Are Anterior Cruciate Ligament (ACL) injuries epidemic in soccer?

Are ACL injuries epidemic?

Does it have to do with improved communication or faster dissemination of news, but it seems that there were never more cruciate ligament injuries than at present. Last weekend a professional soccer player in Belgium, a few days later one in the Netherlands, England, Spain, and when you read the newspaper … just watch the lower divisions as well. Not a week passes without a soccer player is getting injured at the anterior cruciate ligament (ACL).

What’s going on?

Some blame the many cruciate ligaments injuries to the faster game, others to the artificial grass, others to the shoes, or …?
The faster game could be a cause but would that not only be at the highest level? Artificial grass is still rather exceptional in our region and why weren’t there a lot of ACL injuries previously when people still played in ‘the meadow’? And how much research is focusing on improving shoe performance?
Or are we missing something else?

What are the causes of ACL injuries?

To reduce the number of ACL injuries it’s important to know the cause of this injury, so we can determine a strategy to counter them. Some cruciate ligaments injuries are caused by contacts, which we can’t anticipate since soccer is a contact sports (same applies for other contact sports). But we also see a large number of non-contact injuries at players, without an opponent nearby, who rather unexpectedly injure their anterior cruciate ligament. It’s often an exaggerated rotation component between upper leg (femur) and lower leg (tibia) which causes extreme stress in the ligament making it fail eventually. Think of a foot which gets stuck in the turf.

Keep in mind that the rotation can arise from three perspectives: the upper leg rotates outward relative to the lower leg; the lower leg rotates inward relative to the upper leg; upper and lower leg rotate simultaneously away from each other. The injury seems to be not as dramatic as a broken leg; however on the other hand rehabilitation will take at least six months to one year. A lot of athletes even suffer consecutive ACL injuries (relapse).

Preventing ACL injuries?

We have listened to a number of organizations and health professionals who claim to prevent injuries and we now have an idea how they cope with ACL injuries. Also the (professional) soccer teams are doing their best to avoid this type of injury using appropriate exercises. Therefore our attention went to their thinking, strategy and exercises. The most common solution was ‘stability training’ of the trunk, knee and ankle. Rehabilitation specialists indicate an excess rotation in the knee as the cause of cruciate ligament injury and they want to teach the knee to go straight forward instead of moving inward (in other words rotating internally) by applying specific ‘stability exercises’. This knee stability is considered to be THE prevention technique of ACL injuries.

Examples of exercises

Most exercises, also in rehabilitation, focus on letting the knee go straight forward and on avoiding internal rotation, possibly with tubes around the knee for muscle strengthening. Another example was the trunk stability, performing benches … because when the trunk and hip are stable…

Injury prevention? When do you end up in this position while playing soccer? How will this help you?

We now also have examined a number of companies who are providing exercise programs online with a wide range of exercises in which, according to them, the knee must move straight forward and if not … there are more exercises to steer the knee. When we asked further explanation about ‘why’ they believe the knee has to move forward, they usually referred to another employee who had developed the program…

Soccer DVD : ‘Injury prevention and strength training by mobility and flexibility’

And then we looked at all this with a critical eye 😉

The first question we asked ourselves: Why is it that, even when performing stability training and corrective exercises more frequently compared to before, we still see so many ACL injuries? Or would there be more injuries in case we won’t perform ‘stability training’?
Another question might be: Why is the knee not allowed to fall inward, when due to the eversion (falling inward) of the heel bone (calcaneus) when hitting the ground, there will be a pronation movement in the foot (going through the medial arch) which causes internal rotation of the knee?

Euuh??

Let me explain: With every step you take, the falling inward of the heel bone (eversion) will cause a pronation movement in the foot, i.e. your medial arch (the bridge on the inside of your foot) is reduced and because of that pronation there will be a rotational movement of the tibia, including the knee.
And how are we going to prevent the knee of falling inward using stability training if this is a movement which according to the biomechanics of the body MUST be there? And which muscles are crucial to counter the internal rotation of the knee?

So why would we perform exercises in which the knee moves forward if the knee falls inward or turns in many activities? Just try to perform a ‘lunge’ and rotate with both arms at shoulder height away from the front leg, so for example, right leg in front, shoulder and trunk rotation to the left. Where is your knee going? And now turn with both arms at shoulder height to the front leg. Where is your knee going?

When we know how the biomechanics of our body works, how wise is it to train the knee for something it rarely has to do (moving forward)?
What is the reason that, even after a successful surgery, athletes or recreational players still relapse into the same injury? Are we missing something in our rehabilitation?

