When the Game is Taken Away: Training Smarter, Not Harder

Disclaimer: The following is for educational purposes only and every athlete will be a little different. My best advice is to work under the supervision of a reputable professional especially when it comes to age –appropriate strength training. If done right, it is a powerful training tool. If done wrong, you can get injured…while trying to prevent getting injured.

Part 3 of a 3-Part Series on Youth Injuries Sports Injuries.
Click here for Part I.
Click here for Part II.

What are specific things soccer players can do to help prevent injuries? Ironically, many of the same things that will help them become better athletes in general.

Train the muscles you CAN’T see when you look in the mirror.
Think about that the next time you walk into a gym and survey what the clientele is doing. One day, I counted 19 people in the free weight area of the gym…12 doing bicep curls, 3 bench pressing, leaving 4 working on non-mirror muscles. Athletes need to work their Posterior Chain (back of their body) which means most of your time should be spent on strengthening, back muscles, glutes, hip abductors, hip external rotators (females especially), and hamstrings. You need balance among muscle groups on each side of your body; muscles don’t work in isolation and one side will affect the performance of the other.

√ Soccer players, especially female soccer players, are most often quad (thigh muscle) dominant.  Soccer players do enough sprinting and kicking to keep your quads plenty strong. In fact, most females move in such a fashion that they keep their quads strong and their posterior chain weak – remember the body will find the path to least resistance even if this means muscle imbalance. The majority of females run, backpedal, shuffle, and land jumps very upright- because their quads are strong and their glutes and hamstrings are weak. It is difficult for them to stay low in a flexed posture.  As a result the hamstring is too weak and in a poor position to help protect the ACL and glutes have a hard time helping the hamstrings and hip flexors. Common results: ACL tears, hamstring pulls, and the infamous quad/hip flexor strains.

√ All the time we spend sitting at desks and sitting at home encourages a pattern of tight chest muscles (rounded shoulders and forward head) and tight hip flexors while stretching out and inhibiting the back side of our body and the muscles key to producing (and more importantly absorbing) force. A lot of athletes complain of low back pain and tight hamstrings – it is usually a result of tight/overpowering hip flexors pulling the pelvis into an anterior pelvic tilt placing more stress on the low back and greater tension on their hamstrings. Often times, the hamstring aren’t that tight, your posture is just asking them to be longer than normal. This imbalance between the front and back often shuts off muscles on the back side of the body and compensations develop. In much the same way,  you need to train balance in muscles that pull toward the body’s midline (groin) and pull away from midline (hip abductors). Muscles that pull toward the midline are often disproportionately stronger.

√ Weak hips = painful knees. This is a big one for female athletes. As I stated in the previous article, the knee is the slave to the joints above and below it – the ankle and hips. If you want to reduce injuries to the knees  – spend extra time strengthening the hip extensors, hip abductors and hip external rotators to keep knees out of the dreaded knocked knee/inward collapsing posture.

Posterior Chain Exercises: Box Squats, Deadlifts, Lunges, Bridges, Hip Extension, Glute-Ham Raises, Russian Hamstrings, to name a few of the better ones.  Some can cause significant injury if you don’t know what you are doing (i.e. Deadlifts especially), so proceed with care.

Train with your feet on the ground whenever possible and incorporate single leg training into your strengthening program. Your body has to get used to moving in a manner that is consistent with the demands you will place upon it in competition and one that involves the influence of gravity.

√ I have yet to see a soccer game being played while sitting in a machine or laying on your back pushing a weighted platform away from you. However, I have seen plenty of soccer games where players need to run, jump, and cut with their feet on the ground and with external challenges to their upper body. Get out of the machines and get into ground-based strengthening. Less leg press, leg curls, leg extension, hip abduction/adduction machines and more deadlifts, squats, cleans, step ups, lunges, and the like. Remember the posterior chain.

√ Your core (basically the middle 1/3 of your body, NOT just your abs) is absolutely essential in moving effectively in terms of both athletic performance and injury prevention and ground-based training promotes core stability. A strong/stable core allows force to be transferred efficiently into ground or object (soccer ball) and allows the body to absorb force placed upon it.

