Preventing Lower Limb Injuries in Soccer Players Asimenia F.Gioftsidou,Phd,Paraskevi K.Malliou Democritus University of Thrace,Komotini,Greece
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© National Strength and Conditioning Association Volume 28,Number 1,pages 10–13 Keywords: proprioception; balance exercises; balance boards Preventing Lower Limb Injuries in Soccer Players Asimenia F.Gioftsidou,PhD,Paraskevi K.Malliou Democritus University of Thrace,Komotini,Greece to decrease muscle stiffness, and balance ripheral and central nervous system re- summary exercise programs to improve proprio- ceptors (5), mechanoreceptors within ception (1, 3). muscles; tendons; and ligaments have to The frequent use of balance exercis- be activated. Balance exercises seem to The focus of this article will be on how help this activation occur faster and es aids in the protection of athletes to incorporate specific balance exercises more effectively (9). In other words, the from possible injuries. We suggest for soccer players in an attempt to pre- goal of balance exercises should be to re- vent lower limb injuries. duce the time between neural stimuli that coaches include sport-specific and muscular response (15). Further- It is important to understand the differ- more, it is important that balance exer- balance exercises into a daily soccer- ence between proprioception and bal- cise programs improve proprioception training routine.We recommend the ance. It has been hypothesized that pro- not only during the rehabilitation prioception is important for providing phase, but also during the competition use of devices such as mini-trampo- smooth, coordinated movement as well period. This means that balance im- as protection and dynamic stabilization provement may decrease the risk of fu- lines and balance boards with the of joints (4). According to Sherrington, ture injury (6). combination of certain soccer abili- (10) proprioception is the awareness of body segment positions and orientations. Scientists (2, 3, 11, 14) support that bal- ties to be more interesting to the ance exercises are important to athletic Hanney (5) states that proprioception is performance and should be incorporat- players. “the reception of stimuli produced with- ed into an athlete’s daily training. Re- in organism,” whereas balance is “physi- search has shown that the frequent use cal equilibrium.” This means that pro- of these exercises may decrease muscu- occer is one of the most popular prioception is a neurologic process, loskeletal injuries and increase balance sports and attracts many partici- whereas balance is the ability to remain ability (3, 14). Spants all over the world (8, 11). in an upright position (5). Balance exer- This participation, though, leads to a cises are aimed at improving propriocep- More specifically, 1 study (3) mentioned substantial number of musculoskeletal tion; to train the brain to recognize the the positive effect of a specific balance injuries (7). To prevent such injuries, re- body’s segment position every moment. training program on the decrease of ante- habilitation specialists propose specific Therefore, a balance program will train rior cruciate ligament (ACL) injuries. This exercise programs, like strengthening proprioception pathways more effec- 6-week program was of gradual difficulty exercise programs to restore muscle im- tively under competitive circumstances. and was applied to healthy soccer players balances, stretching exercise programs Specifically, to prevent limb injuries, pe- (training group). The results showed that 10 February 2006 • Strength and Conditioning Journal Table 1 Contents of the Balance Training Program Drills performed on (a) trampoline, (b) hemicylindrical board,and (c) hemispherical board Training period Rest period between each drill First drill:heading 1st and 2nd wk:20 s/drill (total 8 min) 1st and 2nd wk:30 s (total 4,5 min) Second drill:leg passing 3rd and 4th wk:25 s/drill (total 10 min) 3rd and 4th wk:25 s (total 3,7 min) Third drill:heading and leg passing alternate 5th and 6th wk:30 s/drill (total 12 min) 5th and 6th wk:20 s (total 3 min) Fourth drill:control and leg passing 7th and 8th wk:35 s/drill (total 14 min) 7th and 8th wk:20 s (total 3 min) 9th and 10th wk:40 s/drill (total 16 min) 9th and 10th wk:15 s (total 2,3 min) (Each drill performed 2 times) 11th and 12th wk:45 s/drill (total 18 min) 11th and 12th wk:15 s (total 2,3min) the training group only had 13% of the in- cific sport, progressing from the easi- wooden disk, 51 cm in diameter, and 1 juries of the control group. Similarly, an- er to the more difficult. cm high with a round hardwood block other study (14) stated that the perfor- 3. Start performing the drills from the (9.5 cm diameter, 3.7 cm high) in the mance of a 10-month balance training more stable surface to a less stable middle of its under surface (hemispherical program on balance boards resulted in the surface. For example, perform