And how will stability training, as we see it performed by so many clubs, trainers and physiotherapists (static bench, knee, hip, ankle), help our body in an activity like soccer, in which we perform a lot of different movements and move in numerous directions?
Stability training does not mean keeping quiet, but stabilizing from movement (from stretch). This principle is often misunderstood and frequently used by people who lack training and understanding. The intentions are good, but the techniques could be improved, at least if you believe that ‘mostability’ (motion + stability) would be a better implementation. To cut a long story short you can summarize it like this : You are what you train: To become faster you train speed, to jump higher you train jumping power… if you train like a bench … you become a bench…

‘The functional strength program for soccer players and soccer coaches : PRO’

You won’t probably like reading this if you’re a trainer or physiotherapist for years and you request your players / customers to perform ‘stability training’ in this way… Don’t worry, we did it too… previously! Only we started to think differently about some things and we wanted to bring more logic into our coaching. The switch from static to dynamic, from lying on the ground to stance does not require that much adjustment…

It’s extremely confusing when a large organ such as FIFA distributes posters and exercise programs explaining for example to maintain the bench for 20 or 30 seconds.

Stability training : Another point of view

The basis of injury prevention

It’s important to know how the body works, how the biomechanics of the human body works and how all our systems, such as muscles, fascia and nervous system function. Once we know what movements to expect in certain activities, such as soccer, a way to prevent injuries is to detect or avoid compensations. For example, when the knee falls inward, the large gluteal muscle is activated to return the knee from its internal rotation. A poor timing or insufficient activation of the gluteal muscle can cause injuries such as the ones at the cruciate ligaments. Performing benches like shown in the movie regarding stability training or exercises that don’t resemble realistic movements (like most machines in the gym) will confuse our nervous system (proprioceptors) and disrupt the timing. Preferably we train our body in the most logical way, in a way it functions and works. Training the knee to ‘move forward’ seems not a good idea because it isn’t something (or not only something) that our knee does when playing soccer. Feel free to look for slow-motion footage of a soccer game and watch in which directions the knee moves.
If a compensation of the body is the cause of the injury, there is a high probability of relapse for as long the cause has not been detected. A surgery restores the damage (and we have great surgeons to do that) however motion analysis and thoroughly building in a logical manner is essential for a healthy knee.
We could easily distinguish the cause of ACL injuries between recreational and elite athletes. The impact of e.g. a sedentary job is amazing: short hip flexors, decrease of the activation of the buttocks, fixed ankles (subtalar). For elite athletes we have our doubts about ‘stability training’, steering the knee, the machines in the gym, performing unnatural movements, abdominal training on the ground, etc …

10 good reasons why (professional) soccer players better don’t work out using strength machines

Avoid movements Training movements

A final fact to think about: What’s according to you the best way to protect your cruciate ligaments?
 What if we are wrong and we maintain the techniques as currently implemented …. and the knee shouldn’t fall inward? Then we opt for the following strategy: You train your body so that your knee can no longer fall inward!
 OR: We are right and we train your body (and not just the knee because that’s only part of the chain) so that it’s perfectly capable of withstanding all movements (such as falling inward of the knee)?
Which one would you choose?

Dynamic stability in stance for soccer

Dynamic stability in stance

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Stability training for soccer players…a different point of view.

History of stability training

We can’t exactly trace in detail when the term ‘stability training’ entered the soccer world, but we notice that ‘stability training’ in soccer has gained ground increasingly in the last 5 years. Without being able to confirm the authenticity, we assume that the technique of stabilizing arose from the medical world, where physiotherapists apply stability training on their patients. Stability training would be useful for ‘unstable’ structures such as pelvic, back, ankle, …

Stability training in soccer

The most powerful organization in soccer, FIFA, has given the stabilizing techniques in soccer a worldwide reputation by including it in their exercise program FIFA11+
The posters showing the exercises can be found in many soccer locker rooms and cafeterias. Health care professionals ensure further distribution of these exercises and soccer coaches apply them in their training.
The exercises are described as a kind of strength training and even as a tool in injury prevention.

What body part is actually unstable in playing soccer?

An inquiry for coaches using these exercises gave us answers like the trunk, the abdomen and spine, the hip, the knee, the ankle, …. Another question might be: How do you notice that a soccer player is unstable at these structures? Isn’t individualization required because stability, or the lack of it, will be different for every player, no?
Most of these exercises are performed in group and approached from a more general form of strength training and injury prevention. The stability training would also help in entering into a duel, because won’t increased stability result in more power and strength?
We’ll get back on this later.

The ‘bench’ and ‘sideways bench’

When we briefly look at the exercises the FIFA11+ is proposing, we notice immediately that some exercises are not performed in stance, as we wonder how exercises, which are not performed in stance, can help us in a sport which is practiced standing.
We arrive at the ‘bench’ and the ‘sideways bench’ (exercise 7 and 8), though we find hamstrings exercise 9 at the very least ‘curious’ … but we will discuss this one elsewhere.
We find the so-called ‘benches’ quite often on our soccer grounds so we are going to analyze them considering ‘how the body works’ and what ‘task’ (playing soccer) the body has to perform. We will also look for, and give examples, how we can bring more logic into the current practices and make them more soccer oriented.
Before going into practice, we discuss the basic principles to better understand why we should or should not make certain choices. The principles will give you insight so you can further develop the examples yourself and bring more logic in training soccer players (and other athletes).

