working hard to make a comeback.
Knee injuries can be one of the worst setbacks to a rising soccer star. Though nothing can absolutely remove injury risk, donating just as much time to strengthening and mobilizing the surrounding tissue can save you months of rehab down the line. We’ll focus here on non-contact injury prevention and general knee health.
According to research on the prevention of non-contact ACL injuries in soccer players, the risk factors include (1):
- Knee joint laxity
- Small and narrow intercondylar notch when compared to cross-section of ACL
- Pre-ovulatory phase of menstrual cycle in females
- Decreased hamstring strength/recruitment when compared to the quads
- Muscular fatigue and altered neuromuscular control
- Decreased core strength and proprioception
- Low trunk, hip and knee flexion angles
- Lateral trunk displacement/hip adduction combines with hip internal rotation and tibial external rotation
So what do we do about reducing that risk? Strengthen, lengthen and train off the field. In a protocol implemented with the Premier league, the top five preventative exercises used by clubs were “eccentric exercise, balance/proprioception, hamstring eccentric, core stability and … Nordic hamstring and gluteus activation.”
Glute strength and dynamic hip stability
First up: We address glute strength, or lack thereof. Neglected glutes stem from overusing the quads, hamstrings, calves or adductors. Tight adductors and weak glutes equate to hip adduction and internal rotation, something we’ve identified already as a risk factor for a knee injury. You have to train your glutes specifically to withstand the force of these muscles and keep your body performing. The first and most important adaptation, however, is neuromuscular control. Prehab with glute activation exercises cues a preferential firing in proper order. Glutes first, then hamstrings, quads, etc., as needed. Your glutes keep your pelvis and femur in a stable position for all activity, and therefore they become the most important.
- Side Lying Clams
- 4-Way Hip
- Band X Walks
- Knee stabilization through movement
Dynamic knee valgus (knees collapsing inward) under stress is a strong predictor of knee injury. Loading different knee, trunk and hip angles safely requires stable knee to hip tracking. Hip internal rotation combined with tibial external rotation usually means trouble. So how do we keep soccer players safe? Single-leg balance training has been shown to decrease deviation from midline over time. But standing on top of a physioball doing tricks isn’t the way to do it. Add movements that you actually encounter. Challenge yourself to rotate or move your torso while keeping your knee and ankle position stable, as in when kicking, landing from a jump or cutting.
- Single-Leg Balance with Reach
- Curtsy Lunge (3)
- Skater’s Squat
Hamstring strength and recruitment
Research has indicated that a higher quad-to-hamstring power production ratio increased injury risk. Therefore, maintaining hamstring-specific strength is critical, especially when lots of lower-body movements are quad dominant, especially in soccer. Not to mention, most passes involve the groin and hip adduction. Add to this repetitive use the strain of extended running, and you have a recipe for an overworked anterior chain. For injury prevention, balance that ratio out with equal mobility in the hips, strength and glute/hamstring recruitment. Muscle fibers create a sort of reflex that can save a joint from slipping out of place. The more trained your body becomes in recruitment, the more responsive it’ll be.
1. Trap Bar Deadlift
The Trap Bar Deadlift is by far my favorite strength training exercise for athletes. It keeps athletes upright transferring the focus to the legs and away from the lower back. Yet the entire back and core must stay contracted to keep the spine stable as the weight is lifted. Many might argue that this transfers the focus away from the hamstrings, but I find soccer players particularly ask their hamstrings to load on a stretch quite often with kicking and sprinting. Additionally, the conventional Deadlift is really hard to get right. It usually takes extra coaching and a careful eye to properly load at the hips, and the injury risk outweighs the benefits. Rather than spend extra hours in the gym, prehab with some of the above exercises. Super setting or pre-exhausting with nordics works as well. That way, you can keep the focus on the backside of the body while still training safely.
2. Nordic Hamstring Curls
Nordic Hamstring Curls should be a staple of any athletic training program. The research on their prevention of hamstring strains alone is enough to warrant their inclusion for soccer. But their benefits extend beyond loading eccentrically. Hamstring activity has been shown to be highest in Nordic Curls when compared to other exercises such as the Stiff-Leg Deadlift and Good Morning. For soccer specifically, eccentric muscular endurance can keep the knee in a stable position in the 89th minute of a game. And no other exercise has been proven to provide that stress adaptation like the Nordic curl.
Neuromuscular control and displacement
Finally, we need to address neuromuscular control. Especially under fatigue, running, cutting and kicking require immediate adjustments on the fly to keep joints stable. Plyometric and balance training have been shown to decrease deviation from the center in landing mechanics. A quick reflex response and neuromuscular control develops through acceleration and deceleration training. Just like improvements in dribbling skill transfer to games, so does practiced movement. The more efficiently you can move, and the more consistently you can do it, the better chance you have of staying healthy.
- Depth Drops
- Lateral SL Hop and Stick
- Hurdle Crossovers to Sprint
1. Alentorn-Geli, E., Myer, G. D., Silvers, H. J., Samitier, G., Romero, D., Lázaro-Haro, C., & Cugat, R. (2009, May 19). “Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors.” Retrieved July 27, 2017, from https://link.springer.com/article/10.1007/s00167-009-0813-1
2. McCall, A., Carling, C., Nedelec, M., Davison, M., Le, F., Berthoin, S., & Dupont, G. (2014, September). “Risk factors, testing and preventative strategies for non-contact injuries in professional football: current perceptions and practices of 44 teams from various premier leagues.” Retrieved July 27, 2017, from http://www.ncbi.nlm.nih.gov/pubmed/24837243
3. Martinsson, N. (n.d.). “Effects of two different strength-training methods to improve adolescents’ physical soccer performance.” Retrieved from http://www.diva-portal.org/smash/get/diva2:917245/FULLTEXT01.pdf
4. Ebben, W. P. (2009, March). “Hamstring activation during lower body resistance training exercises.” Retrieved July 27, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/19417230
5. Small, K., McNaughton, L., Greig, M., & Lovell, R. (2009, July). “Effect of timing of eccentric hamstring strengthening exercises during soccer training: implications for muscle fatiguability.” Retrieved July 27, 2017, from http://www.ncbi.nlm.nih.gov/pubmed/19528859
6. Myer, G. D., Ford, K. R., Brent, J. L., & Hewett, T. E. (2006). “The Effects of Plyometric vs. Dynamic Stabilization and Balance Training on Power, Balance, and Landing Force in Female Athletes.” The Journal of Strength and Conditioning Research, 20(2), 345. doi:10.1519/r-17955.1
7. Hewitt, T., PhD, Lindenfield, T., MD, Riccobene, J., & Noyes, F., MD. (n.d.). “The Effect of Neuromuscular Training on the Incidence of Knee Injury in Female Athletes.” Retrieved July 27, 2017, from http://journals.sagepub.com/doi/abs/10.1177/03635465990270060301