drills board). The second board is a flat wooden decrease in the frequency of lower limb in- from a single-plane balance board to box, 35 cm by 33 cm, and 1 cm high with juries for healthy female handball players. a multi-plane balance board, or a hemicylindrical hardwood block (35 change the surface on which the length, 6 cm high) in the middle of its The content of a balance training pro- board is placed (from soft carpet to under surface (hemicylindrical board). gram should be adjusted to the peculiari- hard tile). The board with the hemispherical bottom ties of each sport (12). Balance exercises 4. Start performing the drills with open moves in all directions. The board with must be done in a controlled environ- eyes and then with closed eyes (if the hemicylindrical bottom moves anteri- ment in which the joints are moving in a that is possible). or–posterior or medial–lateral, according functional relationship to each other and 5. Try to increase the duration of each to athlete’s leg position on the board sur- to the same degree as in normal function- drill. face. With the use of these pieces of equip- al activities, including sports activities ment, the balance training program in- (15). In terms of relative difficulty, exer- Balance Exercise Program cludes 4 different soccer drills (Table 1). cises may be progressed by changing from Because physical therapists recommend bilateral to unilateral standing, from eyes that athletes perform balance exercises, During the first 2 weeks of the balance open to eyes closed, or by adding lower we suggest that coaches include balance program, exercises should be performed extremity motion or upper extremity exercises into a daily soccer training rou- for 20 seconds and then increased 5 sec- skills to the exercise routine (15). All the tine and combine them with soccer drills onds every 2 weeks (e.g., duration in- activities are designed to be a natural part to be more sport-specific and interesting. creased at 3rd, 5th, 7th, 9th, and 11th of playing movements (14). The balance Because our balance exercise program is weeks). Respectively, after the first 2 training exercises performed on balance for healthy soccer players, we suggest that weeks, the rest period between each drill boards require the combination of bal- they begin performing these specific drills should be reduced 5 seconds (from 30 ance ability and certain soccer abilities, in a closed-chain lower limb position (5, seconds to 15 seconds, gradually) (Table like kicking and heading (coming into 13). The proposed pieces of equipment 1). The progression of the balance train- contact with the ball using the forehead). are a mini-trampoline and 2 wooden bal- ing program should be from less to more ance boards. The use of a mini-trampo- challenging surfaces. Athletes start by Balance Exercise Program line can change the weight bearing surface performing the drills on a more stable Progression from hard to soft and provide an element surface, such as placing a board on a soft 1. Start from a 2-leg stance position, and of instability, thus requiring more control surface (e.g., carpet), and progress to a advance to a 1-leg stance position. in the weight-bearing lower extremity for less stable or hard surface (e.g., tile). 2. Select basic drills related to the spe- stability (15). The first board is a flat This can also be achieved by increasing February 2006 • Strength and Conditioning Journal 11 Figure 3. Athlete stands on the mini-trampoline and tries to return the soccer ball by passing it back to the coach. Figure 1. Athlete stands on the mini- trampoline and tries to re- turn the soccer ball by head- ing it back to the coach. Figure 4. Athlete stands on the board with the hemicylindrical bottom surface and tries to return the soccer ball by passing it back to the coach. the distance the coach stands from the lete does the same drill on the board player. The changes to the balance train- with the hemi-cylindrical bottom sur- ing progression should be made every face and then on the board with the second week (e.g., 2nd, 4th, 6th, 8th, hemispheric bottom surface. Continu- 10th, and 12th weeks). The balance ex- ally, while a player is first in a 1-legged ercise program’s duration and progres- stance on the mini-trampoline or on 1 sion can be found in Table 1. of the 2 different wooden boards, he or she will attempt to return the soccer The soccer specific drills that were cho- ball by heading it back to the coach sen for this specific balance program are (Figures 1 and 2). as follows. Leg Passing Figure 2. Athlete stands on the board Headers In this drill, the soccer player is in a 1- with the hemicylindrical In this drill, the soccer player stands legged stance position on the mini- bottom surface and tries to with both feet on the mini-trampoline trampoline and tries to return the soccer return the soccer ball by and tries to return the soccer ball by ball by passing it back to the coach.