How does the body work?

If you want to activate the muscles, it might be important to bring them first at length in a dynamic way. This change in length stimulates the proprioceptors (nerve system) in the fibers (+ fascia) and awakes the whole system in order to respond. Working from stretch is not only beneficial to strength and flexibility but is also a powerful ‘tool’ in injury prevention, because our nervous system switches immediately to ‘protection mode’ and the body is (on the long run) building up more resistance to stretch.

The task: playing soccer

Our body is dynamic, is made to move and works best when trained to respond to various external stimuli, such as playing soccer. It is important for the training of soccer players to take into account the functioning of the body and the tasks entrusted to playing soccer: running, jumping, turning, braking, tackling, entering into a duel, …
Could it be that stabilization training for soccer players is different compared to goalkeepers?

Stability by moving!

One major misunderstanding with respect to stability training is that the body is not made to keep quiet and that you can stabilize by motion instead of ‘holding the position’. We don’t support the examples where you must hold 20 or 30 seconds (such as exercise 7.1 and 8.1) because eventually you don’t do that (hopefully ;-)) when playing soccer, right?
Conclusion : we are going to stabilize and ‘activate’ BY MOVING!

A fixed position or tweaking?

We clearly remember the time where we, as a physiotherapist or a trainer, wanted to show our added value by putting our patients and clients into a starting position of which we thought it was the best and safest position. Meanwhile, we understand that we only train the body optimally if we consider the task and all thousands of different positions in which you end up when playing soccer. By ‘tweaking’ we mean the variation in positions and movements.
We can tweak the three movement dimensions (sagittal, frontal and transversal plan) but also tweak in height, depth, speed, resistance, ….

Consciously or unconsciously?

Based on what we see during training, and also in prevention and rehabilitation, we often notice a kind of coaching in creating awareness of muscle tension: for example tightening of the Quadriceps, of the abs or buttocks or …
Consciously tightening has little ‘transfer’ to real movements or playing soccer.
Just think of sprinting with your opponent towards the ball and entering into a duel …
Which muscles do you consciously tighten? I fear … none!
Unconscious ‘movements’ (eg reaching for … instead of tightening of …) bring your training closer to reality.
Remember: our body does not detect muscle, only movements!
Many years ago, we started to break up our body and name all different muscles. We now realize that we should put all pieces back together and merge them to a whole.

The practice

We will discuss two examples : exercise 7 and 8 of FIFA11+, in other words the ‘bench’ and ‘sideways bench’. We will implement a number of improvements based on the principles we have discussed above and you will notice that, even after the adjustments, a motion analysis is required to minimize the gap to ‘playing soccer’ with focused exercises.

The bench, FIFA11+ exercise 7

The Bench ( exercise 7)

What changes could you make if you were to apply our principles?
• We opt for dynamic movements. This means we don’t implement 7.1 statically, as described. It can be made dynamically by sagging and lifting deliberately. This creates a bit of a stretch. We are certainly not tightening our muscles consciously.
• The leg movement in 7.2 provides more dynamics and had our preference to 7.3 where you go back to a static position.
• Variations: there is no reason why you should stick to this starting position. This means you can also put your legs wider or narrower, the arms (elbows) wider or narrower, 1 arm in front or more backward, performing opening and closing jumps, cross one leg underneath the other leg, … . So tweak the starting position and the movements. You can also make a lateral movement of the pelvis, or a rotational movement, ….

The sideways bench, FIFA11+ exercise 8

The Sideways Bench ( exercise 8 )

What changes could you make if you were to apply our principles?
• We opt for dynamic movements. This means we don’t implement 8.1 statically, as described. It can be made dynamically by sagging and lifting deliberately, like in 8.2. This creates a bit of a stretch. We are certainly not tightening our muscles consciously.
• Exercise 8.2 provides more dynamics and had our preference to 8.1 .
• Exercise 8.3 provides an extra lateral movement of the leg and makes it dynamic. Although it is dynamic, the lateral movement of the upper leg in combination with shoving of the pelvis, isn’t necessarily a movement you will make when playing soccer. (Video coming up soon)
• Variations: there is no reason why you should stick to this starting position. This means you can also put your legs in a front-rear position (similar to running) and make it dynamically by e.g. also swinging your upper leg back and forward, combined with sagging and lifting the pelvis. To stay as close as possible to the reality of running, sag your pelvis when your upper leg is backward and lift your pelvis when swinging the upper leg forward. So tweak the starting position and the movements. You can also make a front-rear movement of the pelvis, or a rotational movement, ….

