Common Soccer Injuries Knee Injuries

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                     Common Soccer Injuries
               Created by Michael Deegan DPT Hillsboro Physical Therapy

Recognizing, Treating, and Preventing common soccer injuries

        As any player knows, soccer is a high performance sport that requires speed,
strength, flexibility, agility, and endurance. In order for athletes to remain in top physical
condition they need to train properly and also know how to manage and treat the various
injuries that are bound to occur while playing in highly demanding games and over long
seasons that often become year round regimens.

        It is important that athletes, coaches, and parents be able to
recognize common soccer injuries and be knowledgeable about
how to prevent and treat certain kinds of injuries so that the
athlete can continue to play and perform at a level that is
appropriate for the demands of the game.

        The information that is given below is the second of a four
part series on common soccer injuries, and will hopefully give the
athlete guidance about how to maintain health in the face of injury and potential injury.
Michael Deegan is a physical therapist at Therapeutic Associates Hillsboro Physical Therapy.
Michael has both played and coached soccer at the High School and Club level in Southern
Oregon. If you have any questions please feel free to contact Michael Deegan, DPT or Timothy
Brinker, PT, OCS, COMT, FAAOMPT (Director) at 503-844-9294 or email
                                  Knee Injuries

Anterior Cruciate Ligament (ACL) sprain/tear:

How does the injury occur?
     Typically ACL sprains/tears occur as a result of either non-contact or
     contact traumatic injuries
     ●Non-contact (approximately 70% of serious knee injuries are non-
          -An audible pop often accompanies this injury, which usually
          occurs while changing direction, cutting, or landing from a
          jump (typically a hyperextension/pivot combination occurs).
          -Athletes are usually unable to return to play because of pain,
          swelling, and instability or giving way of the knee.
          -These injuries usually occur as a result of contact at the front
          or side of the knee
          -These injuries often are associated with other ligamentous and
          meniscal injuries

                                                   The ACL limits forward
                                                   translation of the tibia (the
                                                   large bone in the lower leg)
                                                   on the femur (the upper leg
                                                   bone). This view is looking at
                                                   the front of the knee, and the
                                                   patella (knee cap) has been
                                                   removed in order to visualize
                                                   the ACL

What is the epidemiology with regard to ACL injuries?
     ▪An estimated 80,000 ACL injuries occur in the U.S. every year
     ▪The estimated cost of these injuries is over a billion per year
     ▪An ACL injury is 2-8 times more likely to occur in females than
     ▪95% of ACL injuries occur within the age ranges of 16-45
     ▪The average age is 26
     ▪Ages 16-26 account for 50% of ACL injuries
     ▪Soccer and basketball are responsible for greater than 66% of ACL
     injuries in females 16-26
How can ACL injuries be prevented?

       While there is not presently a “clear understanding of the cause of
non-contact ACL injuries . . . prevention programs designed to increase
neuromuscular control, improve balance and teach avoidance strategies for
at risk situations appear to be effective in decreasing injury rates.”
-Journal of American Academy of Orthopedic Surgeons, 2000

      ▪There are 5 important components that need to be addressed when
      trying to control for mechanisms of non-contact ACL injury

   1. Postural control: this relates to proper control and orientation of the
      upper body/trunk and the hip, knee, and ankle
   2. Technique: an athletes technique with running, jumping, turning, and
      twisting must be perfected
   3. Knee position: the knee alignment and balance are crucial in helping
      to dissipate abnormal forces in the knee
   4. Neuromuscular: the ability to fine tune the body’s position sense,
      reaction timing, and muscular patterning are helpful when attempting
      to deter injury
   5. Muscle: developing appropriate strength, sequencing, and
      conditioning for specific muscle groups in the hips, knees, and ankles
      help to improve knee positioning

What general exercises can be used to help address these 5
important components related to ACL injury?

Flexibility: Stretches should be performed after a 5 minute warm-
up and after a 5 minute cool down post-activity. All stretches
should be held for 30 seconds.
                                  Hip flexor

Calf                              Quadricep

       IT Band                      Piriformis

   Pictures provided by Visual Health Information

   Strength: exercises should be performed to fatigue and adequate
   rest should be allowed between sets. Strengthening is best
   performed on an every other day basis. Emphasis should be placed
on maintaining the center of the knee over the 1st and 2nd toe while
performing the exercises.
  single leg

Emphasis of these exercises should be to reach with the leg as far as possible while

step up /

Speed / Strength / Proprioception: Maintaining the center of the
knee over the 1st and 2nd toe while performing the hopping and
jumping activities is fundamental. It is important to be able to
    quickly hop to one position and back in a controlled manner with
    proper alignment.
double leg

single leg

    What prevention programs are available for athletes?

    Santa Monica Orthopedic and Sports Medicine: The PEP program This program can be taught to teams and groups by
    Hillsboro PT staff

    Cincinnati Sportsmedicine Research and Education Foundation:
    Sportsmetrics USA.
    This program is available through Therapuetic Associates Physical Therapy

    How do you treat an injury when it occurs?
 ▪Rest, Ice, Compression, and Elevation (RICE) are the main stays of
initial treatment to help protect the joint, control inflammation,
swelling, and pain

 ▪In the setting of a mechanism of injury as stated previously along
with significant swelling and pain, it is important to see your regular
physician and receive a referral to an orthopedic physician. A MRI
should be used along with a thorough clinical examination to
determine the extent of the injury.

 ▪If a MRI is positive for a tear and the knee is demonstrating
instability with clinical testing, then the likely course of care is to
pursue operative repair.

 Pre-operative care:
 ▪Phase I: It is important that the swelling is well controlled and the
knee demonstrates appropriate range of motion, strength, and
proprioception. It is particularly important to have full extension
(straightening) prior to having surgery.

 Post-operative care:
 ▪The physician will determine the appropriateness of the type of
rehabilitation program that will be used after surgery.

 ▪Typically the rehabilitation is broken up into three phases after
      -Phase II: weeks 0-2 postoperative
             Goals include:
      1. Obtain full extension relative to the uninvolved leg
      2. Achieve 90 degrees of flexion (bending)
      3. Improve quadriceps muscle control
      4. Minimize swelling
      5. Promote incision healing

      -Phase III: 3-5 weeks postoperative
            Goals include:
      1. Normal gait pattern without assistive devices
         2. Range of motion: 0 degrees extension to 125 degrees
         3. Increased tolerance on closed kinetic chain (feet in
         contact with the floor) exercises
         4. Normal patellar (knee cap) mobility

         -Phase IV: week 6 through discharge
                Goals include:
         1. Strength: 70% of uninvolved leg as measured on a
         one repetition maximum leg press test or other closed
         kinetic chain functional test, such as a single leg squat
         excursion or lunge distance.
         2. Return to full recreational and sport activities as
         previously indicated by the athlete
         3. Range of motion: 0 degrees extension to 135 degrees

What does an injured ACL look like on a MRI?
This is a side view of the knee. The
oval represents where the ACL
should be. The black on the
periphery of the oval are the
remaining components of the ACL
that are still attached to the bone.

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