Injury Prevention in the World’s Sport: It’s All in the Hips.
Well folks, our World Cup fever has officially broken with the end of the tournament and Spain claiming victory. But our love for the game simmers on, and hopefully more than a few of us are inspired to continue to play.
We know from the tournament that a team’s ability to win depends on the strength, endurance, and cohesion of the players on the pitch. And surely the risk of a loss exponentially increases the moment a player goes (truly) down. So how do these athletes best prepare their bodies for that awkward landing, that slippery pitch, or that foul they didn’t see coming? I’ll tell you: it’s not about keeping your head level, or keeping your foot on the ground. It’s all in the hips - and the ability to keep the core stable and the glutes engaged, whether you’re expecting the next impact or not.
When the fans see a player go down, we’re often wondering if they tweaked their ankle, pulled their hamstring, or got cramp in their calf. And sure - these things happen with planting on an uneven pitch, reaching a little too far in an all-out sprint, or exploding up for the header. But when we’re talking prevention, this local PT, mom, and boys’ rec soccer coach wants you to focus on the injury that’s most likely and most impactful: and in fútbol, that’s a torn ACL (anterior cruciate ligament).
The ACL is a ligament deep in the center of the knee that prevents the tibia (or shin bone) from moving too far forward in the knee joint, past the femur (thigh bone) and the patella (knee cap). It’s the strongest stabilizer within the knee joint. And without one? The knee is inherently less stable, and all the muscles around the knee and hip must work harder to protect further injury to the joint - whether that comes from another sudden impact, or the repetition of everyday walking. The good news is that these muscles can learn to compensate for the knee’s new-found instability, but only to a certain extent. Can someone without an ACL return to their daily joys of hiking and biking? Absolutely. Can a college athlete looking to go pro maintain her level of play after a tear? That’s less likely.
A torn ACL can end fútboler’s career before it really has a chance to begin. Most ACL tears occur in athletes < 25 years of age, with college athletes statistically more likely to get injured than high school athletes. It takes 8-12 months after ACL reconstruction to return to sport, and while 78% of athletes do return, only 50% are able to return to their prior level of play. There’s life-long impacts of this too: ACL reconstruction increases the risk of knee arthritis and need for knee replacement by 35%. All that to say: it doesn’t really matter what your age, your sport experience, or your level of competition is. If you’re on the pitch, it’s a good idea to engage at least a warm up, if not some cross training, for injury prevention.
While most of fútbol is running forward from one end the pitch to the other, a dynamic multi-directional warm up is critical to get all your stabilizing muscles engaged and ready for the match. The FIFA 11+ is a great example of this, and is considered the gold standard dynamic warm up, recommended for players from youth recreational leagues up to the pros. It contains all the critical needs: moving laterally, rotationally, backward, on one leg, and responding to external impact. Engaging these motions wakes up your glutes - the muscles that stabilize the femur, controlling the angle of the knee and thereby limiting the torque and force placed on it during play. Your glutes hold your femur in line, preventing it from falling or rotating in toward your midline and keeping your knee pointed straight ahead. Without the glutes engaged, the femur will shift inward and place increased stress on the inside of the knee joint. If this motion happens at the same time that your knee experiences a high external torque or force, your ACL is at risk . . . and if it’s significant enough, you can even injure the “terrible triad” (the ACL, the MCL, and the medial meniscus).
But I have to admit: even though though I’m a PT, when I coach my U11 boys, I don’t engage the full FIFA 11+ warm up. I mean, what 10 year old boy has time or attention for that anyway? But I do have them do some critical things. We run forward, backward, and grapevine along the lines. We do some jumping jacks and windmills. We drop to the pitch and stretch around our full hips through side lunges, forward lunges, and twists. We get back up, practicing ball rolls and touches to loosen our ankles and engage some gentle plyometrics (read: jumping). And then we’re off with some dribbling drills to launch into the real meat of the practice.
If you, your team, or your coach is not engaging a multi-directional dynamic warm up like this, consider it. Open the dialogue, and remain open to suggestions and adaptations. The best news is this will work to prevent injury, and the good news is there’s not just one way to do it. A great warm up can look like . . . well, almost anything that gets you and your team moving in every direction. As long as it fits your ethos, it’ll work for you and your team.
And if you’re ready for something more like a cross training program? Well, I know a PT who can help you create that program, tailored to you. Click here to Schedule a Sport Physical or Fitness Program Assessment and Plan.