Comparison and evaluation of exercises 7 and 8

Both prior and after the adjustments, exercise 8 gets our preference (at least when duel strength is the goal) compared to 7, because in soccer you seldom enter a duel in the sagittal plan (front-rear) but more in the frontal plan (lateral movement). Creating stability in the frontal plan of the hip gets our preference.
We have deliberately chosen these two exercises, because there is little transfer to soccer (you stand upright on two legs or one). Improving stability, increasing duel strength and working on injury prevention should be done in stance, partly because muscles respond differently depending on their starting position. The FIFA11+ exercises in stance, where there is dynamics and no deliberate corrections, are highly useful.

So if you want to train soccer oriented, make it dynamic, tweak your movements, work as much as possible in stance and allow the movements to resemble ‘playing soccer’. Even without a detailed motion analysis or a detailed knowledge of functional anatomy and biomechanics of the body, you will bring as a coach or player more logic in your workouts.
video : 3D dynamic stability training for soccer

Soccer DVD: ‘Injury prevention and strength training by mobility and flexibility’
The functional stretching program for soccer players and soccer coaches

Good luck!

Willem Timmermans
Physiotherapist – Personal Training – Applied Functional Science – Education
Functional Injury Prevention – Training – Rehabilitation
www.act2prevent.com
www.top-training.tips.com

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Functional abdominal training for soccer goalkeepers

How do you, as a goalkeeper, train your abs? Or what abdominal exercises do you, as a coach, ask your goalies to perform? Does your abdominal training look like everyone else is doing it: bridges and crunches?
Have you ever thought about how you can train your abs specifically for ‘goalkeeping’? Are there any disadvantages to our current way of abdominal training? To performance? To the risk of injuries?
In this article we will share our insights on abdominal muscles and how we can optimize abdominal training for goalkeepers.

Should abdominal training for a goalkeeper be different compared to a soccer player?

When we aim to train effectively, it’s important to know the task of the goalkeeper.
And we’re not talking about keeping the zero on the score board (because that’s what we all expect) but about the physical tasks, the actions a soccer goalkeeper has to perform during the game or training.
So it concerns kicking from hand, drop shot, kicking from ground, handling back passes, picking up the ball, reflexes to close shots or deviations, anticipating high balls and crosses, diving into the corners,reaching/floating to the square, etc.
The difference compared to a player (and that’s not new), is that the goalkeeper may use his hands … and is reaching those hands in all directions. While a player’s arms and hands remain rather close to the body. Nothing new you would say, were it not that this impacts the training of our goalkeepers as their ‘task’ is somewhat original and unique.

Abdominal muscles

Important to know is how muscles function, how they help us in daily activities and how we can specifically activate or train them for ‘goalkeeping’. There are a lot of different approaches, millions of abdominal programs and plenty of people who daily exercise their abs. We hope to clarify in this article (to a certain extent) how you, as a coach or player, could train abs most effectively.
Some items will be slightly different than you thought and require a certain adaptation. We provide clear explanations and examples, so give yourself enough time to possess it, try it out and FEEL it!
Think of it as a complement to what you already know.
Subscribe to our educational and FREE 12-week abdominal program

Here we GO!

Abdominal muscle function

To make it clear and easy to understand, consider the abdominal muscles as the ‘soft tissue’-connector between two large bony rings in the body: on one hand, the pelvis, on the other hand the chest with the ribs.

The abs will become active when moving either one or both rings at once (like running). Not only abs, but all our muscles, create movement by contraction (concentric, the attachments move to each other) but also take care of braking/decellerating movements at the point of extreme stretch (eccentric, the attachments are separated).

Our abdominal muscles don’t only become active when reaching up from supine (concentric) but also in stance when inclining the trunk backwards (eccentric), when raising the trunk upwards from lateral lying position (concentric) but also in stance when inclining the trunk laterally (eccentric, meaning decellerating at the side which is being stretched).
For rotations it is often more difficult to sense it, but if you rotate your trunk to the left and right in stance, you will get on both sides a concentric and eccentric activation of the obliques depending on the movement. Our abdominal muscle activation will therefore depend on the starting position (supine, lateral lying position, stance, …) and the movement/task.

Crunch, straight or oblique, concentric


‘Bridge’, make it dynamic!


Stretch/activate by bending laterally

A number of questions which you can already answer. These will help you understand the logic.

What do you think could be a disadvantage when always training concentric?
What are the benefits of training the abdominal muscles eccentric? And how do you do that?
How often does a goalie need to reach up from lying position during a game?
How often does a goalie need to reach towards the ball during a game?
Do you think there is a difference in training the abdominal muscles for both actions?

Train your abs concentric or eccentric? Or both?

