SOCCER REHAB

The Soccer Athlete

Soccer players are unique athletes from both a musculoskeletal and metabolic perspective.  Frequently, rehab professionals fail to understand and treat these unique demands during injury recovery, leaving the athlete both unprepared for their sport, and at risk of injury when returning. So how are soccer players different?

• • High aerobic AND anaerobic demands - Few sports demand the level of aerobic endurance as soccer, while also requiring frequent bursts of anaerobic effort (some combat sports like boxing, MMA, wrestling also require this).  Elite players cover an average of 10-12 km per match, with an energy expenditure of around 1500 kcal. The majority of this running is done near the anaerobic threshold at 80-90% max heart rate, with an average of 10-25 all out sprints, high intensity running every 60-90 seconds for 90 minutes, and dozens of challenges / tackles which are all anaerobic efforts.  This means that while aerobic glycolysis and stored muscle glycogen serve as the primary energy system during a match, we see that aerobic oxidative, anaerobic glycolytic, and phosphagen systems are also essential. In fact, there is a direct correlation between the ability to use anaerobic / phosphagen systems and higher level of competition. When fatigue sets in, our risk of injury multiplies; the incidence of muscular and ligamentous injuries in the final 15 minutes of each half is much higher than the rest of the game in amateur and elite soccer. From a rehab perspective, this means that it is crucial to find alternative ways to train and measure aerobic and anaerobic fitness during injury recovery.

  • Asymmetrical movements - most players are right or left footed, and rely heavily on controlling the ball, passing, and shooting with that foot. This is, of course, true for handedness in upper body sports as well, but creates unique challenges in the legs as they are used for both propulsion and striking the ball.  Asymmetries develop due to different muscular requirements between a stance or planting leg, and a swing or striking leg. Foot dominance also affects which direction we shield an opponent, which directions we prefer to turn, and how we open and close our hips.  As evidenced by a significant difference in injuries between dominant and non-dominant legs in recreational and elite soccer players, these asymmetries likely increase specific injury risks that can be minimized through proper rehab and strength training. 

  • Position specific requirements - Every team sport has position specific requirements, but having a therapist or performance coach who understands these requirements will prepare you better for a safe return to sport.  In soccer, we see position specific differences in the energy system requirements, specific movement patterns, joint range of motion, number of challenges, number of sprints, and more. Position and playing style can therefore affect injury risk. For example, wingers / outside mids have been shown to perform the highest number of sprints per game; repetitive sprinting increases risk for hamstring and calf muscle injuries, and exercise interventions must match these demands in rehab and performance training. Center mids have the highest overall incidence of injury, as well as most distance covered overall and at moderate to moderately high speeds; aerobic fitness, and safe change of direction strategies are particularly important to reduce injury risk in that position. Center back and center forwards, on the other hand, engage in more aerial duals and may benefit more from certain plyometrics and aerial contact drills.

  • Greater single leg stance time - when one leg is occupied with controlling the ball or trying to block a pass / shot, more time is spent on one leg. This increases the demands of the hip and ankle stabilizers and predisposes the player to risk of contact injuries on the single planted leg.

  • Joint position during soccer specific movements - once again, the fact that in soccer alone, the legs are used for both propulsion of your body as well as your tool to control the ball, pass, shoot, block a shot, etc., means that the movement patterns and positions we get ourselves into are different from every other running and cutting sport. Deceleration while reaching to block a pass or shot is common way to tear an ACL, which is unique to soccer. Sprinting, while reaching a little too far to reach the ball you failed to perfectly control, increases risk of hamstring and groin injuries - groin injuries which are more frequent in soccer than any sport but hockey. Goalkeepers have very specific movement patterns, including the need for hip internal rotation to drop the knee to block a shot through the legs. Strength training muscles and joints through the full range of motion they need to go through in a game is crucial to reduce certain injuries which occur at the extremes of our range of motion.