√ To make things even more realistic, incorporate single leg ground-based training into your program. (Example: single leg squats, single leg deadlifts, lunges, split stance activities.) The majority of the game is spent on one leg, you can hide a lot of deficiencies when you have the help of another leg (especially hip weakness). Get single leg work in to help ensure legs are as balanced as possible. Both double and single leg activities have their place in a strengthening program; make use of both.

Train to absorb force as much as produce force: Injuries usually happen as a result of inability to decelerate the body or control the deceleration of the body.

√ Plyometric/Jump Training – I tell the athletes in both my injury prevention programs and in formal ACL rehab that the goal is to learn to land jumps like a ninja or a cat (or a combo) – as quietly as possible. Landing jumps with the ankles/knees/hips flexed allows the muscles to absorb force and save ligaments and bones. The quieter the landing, the better your force absorption.  Start with both feet and progressing to single leg jumping and jumping in a variety of directions.

√ Single leg exercises – as mentioned before, the sport of soccer places high demand on one leg at a time, especially for high speed cutting and changing of direction.  Focus on the eccentric phase of single leg exercises, working to slow down against gravity while maintaining good knee position. (Control of the lowering phase of a single leg squat without letting the knee cave in toward midline, for example.)

√ Core training – Weak core = force goes places other than where it is intended= injuries and poor performance. Not to beat the car analogy to death but there is a reason why Indy Car pit crews make sure the lug nuts are ridiculously tight before sending the car out on the track. The car runs more efficiently and a wheel isn’t going to fly off causing the car to go into the wall.

Train balance, literally. More and more studies are tying poor balance to higher risk of injury (up to 6.5 times greater risk in some studies). You CAN improve balance if you work at it. Balance training requires muscles on multiple sides of a joint to work together and encourages better joint awareness so when the joint gets in a compromising position it can recruit the right muscles to correct and protect itself – especially with respect to knees and ankles. How do you improve balance?

√ Single leg activities, both strengthening activities and plyometric work – focus on good joint position (don’t let those knees wander inward) and controlled landings.

√ Incorporate unstable surfaces into your training environment – warm up for squats by doing body weight squats on a tilt board or balance on one leg on a bosu ball with your eyes closed, the possibilities are endless. I do so much unstable surface work with my ACL rehabs I joke they could join a circus to pay for college if the soccer doesn’t pan out.

√ Incorporate challenges to the upper body in the training environment (Med ball tosses, someone providing a challenge to your balance/nudging you, uneven load of weights, holding weight away from one side of body, etc…)

√ Take away your vision – we rely so much on our eyes that we often neglect to let our joints tell us where we are space. Something as simple as standing on one leg with your eyes closed will force the body to get information from a different source– then combine it with some of the other components above.

1620 MINUTES = 27 HOURS
That is the amount of time that my U18 team works each year on injury prevention/reduction. That is roughly 15 minutes each practice. When do we get it in? It’s their warm-up. Why do we do it? It gets them warmed up and it’s effective for reducing injury– more on that later. We kill two birds with one stone. Is it going to stop every kid from getting hurt? No. If I can stop one additional player from going through an ACL injury it is worth it in my book not to mention it is going to help with other issues (groin pulls, hamstring and quads issues, ankle sprains). This is what they do:

• They spend 3-4 minutes getting their core temp raised while moving through an agility ladder in addition to working on cutting, accelerating, decelerating movements.
• They spend 2-3 minutes moving through a series of dynamic movements for the purpose of mobility/stretching/and turning on muscles.
• They spend 1-2 minutes working on landing jumps and hops in multiple planes with focus on form.
• They spend 1-2 minutes on ankle strength/proprioception while getting in some time with the ball.
• They finish up with 1 minute working on posterior chain strength.
• And they still have 2-3 minutes to talk their neighbor’s ear off about what happened at school that day – which is essential if you want them to pay attention the rest of practice.