The focus in our training is currently primarily (too much) on the concentric part, in which we bring the attachments closer to each other, think about the crunches. In a crunch (see photo above), we lift our trunk from supine position in order to train the abs (concentric).
Ever after the ‘trend’ stabilization training has reached soccer, ‘bridges’ are performed quite often; making a bridge starting in a prone position, leaning on elbows and foot points and maintain that position as long as possible. One can also start in a lateral lying position. This exercise is useful for goalies although we prefer dynamic movements instead of static. By sagging and raising again from a prone or lateral lying position, you make it dynamic and you go from eccentric muscle work (stretch) to concentric. In this way you train the ‘braking’ function of abdominal muscles.

The above exercises are very useful for a goalkeeper; however we wish to add the following. A goalkeeper has to reach towards the ball several times during training or match which requires the braking effect of abdominal muscles. Suppose we only work concentric (shortening the muscle), it can harm the scope of our goalkeeper and have disadvantages on the posture and mobility and increases the risk of injuries.
Is it not important that you, as a goalkeeper, can fully stretch? Wouldn’t it be more productive to combine that with ‘functional abdominal training’?

Imagine this: you sit behind a desk in a bent position all day long. At night you go to the goalkeeper training and you need to reach to the square, do you think the bent posture will help or hinder you?
Suppose you start the training with ‘crunches’, does that help you or does it have the adverse affect on your posture and stretching?
Hopefully we understand by now that crunches are sometimes necessary; however we also need the opposite movement: the opening of the trunk, the activation of the braking effect of abdominal muscles.

Doesn’t stretching increase the risk of injuries?

A logical and frequently asked question, but if you’re not training the body to what it has to do afterwards, how can it complete its task safely? A goalkeeper must be very flexible and explosive and we will make him more athletic by training him in this way.
We assume that we all know to start always the training with a focused warming up and to increase the intensity gradually.
So contrary, any athlete at any level will sport safer when his/her body has built up more resistance to stretch.
Soccer DVD : Injury Prevention and Strength training by mobility and flexibility

The practice, go the other way!

Ok, it seems logical to open the trunk when training the abdominal muscles because we also need to do that when reaching towards the ball … but how do we train that?
Very simple, stand up and reach with both extended arms above your head and lean backwards, you will feel the stretch in the abdomen. Same thing but now reaching with both arms sideways to the left and right, you will feel the stretch in your flanks, right?
Make it more difficult by repeating this with small weights or a medicine ball. You will feel the stretch on the abdomen and this training has no disadvantages on your attitude, on the contrary.
So instead of getting up from supine position and bend, we lean backwards in stance, meaning the other direction.
You can vary on two legs, one leg, with jumps front-rear, left-right, …

Abs at stretch, 1 leg, with dumbbells


Swing the medicine ball from bottom left


to upper right, stretch + rotation ! And vice versa.

Functional abdominal training

Functional training is training in function of your task… so if your training resembles your final assignment (goalkeeping), you’re already quite in the right direction.
The simple practical example shown above can be further developed in a creative way.

1. Think of all the movements a keeper must make and ensure that your strength and abdominal training resembles them. Don’t only make muscle strengthening movements in a lying position but also in stance and include a lot of rotations in your training.
2. Consider the 2 rings and bring them in motion. The abs will become active right away without you having to know all the details.
3. Think especially of the eccentric (stretching) movements.
4. Material: Some little dumbbells or a weight ball, the logical insights and you can start working.
5. Contact us at info@act2prevent.com for more information or questions.
6. ‘The Functional Stretching Program for soccer players and soccer coaches’

Good luck!

Willem Timmermans
Physioherapist – Personal & Lifestyle Trainer – Applied Functional Science – Education
Functional Injury Prevention – Training – Rehabilitation
www.act2prevent.com

Lieven De Veirman
Personal Trainer – Coach Act2prevent – Applied Functional Science
Functional Injury Prevention – Training
www.act2prevent.com

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Functional stretching for youth soccer players

Is stretching useful?

Whether or not stretching is useful, is one of the most frequently asked questions. Even today there is still much controversy and health and sports professionals are contradicting each other. Obviously recreational and professional athletes get confused. And we will discuss later that both fans and opponents are partially right, because the answer is …

‘It depends on … ‘!

What does it depend on?

In order to answer correctly on the question whether stretching is useful, it’s important to understand how the body works and especially how the nervous system works. Our muscles contain proprioceptors / sensory nerves that give us information about the extension and the shortening of our muscles. By stimulating these proprioceptors we will awake and alert the muscles, allowing them to better respond to movements, in this case ‘playing soccer’.
Often a poor response of the sensory nerves will cause injuries when playing soccer, as for example at the end of a match when we get tired. In case we wish to perfectly prepare our body to play soccer, we opt for dynamic stretching, simply because they have the biggest impact on the nervous system.
To be clear, we’re talking about the stretching BEFORE and during the exercise, meaning while warming up or during training. Many athletes choose to perform static stretching after the exercise as a form of relaxation or cooling down so that’s a different situation.

Dynamic stretching as injury prevention?

