How do injuries occur?
ACL injuries can happen from direct contact to the knee, but most often the injury happens in the absence of any direct impact on the knee. The usual description is a rotation of the femur over a fixed tibia when the knee is near full extension. During play, this could be when a player plants their foot and changes direction. A specific and complex sequence of events has to happen to tear the ACL. Most feel that if the knee is near extension and then collapses inwards, the ACL is placed under considerable strain and can tear. When it does tear, the athlete feels immediate pain and instability of the knee. They many even hear an audible ‘pop’ when it ruptures.
The Anterior Cruciate Ligament is extremely important to the competitive soccer athlete. This ligament controls rotational forces in the knee. If this ligament is torn, sudden changes in direction become nearly impossible. Prevention of injuries to the ACL should be part of every soccer-training regime.
For more information about the anatomy,causes, symptoms, diagnosis, treatment and rehabilitation of the ACL visit our online medical library. CLICK ON THE LINK
http://www.eorthopod.com/eorthopodV2/index.php?ID=c088f90d6f348c958e5eb9f3a5c5a117&disp_type =topic_detail&area=17&topic_ id=4224b24737b5599e345b42bb7d13df68Statistically, women soccer players are at a higher risk to tear an ACL. There are many theories as to why females are more at risk for this injury. Some of them include: a narrower notch width of the femoral head; the relative strength and muscle recruitment pattern of the hamstring muscles relative to the quads; high levels of estrogen; and, lack of proper training at a young age. Most experts believe that the incidence of ACL tears can be lowered by instituting some simple changes in the training of not only female athletes but all athletes.
General soccer training should be centered around a properly periodized strength, flexibility, and aerobic conditioning program. The program should be planned so that the soccer athlete progresses through specific phases of conditioning culminating in peak performance at the end of the sport season. The three basic cycles are: pre-season preparatory cycle; in-season cycle; and post-season cycle.
Coordination Improves Performance
Neuromuscular control of the knee during athletics is maintained by a complex interaction of the quadriceps and hamstring muscles. This includes both the muscles and the nerves that trigger the muscle contraction. Due to this non-contact ACL injuries may be a result of a breakdown in, or the lack of, the neuromuscular recruitment patterns necessary to prevent undue stress on the ACL.
The balance of power and the recruitment pattern of the quads and hamstrings have been shown to prevent ACL injuries. The quad muscles are an ACL antagonist, that is they place stress on the ACL when contracting. The hamstrings are an ACL agonist, removing ACL stress when contracting.
Due to this, if the hamstrings are excessively weak or inflexible they may not adequately protect the ACL during a strong quad contraction. Also, if the quad group is excessively strong, relative to the hamstrings, the ACL may be torn due to a lack of hamstring “protection.” ACL injury prevention should then focus on a balance in strength between the hamstrings and quads. It is recommended that the hamstrings should be 60 – 80% as strong as the quads. Also, proprioceptive exercises should be utilized to improve the neuromuscular recruitment patterns of the quads and hamstrings.
The off-season strength program should focus on the exercises that result in increased hamstring strength and flexibility as well as coordinative jumping exercises (plyometrics). During the first few weeks of training the emphasis should be on teaching proper jumping and landing techniques. The athletes should be taught to land on the balls of the feet with the knees flexed and the chest over the knees. They should be constantly reminded to avoid any excessive side-to-side or forward-to-back rocking of the knees upon landing. Valgus (inward) movement of the knee upon landing should also be discouraged. The athlete should also be taught how to land “softly.” This type of landing occurs when the athlete lands on the balls of the feet then rocks to the heels. Proper back posture should also be reinforced verbally.
Proper body mechanics are the goal in the early stages of this type of program. Emphasis on power and explosion should only be instituted after the athlete performs the jumps properly.
Weight room activities should focus on exercises that improve hamstring strength and coordinated firing with the quad muscle group. Examples of these types of exercises are: hamstring curls, squats, power cleans, and dead lift. As with the plyometric exercises, proper technique should be taught prior to increasing the load. Be sure that the athlete’s hamstrings are 60 – 80% as strong as the quad muscles. For example: If the athlete can perform a 1-leg knee extension with 100 pounds they should be able to do a 1-leg hamstring curl with 60 – 80 pounds.
TESTING, INJURY PREVENTION AND REHABILITATION:
HECTORPT SPORTS offers advanced neuromuscular and balance testing\training.
The Biodex Isokinetic machine measures quadriceps to hamstring ratio.
The Biodex Balance machine is used for single leg stability testing.
SUMMARY:
Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players participating in the game as on 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes a significant loss of time from competition in soccer.Lower extremity plyometrics, dynamic balance and strength, stretching, body awareness and decision-making, and targeted core and trunk control appear to be successful training components to reduce non-contact ACL injury risk factors (decrease landing forces, decrease varus/valgus moments, and increase effective muscle activation) and prevent non-contact ACL injuries in soccer players, especially in female athletes. Pre-season injury prevention combined with an in-season maintenance program may be advocated to prevent injuries.
A courtesy of HECTORPT SPORTS Rehabilitation Services of Clifton Park and Colonie NY.
www.hectorpt.com (518)577-5214
HECTORPT PHYSICAL THERAPY ALBANY 12205- HECTORPT PHYSICAL THERAPY, CLIFTON PARK NY 12065
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