Knee Pain and Injury Prevention in Soccer

Soccer is a sport with worldwide popularity and a reported million people playing in the U.S. ["The 1998 National Soccer Participation Survey”]. 

Injuries are common to any sport.  In soccer, approximately 70% of all game and practice injuries affect the lower extremities.  Common injuries include:

1. Ankle ligament sprains
2. Upper leg muscle-tendon strains
3. Pelvis and hip muscle strains

We could spend a lot of time and attention going through each of these specific conditions.  The issue, though, that connects most of these issues is that of balance (or rather imbalance) of muscle groups around joints. 

Knee anatomoy and patellofemoral syndrome

Patellofemoral syndrome, for example, is an extremely common cause of anterior knee pain.  The symptoms in simplistic terms are a result of weakness in some of the muscles around the knee that control the tracking of the kneecap in the groove on the front of the knee.  

Restoring balance and coordination of muscles around the knee and hip is a great fix for patellofemoral syndrome and also for most of these other described injury patterns.

Strengthening Exercises for Injury Prevention:

Following are some of my favorite exercises for general prevention of knee and hip issues:

1. Single leg squat:

This exercise is great for working on motor control for the hip, knee and ankle.  Studies have shown this specific exercise to be a good cure for patellofemoral syndrome but it also has is recommended for ADL injury prevention and works for ankle rehabilitation.

Variations on this exercise can involve performance of the single leg squat on a flat surface (beginner), on an incline (intermediate) and on an unstable surface like a balance mat (advanced).

2. Theraband hip abduction and extension:

Not pictured in this video is the use of this same exercise setup but walking backwards (in addition to the walking sideways demonstrated).

This is a good exercise generally for restoring balance around the hips.  It also can be useful for treating lateral hip pain.

3. Cook hip lift:

Cook hip lift for strengthening hip extensors

A good exercise for re-educating/strengthening the hip extensors

A Word About Stretching:

Stretching is one factor that has been looked at extensively for this issue of injury prevention.  On any given field before practices or games (including soccer and most any other sport you can imagine) you will see teams running through stretching regimens.  Lawrence Hart, MD comments that “stretching has become embedded in sport folklore as the universal strategy for injury prevention.” [Clin J Sport Med. 15(2), March 2005]

Thacker et al. published a meta-analysis in the Clinical Journal of Sports Medicine in which they reviewed 361 studies reporting on flexibility, methods and effects of stretching and injury prevention.  They found that “stretching had no effect in reducing injuries.” [Clin J Sport Med. 15(2), March 2005]

So, go ahead and keep stretching if you want.  Just make sure you include some hip, knee and ankle strengthening exercises as described above.  And last but not least, a good core exercise program can help any athlete with performance and injury prevention.  There are lots of good core exercises.  My favorites are listed elsewhere on this blog at: http://www.backexercisedoctor.com/journal/2008/7/17/back-pain-generalities-and-my-favorite-back-exercises.html.

Comments

[jared weichers]

I can't find the article at this time, but it referenced the importance of athletes practicing single leg balance 2 minutes a day decreased the incidence of ACL injury by close to 50%. I did find one recent article that had a multifaceted injury prevention program that reduced injuries to the knee by an impressive amount the abstract follows:

Arch Intern Med. 2010 Jan 11;170(1):10-1.

BACKGROUND: Knee injuries end many careers among female soccer players. The number of injuries can be anticipated to increase because of the increasing popularity of the sport worldwide and the higher incidence of knee injuries among young females compared with males. METHODS: In a community-based intervention trial performed from February 1 through October 31, 2007, we sought to reduce the number of knee injuries among female soccer players aged 13 to 19 years (N = 1506), representing 97 teams from 2 Swedish counties. A physical exercise program designed exclusively for female soccer players was combined with education of athletes, parents, and coaches to increase awareness of injury risk. The training program aimed to improve motor skills, body control, and muscle activation. New acute knee injuries, diagnosed by the physician, were the main outcome measure. RESULTS: Three knee injuries occurred in the intervention group and 13 occurred in the control group, corresponding to incidence rates of 0.04 and 0.20, respectively, per 1000 player hours. The preventive program was associated with a 77% reduction in knee injury incidence (crude rate ratio, 0.23; 95% confidence interval, 0.04-0.83). The noncontact knee injury incidence rate was 90% lower in the intervention group (crude rate ratio, 0.10; 95% confidence interval, 0.00-0.70). Adjustment for potential confounders strengthened the estimates. Forty-five of the 48 intervention teams (94%) reported a high adherence of at least 75%. CONCLUSION: The incidence of knee injuries among young female soccer players can be reduced by implementation of a multifaceted, soccer-specific physical exercise program including education of individual players.

Injury prevention is an important component of any sports program.

[jared weichers]

Another good article that studied a cohort of individuals to determine good knee injury prevention strategies is below:

.
Source:The American Journal Of Sports Medicine [Am J Sports Med] 2009 Nov; Vol. 37 (11), pp. 2108-16. Date of Electronic Publication: 2009 Sep 24..

Abstract:BACKGROUND: Patellofemoral pain syndrome is one of the most common chronic knee injuries; however, little research has been done to determine the risk factors for this injury. HYPOTHESIS: Altered lower extremity kinematics and kinetics, decreased strength, and altered postural measurements will be risk factors. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: A total of 1597 participants were enrolled in this investigation and prospectively followed from the date of their enrollment (July 2005, July 2006, or July 2007) through January 2008, a maximum of 2.5 years of follow-up. Each participant underwent baseline data collection during their pre-freshman summer at the United States Naval Academy. Baseline data collection included 3-dimensional motion analysis during a jump-landing task, 6 lower extremity isometric strength tests, and postural alignment measurements (navicular drop and Q angle). RESULTS: Risk factors for the development of patellofemoral pain syndrome included decreased knee flexion angle, decreased vertical ground-reaction force, and increased hip internal rotation angle during the jump-landing task. Additionally, decreased quadriceps and hamstring strength, increased hip external rotator strength, and increased navicular drop were risk factors for the development of patellofemoral pain syndrome. CONCLUSION: Multiple modifiable risk factors for patellofemoral pain syndrome pain have been identified in this investigation. To decrease the incidence of this chronic injury, the risk factors for patellofemoral pain syndrome need to be targeted in injury prevention programs. CLINICAL RELEVANCE: Prevention programs should focus on increasing strength of the lower extremity musculature along with instructing proper mechanics during dynamic movements to decrease the incidence of patellofemoral pain syndrome.

[The Back Exercise Doctor]

Thanks for the feedback. Those are good articles. I really do like the single leg squat as an exercise for hip, knee and ankle issues/prevention.