When we understand how we can prepare our muscles to play soccer at best by dynamic stretching, then this is actually already an act of injury prevention because soccer is also a very dynamic and explosive sport. Static stretching seems to us a less efficient technique to prepare for a dynamic sport.
By stimulating the nervous system, we activate our ‘protection’. We therefore need to take into account that we have to make them not only dynamic but also ‘task oriented’. (See below)
When our body gets more and more accustomed to dynamic stretching, we build up a natural resistance against muscle injury, because muscle injuries often result from unexpected or extreme movements, like for example an unexpected slip. That’s also why we stretch a lot our muscles in ‘functional strength training’.

Soccer DVD : Injury Prevention and Strength training by Mobility and Flexibility

Task oriented?

Our task is ‘playing soccer’, so it seems most important to stretch the muscles into positions that also occur when playing soccer.
In what positions do you end up when playing soccer?
When you would answer this question, then you come to the conclusion : a vast number of different positions!
Is it realistic to have our soccer players stretch in a fixed position (e.g. feet straight forward, knees straight, back straight, etc …) or can we introduce more variations in our dynamic stretching?
Maybe we could look at it more like ‘stretching movements’ instead of ‘stretching muscles’?

‘Tweaking’

Tweaking of movements and positions means bringing many variations. We can make variations in the direction of the stretch, the position of e.g. the feet, the scope of the movement (e.g., deep, deeper, deepest), ….
Let’s make an example to clarify. Start in stance, step forward with 1 foot and reach with your hands to the knee of the front leg. This movement is known as a stretch of het hamstrings (+ buttocks and lumbar region).
In what ways can we tweak this stretch?

* Bent or extended leg, both result in hamstring stretch; however the effect is different.
* Tweak the foot positions by turning the foot of the front leg in and out (and continue the forward reach).
* Tweak the direction, e.g. reach left and right of the knee.
* Tweak the scope by reaching deeper towards the ankle instead of towards the knee or even towards the ground.
* Tweak the speed by increasing the intensity.

1 foot in front, leg bent or straight


reaching forward, dynamic at knee, shin, ankle,...


'tweak the direction'

The principle of ‘tweaking’ is actually very easy to understand, even though it often goes against what we ‘are used to do’ (fixed positions and exercises). The above hamstring stretch will prepare the hamstrings to all kind of situations because that’s what happens when playing soccer, right?

‘Functional stretching’

What?

Functional stretching is stretching in function of what you want to do, of the movements you will perform in your sport. In other words, functional stretching is different for a golfer compared to a soccer player. At this point we notice that runners, soccer players, badminton players, … often perform the same stretching, while their activity is significantly different. We believe that most non-functional stretching doesn’t have negative impact on performance; however we are confident that task oriented stretching will prepare the body better, especially in terms of injury prevention and performance. You can easily put it this way: does your stretching resemble a movement you perform in your sport?

Example:
To support our principle of ‘functional stretching’, we will provide a well known example: the classic quadriceps stretch, where we pull one foot towards our buttocks and keep it there for some time. We could ask the following questions?

• When do you end up in this position while playing soccer?
• How could you make the stretching dynamically taking into account the above information?
• How could you tweak this stretch so it will help you to play soccer?

When we make a movement analysis of soccer activities and of the quadriceps function while playing soccer, we will notice that the quadriceps is e.g. active when running and when kicking at the ball. We never really see the example of the heel touching the buttocks and certainly not of an isolated movement of only the quadriceps. Both when running and when kicking, there is also an activation of the hip flexor (by extended rear/back leg) and the abdominal muscles. It’s a good idea to also involve these muscles in our stretch and ensure that the stretch is dynamic and ‘tweakable’ in different directions. The pictures below show the ‘true stretch’. We don’t have this equipment (yet) in soccer clubs; however a step and a doorway (where you can place your hands) may also help. Once you understand the principle, it will only require some creativity to come up with better techniques for the other muscles / movements as well.

Stretch movements – not muscles!

hip stretch, sagitale plane


hip stretch, frontal plane


hip stretch, transverse plane

The rear leg is put on a step. In this way it brings the lower body in the position of kicking or running and it introduces stretch on the quadriceps, hip flexor and abdominal muscles. Lifting the arms above the head will increase the stretch; however is not required. We make a dynamic forward movement of the pelvis, increasing the stretch in all structures. In the middle photo we tweak the trunk position and thus the impact. On the right picture, we rotate the trunk and we move the right shoulder forward as this resembles the walking pattern.

Remember!

1.Perform the preparatory/warming -up stretch dynamically because the body is dynamic and soccer is a dynamic sport.
2.’Tweak’ your stretching by changing positions, directions and scope frequently. When your warming up progresses, you could also increase the speed of execution because soccer has large changes in speed as well.
3.Opt for task oriented ‘functional stretching’ so your body is better prepared reducing the risk of injury and increasing the performance. Stretch movements – not muscles!
4.We don’t like change so we attach us to what we are familiar to. Changing and sustaining a number of techniques is not always easy so give yourself enough time to integrate them. The logic and principles behind them will help you to introduce change.
5. The Functional Stretching Program for soccer players and soccer coaches.


