|
 Marc R. Bernier is a physical
therapist and certified strength and conditioning specialist at HealthSouth Sports Medicine & Rehabilitation
Center in Birmingham, Ala. The national coordinator of the HealthSouth
Sports Soccer Program, he has served as a sports medicine consultant to
the Galatasaray Professional Football (Soccer) Club of the Turkish First
Division. Additionally, he is the sports medicine and training advisor to Soccer Jr. magazine and is the president/owner of Athletico Soccer
Conditioning Systems.
The successful soccer athlete relies on the precise coordination of
stability, agility and power production. When healthy, the soccer player
trains these components during everyday drills, scrimmages and games. When
injured, however, deficiencies result that can reduce the athlete's level
of play or even cause re-injury. As sports medicine clinicians, we must
realize that the soccer player has unique ancillary needs that must be
addressed during the rehabilitation process in order to optimize the
functional outcomes of these athletes.
Proprioception and joint kinesthetic awareness are critically important
for both injury prevention and successful performance, in the soccer
player. The role that these characteristics play can be seen in almost any
skill of the sport. While kicking a ball, proper joint positioning of the
ankle must occur to ensure that the ball travels in the intended direction
and at the intended trajectory and velocity. If a player should land on an
inverted foot after jumping for a head ball, the afferent discharge to the
peripheral nervous system must be fully functional, allowing for reflex
splinting of the ankle stabilizing muscles to prevent an injury. Most
importantly, it must be noted that soccer is one of the only sports in
which the majority of the skills rely on a single leg stance while
performing. Kicking, shooting, trapping and passing all involve one
leg performing a skill while the other is providing single leg support.
This information should indicate to sports medicine professionals
that we must heavily train the proprioceptive and kinesthetic awareness
components during rehabilitation. This training, however, must be done
functionally. To fully appreciate the wide range of dynamic positions and
internal/external forces that a soccer player needs to be able to
stabilize and control, simply examine the game action photographs that
often appear in newspapers, magazines and soccer apparel catalogs.
Proprioception and balance are not static traits in sports; they are
highly dynamic and should be trained as such.
During the rehabilitation of soccer players, the clinician needs to
challenge the athlete's proprioception while performing soccer-specific
skills. As with all rehabilitative protocols, progression of the chosen
exercises is criterion-based, with mastery of one level required before
initiation of the next. The beginning of the program (depending on the
severity of the injury) should begin with single leg standing activities
on the involved leg while simulating different skills (Table 1).
Once the patient is able to display appropriate levels of stability
with the exercises outlined in Table 1,
the degree of dynamic stabilization required should be increased. The
reason for this increase is simple: soccer players rarely perform an
activity during a game from a stationary position. To be proficient in the
sport of soccer, it is imperative that players be able to perform the
skills while moving at varied speeds and in many directions. These
alterations place greater emphasis on the body's ability to stabilize from
a dynamic (muscular) standpoint, rather than a static (ligamentous) standpoint. Considering the subsequent muscular weakness and atrophy that occur
post-injury, the introduction of dynamic stabilization activities (Table 2)
into the rehabilitation process can provide significant benefits during
the return-to-play phase.
One other commonly overlooked component of sports rehabilitation with
soccer players is footwork training. As can be expected, soccer demands a
very high degree of agility and fast footwork. In a typical match, a
soccer player will perform more than 1,000 different activities
(sprinting, kicking, tackling, etc.), which change every six seconds. To
accomplish this feat, the player must be very "light on his or her feet,"
preparing for sudden changes in direction, unexpected passes or avoidance
of tackles from opponents.
While training this component is not typically done by sports medicine
clinicians, it Is easy to do in a clinical setting and patients enjoy it.
The easiest way to train footwork is by using some form of agility ladder,
which can be made or purchased from most rehabilitation equipment
catalogs. The ladder is made of plastic and nylon and lies flat on the
floor. The athlete simply runs through the ladder in any assortment of
patterns: forward, laterally, backward, grapevine, diagonals, etc. The
ladder is necessary because it forces the patient to hit an intended
target area, which requires full control of the lower extremities. The
emphasis is on light, quick steps and attempting to return the feet to the
ground as quickly as possible.
Footwork drills (Table 3)
are extremely important for soccer athletes because of the numerous quick
and repetitive changes in direction and speed that occur during a match.
It is impossible for a soccer player to explosively change direction or
speed while his or her feet are in the air. Consequently, the athlete
should return the feet to the ground as quickly as possible so that the
lower extremities can initiate the desired maneuver. Therefore, high-knee
running and related activities are not appropriate for soccer players.
The concepts discussed in this article will have a significant effect
on the functional outcomes of your soccer athletes. Subjective feedback
from several European players treated by the author has indicated an
actual immediate improvement in their overall level of play after acute
anterior cruciate ligament/medial collateral ligament injuries and
subsequent reconstructions, as compared to pre-injury levels. Additionally,
these activities will help restore the soccer player's confidence in the
injured region and should enable him or her to resume unrestricted play
sooner.
Address correspondence to:
Marc R. Bernier, PT, CSCS
HealthSouth Sports Medicine &
Rehabilitation Center
1201 11th Ave. S., Suite 100
Birmingham, AL
35205
SoccerPT@hotmail.com |
