How to reduce the risk of football injuries with specific strength and conditioning

As many people already know, and may have experienced, there’s always going to be a risk of getting injured when you play sport. The most common injuries in the most popular sport in the world are all in the lower limb - anterior cruciate ligament (ACL) injury, ankle sprain, hamstring strain and groin strain. 

Have you got knee pain or ankle pain and need help with treatment and a specific rehabilitation plan? Click here to book your session now (online appointments also available). 

We are all aware that a structured progressive warm up that includes specific strengthening, DYNAMIC stretching (because static stretching before exercise has been shown to decrease muscular performance), changing directions and plyometrics reduces the risk of injuries. See here for examples of some specific warm up routines. Acquiring enough recovery and sleep, eating the right foods and concentrating on nutrition can improve performance. Also wearing the right protective gear and doing a proper cool down will all help towards reducing the risk of injuries. 

But why these specific injuries? Good question. It all comes down to this:

Can the body manage the load and forces of the specific movement patterns associated with football?

Has the body acquired the ability to move effectively as an integrated system by acquiring good neuromuscular control?

It is well known that strength training reduces the risk of injuries. A randomized study from The Journal of Strength and Conditioning Research by Zouita et al (2016) examined the effect of strength training on physical fitness and injury occurrence in 52 young elite soccer players. They were divided into two groups: experimental and control group (no strength training). The experimental group took part in 2-3 90-minute strength training sessions over 12 weeks (separated by 1-week recovery). The physical fitness parameters were sprint tests and jumping tests. The injury rates were recorded throughout the season. The experimental group performed significantly better in sprint running and there were also improvements in jumping tests compared to the control group. 17 injuries were recorded over the season, 13 from the control group and 4 from the experimental group. This shows that strength training not only reduced the risk of injuries, but induced performance improvement.

Strength and conditioning (S & C) that is sport specific is great for reducing the risk of injuries and improving football performance no matter what the age of the individual. S & C focuses on movement quality to improve performance. It’s about developing better movement patterns to reduce the risk of injury and therefore improving performance e.g. strikers being able to shoot with more power or accuracy, a midfielder with better passing accuracy, a goalkeeper with better reflexes in order to save a shot.

In this article there are plenty of studies (here if you want to see them) to show that a specific type of strength training provides a greater effect for reducing the risk of injuries, it’s called eccentric training. An eccentric muscle action is an overall lengthening of a muscle as it develops tension and contracts to control motion performed by an outside force. An example is the lowering phase of a deadlift or a calf/ heel raise (shown below). 

There are some studies from the aforementioned article on how football players with functional asymmetries between the quads and hamstrings can also possess a higher risk of injuries too. It isn’t just the hamstrings getting injured due to lack of eccentric strength and nordics can be useful in a S & C programme, the quads also are susceptible to injury if there is insufficient flexibility in the muscle group. Here are some exercises to help rectify this:

S & C is not only about weight training. To get the best out of S & C, a good coach will use most methods. For example speed and agility, plyometrics, core stability, mobility, balance and proprioception, and endurance. Here are some other benefits of getting a S & C coach. Check out an example of some plyometric hops: 

One method of training that often gets forgotten is proprioception. Proprioception is the awareness and position in the body. This can be worked on with specific exercises and balance work which greatly helps people become in tune with their bodies and reduce the risk of injuries. Here is an example of this type of training:

Álvaro Cristian Huerta Ojeda, et al (2019) concluded that it was not just a proprioceptive training programme that reduced the risk of injuries in football players but other programmes such as strength training, neuromuscular training, balance training and postural control training. Therefore the coach needs to ensure they are including very specific movements for the player to get them prepared for events such as hopping over a player to prevent from being tackled, changing direction quickly to confuse the opposition and having the ability to land efficiently from heading the ball but being shrugged by an opponent. The more specific the training, the more it will improve the player’s movement patterns to reduce the risk of injury because the player will have remembered that specific movement pattern and understand how to function and move better. 

Neuromuscular training is used to improve the nervous system's ability to generate a fast and optimal muscle firing pattern, to increase dynamic joint stability, to decrease joint forces and to relearn movement patterns and skills. The goal is to achieve a state of "readiness" of muscles to respond to joint forces resulting in enhanced motor control. It focuses on performing exercises that train the muscles and nerves to react and communicate better with each other so that the body can perform movement patterns and skills with biomechanical efficiency. It must include specific exercises to target the muscular and neural components of movement. Knowing how to land well from jumping with help reduce the risk of an ACL injury. It should include balance, agility, plyometrics, perturbation training and football specific movement patterns and should be implemented into football training sessions. Here The Total Player have demonstrated some multi-planar movements:

A paper from the Journal of Orthopaedic & Sports Physical Therapy gives a few exercise examples: the Star Exercise and Balance Reach Arm and Leg. We have teamed up with The Total Player who has kindly demonstrated these exercises below. 

Fitzgerald et al (2000) studied 26 patients with ACL rupture. The patients were randomly assigned to a standard rehabilitation programme with or without perturbation training exercises. Adding the perturbation exercises in reduced the risk of continued episodes of the knee giving way during sporting activities and maintained knee function at the 6 month follow up compared to the group who didn't perform the perturbation exercises. Here are some examples of Perturbation training:

Another question often asked after an injury, especially ACL injury is whether or not surgery is needed to be able to play sport again. Well a study done by Ihara and Kawano in 2017 found that around 80% of 102 individuals with an ACL rupture healed without surgery and just did rehabilitation only. 

To summarise:

• Dynamic stretching in a warm up is better for reducing the risk of injuries. Static stretching before exercise has been shown to decrease muscular performance.
• Acquiring enough sleep, recovery and adequate nutrition can all contribute to improved performance and thus decrease risk of injuries.
• Strength training, specifically eccentric strength training has been shown to reduce the risk of injuries. 
• Football players with functional asymmetries in the quads and hamstrings possess a greater risk of injuries - a lack of eccentric strength in the hamstrings and insufficient flexibility in the quads.
• An S & C coach will use all methods in their training programme - strength, agility, speed, plyometrics, balance & proprioception, neuromuscular training, core stability, endurance and flexibility. 
• Neuromuscular training is used to improve the nervous system's ability to generate a fast and optimal muscle firing pattern, to increase dynamic joint stability, to decrease joint forces and to relearn movement patterns and skills.
• Training the athlete in restoring or improve reaction times is referred to as perturbation training. Balance is a conscious effort to hold a position without falling.
• Surgery is not always needed to return to sport following a complete rupture of the ACL. 80% of 102 individuals healed with rehabilitation alone.

 References

https://www.footballscience.net/special-topics/injury-prevention/

https://www.footballscience.net/training/

Fitzgerald GK, Axe MJ, Snyder-Mackler L. (2000). The efficacy of perturbation training in nonoperative anterior cruciate ligament rehabilitation programs for physical active individuals. Journal of Physical Therapy in Sport. 80 (2):128-140

Ihara, H & Kawano T. (2017). Influence of Age on Healing Capacity of Acute Tears of the Anterior Cruciate Ligament Based on Magnetic Resonance Imaging Assessment. Journal of Computer Assisted Tomography. 41 (2), 206.

Kirkendale DT, Junge A, Dvorak J. (2010). Prevention of Football Injuries. Asian Journal of Sports Medicine. 1 (2): 81-92.

Zouita S, Amira Zouita B-M, Kebsi W, Dupont G, Ben Abderrarhman A, Ben Salah FZ, Zouhal H. (2016). Strength training reduces injury rate in elite young soccer players during one season. The Journal of Strength and Conditioning Research. 00 (0):13.