Integrating functional stretching for youth soccer players

At what age?

A frequently asked question and the answer is common: it depends!
On what?

Well, we can ask ourselves at what age the flexibility of youth soccer players drops? Or from what age it seems useful to spend more time to flexibility? Or might there be advantages to teach it before there is a need to? Or could we maybe ‘mask’ the stretching as flexibility training?
Which young soccer player trains weekly on flexibility? Which club has integrated this already into the training program? And how do they bring it?

Individual differences

We notice that a young soccer player becomes less flexible and less coordinated during the period of accelerated length growth, for most players around the age of 13-14 years (individually different). There is often a remarkable growth spurt at a younger age, but most children have fewer disadvantages if they are 9 or 10 years old.
However, it makes sense to integrate the flexibility training prior to the length growth. Consider it as an initiation for later. This means we can commence to teach a few basic principles at the age of 11-12 years, without looking at it as an isolated part of physical preparation. There are plenty of opportunities to integrate ‘flexibility’ in the form of movement games and skill circuits.

‘Transform yourself into an athlete’

Sharing responsibility at physical level will ensure that the young soccer player will develop more skills in terms of injury prevention, functional flexibility, functional strength training, …
It seems wise to teach to young players the principles / skills and not only telling them WHAT to do but also explain WHY. In this way we are not only creating skilled players but also smart athletes who are able to train themselves in the best possible way. There is indeed not always a qualified trainer available during mid-season, during or after injury, … or if you decide to train more by yourself.

Transform yourself into an athlete

Training-demo, VV Vosselaar, champions 1ste prov. Antwerp 2010-2011

Functional stretching for adults???

Adults often have more difficulty to apply new techniques compared to young players because they are usually less ‘flexible’ 😉 ( in changing behaviour and habits ). If we succeed to timely train young soccer players, they will create better habits as adults. The choice whether or not someone is open to improvement is very dependent on how you bring it. A logical explanation with practical examples and the actual implementation of the techniques are already a great help.

The Functional Stretching Program for soccer players and soccer coaches.

Soccer DVD : Injury Prevention and Strength training by Mobility and Flexibility

education for soccer coaches, strength and conditioning trainers, physiotherapists,...

Conclusion

When we start thinking logically about a number of stretch techniques we see that there is often a gap between ‘the preparation of the sport’ and the actual ‘sport’: playing soccer.
Functional stretching reduces the gap and will lead in combination with ‘functional strength training’ (not covered here) to a lot of benefits in injury prevention, training and rehabilitation.
Integrating new techniques is easiest with young players; because they are often more flexible (also mentally ;-)) compared to adult soccer players who rather cling to old habits. The contribution of a skilled trainer and soccer coach will determine the success of both the young and adult soccer player; however let’s focus on teaching the principles and insights rather than teaching the techniques only. Teaching players on a physical level will relieve the trainer and will increase the responsibility of the player for his own athletic performance (and success).


The Functional Stretching Program for soccer players and soccer coaches.

Best regards.

Willem Timmermans
Physiotherapy – Personal & Lifestyle Training – Applied Functional Science – Education
Functional Injury Prevention – Training – Rehabilitation

Willem Timmermans, physiotherapist and trainer

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What can we learn from the Cybex test for (professional) soccer players? Or not learn?

Cybex! What’s that?

The ‘Cybex test’ is a test which is currently being implemented by hospitals, universities, rehabilitation centers, … . During the test you sit on a chair and variations in force are measured in front side – back side of the leg (Quadriceps – Hamstrings – ratio) and front side – back side of the trunk (abdominals, back muscles).

Purpose of the Cybex measurements?

The intention is to locate the differences and imbalances and it would also help in predicting injuries.

As the picture shows, one is firmly attached to a chair and during the leg test one is supposed to extend the leg (Quadriceps) and bend the leg (Hamstring) against a resistance. A software program measures the results and displays the differences and attention points. This test is applied (mainly) to professional athletes and a lot of professional soccer players with injuries.
In order to better understand the usefulness, the functioning and the conclusions of the Cybex test, let’s take a closer look at the operation of this machine and its test protocol. For the fans or the ‘believers’ of the test, it will be confronting (our apologies); however if we wish to make progress in assisting our athletes, we have to face it in order to achieve the best results.
Here we go!

Muscle Isolation

A first question: why would we isolate muscles (one element in a muscle chain) to measure them? When we look at how the body works, especially when playing soccer, we see that the muscles work together to execute a certain task. When jumping, running, kicking, tackling, … the movement ALWAYS includes the activity of several muscles. The timing of this functioning will be essential to perform sports safely. In other words we benefit big time when we train ‘movements’ and not muscles. This approach is often very different than we are used to; however by introducing ‘functional’ training, we return to more natural movements and logic.