It took 20-30 minutes to teach them the first day and a lot of attention to their form the first couple of weeks. They are pretty much on autopilot with it now, but it does require me to keep an eye on the quality of what they are doing so it doesn’t become sloppy and useless. If the quality is poor, they are just reinforcing poor movements and defeating the purpose.

INJURY REDUCTION PROGRAMS
The current research supports the effectiveness of a number of ACL preventative programs. There are about 9 different studies that show they work and with different levels of effectiveness up to 88% reduction in the risk of knee injuries. Does that mean it is going to prevent every ACL injury from happening? No. But it is a tool that needs to be in the tool box.

Mike Boyle is a highly regarded strength/performance coach out of Boston who trained the New England Revolution (MLS) from 1998-2000, the Boston Breakers (WPS) from 2000-2003, and the US Women’s National Team for the 2004 Olympics. In his time with those teams, there were no ACL injuries; this is virtually unheard of especially in working with the highly competitive women’s teams for as long as he did. Why? He incorporates much of what has been stated above into his training.  In fact, he says ACL injury reduction training is “just good training” meaning if you train right (and trained by someone who really knows what they doing) your athletes shouldn’t be getting injured. Side note: Boyle is also a pretty adamant critic of sport specialization in young athletes. This is coming from someone who trains some of the best collegiate and professional athletes on a daily basis.

Mike Boyle-like dedicated strength training isn’t realistic for everyone simply because of time and money. Another valuable option is to look into dedicated injury prevention programs in a group setting or at the very least, build it into your warm-up. It isn’t as comprehensive as dedicated strength training, but research shows it is effective. The program cited above that had an 88% reduction rate was a 15 minute program used as a warm-up 2-3 times weekly. A number of similar programs had reduction rates over 70%.

MULTISPORT ATHLETES
Lastly, in an age of sport specialization, sport training programs for babies (wish I was kidding), and year-round play, the multisport athlete has gotten lost. Quite simply, cross training is one of the best ways to stay healthy, provided the athlete is also getting adequate rest. Mixing up movement patterns and training other muscles is definitely a good thing. Yet, more kids are dropping sports earlier and earlier to specialize in one sport. Too many parents and athletes are concerned they going to get passed up if they aren’t getting touches on a ball every day of the week, aren’t hiring the outside technical trainer, aren’t guest playing on the older team, aren’t playing in yet another league, and not signing up for the next camp.

As a coach, I value high performing soccer teams/players and I understand that you aren’t going to get better at soccer sitting on your couch or playing the flute. However, I think the pendulum has swung excessively to one side. There needs to be more balance – or at least SOME balance. Players aren’t going to deteriorate simply because they aren’t playing soccer 24/7. Don’t discourage the multisport athlete; there are ways to make it work. This year’s Minnesota State High School Soccer Coaches Association’s Ms. Soccer, Taylor Uhl, is an outstanding basketball and lacrosse player. Last year’s  Ms. Soccer, Kassey Kallman, was quite the basketball player at Woodbury High School for four years. One will go on to play soccer with the Gophers next season, the other had the most minutes played at Florida State and was a Freshman All-American this past fall. They didn’t fall off a cliff because they weren’t playing soccer every waking minute of their adolescence; quite the opposite in fact.

Keys to keeping young athletes in the game:
Be careful not to confuse getting tired with getting better.
Place value on quality, even when it sacrifices quantity.
Tune up the car more so it crashes less.
Breaks are good, variety is better.
TRAIN SMARTER.

About the Author: Julie Eibensteiner PT, DPT, CSCS is a physical therapist and owner of Laurus Athletic Rehab and Performance LLC, an independently owned practice specializing in ACL rehab and prevention in competitive athletes. In addition to being a regular contributor to IMS on topics of sport injury and prevention, Eibensteiner holds an USSF A License, coaches a U18G MRL team for Eden Prairie Soccer Club, and assists with the Men’s and Women’s soccer programs at Macalester College.