So what do we learn by isolating and measuring separately one’s Quadriceps and Hamstrings?

Muscle Function

How do Quadriceps and Hamstrings function when playing soccer?

Perhaps one of the biggest mistakes we ever made in studying the anatomy and muscles is the use of a corpse instead of a living person.
What is the difference in muscle activity between a corpse and a living person?
If we pull the Hamstrings of a corpse in prone, we notice that the heel moves towards the buttock. At that time they concluded that the Hamstrings bend our leg and are also able to do that while seated and in stance. However it appears that the function of the Hamstrings when eg playing soccer (and of any living / moving person) is completely different. The Hamstring will extend the leg (which is the opposite of what we always thought), become active when bending forward (eg when landing after a jump), when turning the knee inward and outward and when moving the hip laterally.

Question: if we know that muscles function in 3D (3 plans: front-rear, lateral, rotations), which 2 plans do we miss if we only bend-extend in the Cybex test?

Question: if we know how Hamstrings and Quadriceps function when playing soccer (in stance), what will a measurement while seated teach us?

Eccentric instead of concentric functioning of muscles

Probably those words don’t tell you much if you are not medically trained so to summarize, eccentric stands for stretching the muscles, separation of the tendons and concentric for shortening the muscles, closing the tendons. These are two opposite situations in which a muscle can function and as you might expect, combinations are also possible but we won’t discuss them here due to the complexity.
The fact is that muscles respond and develop their strength from the extended / eccentric position. They are not only initiating movement but also brake movement. If they brake movements, they also end up in the eccentric phase. Training muscles from their eccentric phase does not only improve the muscle strength, it also serves as a powerful advantage in injury prevention because many muscle injuries occur due to an unusual or unexpected extension. If you eg want to kick a ball, you will swing your leg backwards first in order to develop your power from there. If you want to head for the ball powerfully, you’ll also move your trunk backwards first and develop the forward force from there. Because muscles and nervous system respond very actively to this eccentric phase, we are particularly interested in the areas where the stretch arises. Our approach of injury prevention (muscle injuries) is in function of this principle.

When do the body and the muscles end up in an eccentric phase during the Cybex test? Don’t we measure only concentrically while when playing soccer the concentric muscle function is preceded by an eccentric ‘load’? If you want to know your blood pressure, you don’t measure the heart rate, right?

Muscles react differently according to their starting position!

We already mentioned that it’s not logical to test a soccer player (who plays soccer in stance) while seated, because muscles function differently in stance compared to seated position. On top of that, a sitting position will switch off the buttocks, the foot is no longer touching the ground, the calf is not functioning and when stretching the leg extensively (Quadriceps) an excessive force is developed on the patella (knee cap) while in stance and when stretching the leg extensively, the force on the patella is rather minimal.
What message do we give the tested soccer player when the Cybex test indicate that the Hamstrings are too weak?
Logically, the soccer player will train the Hamstrings, right? He will do that in a way which will yield a better result next time, no? Meaning, sitting on a chair, pulling the heel to the buttocks against a resistance? Or prone position, same thing? Or Lying on the back, eg pulling a fit ball towards you?

We are confident that the results of a re-test will be better, but is this useful when playing soccer, when the Hamstrings are active in 3D, where the position of the foot, knee and hip will influence the Hamstrings, where the Hamstrings and the Quadriceps have a different function compared to a sitting position, where they develop their strength from contraction to stretch, where in every movement also other muscles control that movement and where there is no isolation at all?

Conclusion

There are to date no casualties yet due to the Cybex test; however we are convinced that our time (and investment) can be used more efficiently and that we probably can come to a more logical assistance in injury prevention, training and rehabilitation. In any case the developments in functional training bring more logic into our approach.

The foundation: Functional Anatomy

There is an urgent need to update our education and adapting the classic anatomy (based on a corpse) to the functional anatomy (of a body in motion). Understanding the basic principles of biomechanics and human movement are necessary to assist our (top)athletes in a way that they deserve!

Soccer DVD : Injury Prevention and Strength Training by Mobility and Flexibility
http://www.act2prevent.com
http://www.top-training-tips.com

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How do you stretch? Does stretching for playing soccer, basketball, volleybal or running looks the same for you? Is it possible that we can make a difference in preparing the body, depending on the activity? Did you ever hear about ‘functional stretching’? What is your idea about this topic?

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Should we protect athletes against oxydative stress? We need oxygen to stay alive but meanwhile it makes us older and attacks our cells. We can protect ourselves against the oxydative stress by taking more anti-oxydants. Do professional athletes need more anti-oxydants or not? And what about recreative sports? Give us your opinion!

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