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Fitness first - How to prevent ACL injuries

One of the biggest fears of professional footballers is to suffer an injury so serious it will keep them out of action long enough to miss a whole season.

That could threaten one’s contract with a club, performance and self-esteem. The rupture of the Anterior Cruciate Ligament (ACL) on the knee is probably one of the most dreaded injuries in football, and a common one it is. It is a non-contact injury, and it is impossible to predict when such injury may happen.

A couple of weeks ago, 30-year-old Manchester United defender Nemanja Vidic (pictured) became the latest footballer to have ruptured the ACL.

This is sure to keep him out of the rest of the season as the recovery time of this kind of injury is nine months after surgery.

The knee is a very “stiff” joint (hinge joint) that can only flex and extend - unlike the shoulder, which can flex, extend, rotate, elevate, abduct, adduct and more.

One of four major ligaments

The Anterior Cruciate Ligament (ACL) is one of the four major ligaments on the knee located in the centre of the knee and attaching the femur to the tibia.

It prevents the tibia from extending excessively beyond the femur, and its tear typically results from a violent twisting of the knee when landing from a jump or deceleration phase of a quick directional change.

The quadriceps and hamstrings attempt to control the deceleration on the knee, but the position places a great overload on the ACL.

There are many studies available that suggest possible factors that could lead to an ACL injury, such as the different cleats in football boots, weakness in hip and/or ankle stability, poor form, weak hamstrings and genetics.

Trying to find out which factor has caused such injury is nearly impossible, as one could have led to the other. However, like many things, you can put a few simple measures in place to significantly reduce the possibility this injury might happen to you.

Prevention

Surprisingly, strengthening the quadriceps and hamstrings with a resistance training program actually does not have a high rate of impact in the prevention of ACL injuries.

On the other hand, knee stability and balance training along with plyometric exercises have been found to help.

Stability and balance training enhance the co-contraction of the quadriceps and hamstrings, aiding in the stabilization of the knee joint and reducing the ligament loading in the deceleration process.

These, along with plyometric training, reduce muscle response times so players are more able to perform rapid and unexpected sports maneuvers with less of an overload on the ACL, reducing the incidence of injury.

So who should do these exercises? Any footballer, professional or not, who has a previous history of ankle injury and hip instability should keep up stability and balance training and a plyometrics program for the lower body.

Family history

I would also advise those who have a family history of ACL tear to enroll in such programs, as they will be more likely to develop such injury than others.

The quadriceps are a group of four muscles that run along the femur. The vastus medialis is the lowest portion of it, being located on the inside of the leg just on top of the knee.

It’s very prominent causing a typical roundness around the internal (medial) top part of the knee.

Standing on one leg, perform three sets of 15 repetitions of small knee bends on each leg. You can advance this exercise with the use of a tilt/balance board. To increase difficulty even further incorporate dual tasks, such as raising your arms sideways while squatting.

This exercise helps to increase body and joint proprioception.

Antagonists

The adductors are the inner thigh muscles, and abductors are on the outside of the leg. Those two muscle groups are antagonists, as the hamstrings and quadriceps are. It is important to make sure they are evenly strong to prevent instabilities on the inner and outer knee.

For adductor strengthening lie on your side and support your head with your hand and elbow on the floor. Bend the knee of the top leg and place your foot flat on the floor, then keep the bottom leg straight whilst raising it up and down with your toes pointing forward.

Still lying on the same side, bend the bottom leg, straighten the top leg and with toes pointing forward, raise the top leg up and down.

Perform three sets of 15 repetitions for each exercise for each leg. You can add more resistance by using ankle weights.

Plyometric Exercises Plyometric exercises are explosive and designed to build power, strength and speed, emphasising neuromuscular control.

Landing

The most important element when considering performance technique during plyometric training is the landing - it must be soft with a bent knee and a straight hip. While these exercises can be basic, it is critical that they are performed correctly.

Plyometrics can increase the risk of injuries if you don’t follow certain safety precautions and are only recommended for well-conditioned athletes. Make sure you warm up thoroughly before starting, and build up gradually from small jumps, landing softly to absorb shock.

Perform these exercises on soft surfaces only and make sure your footwear has plenty of cushioning.

Use plyometrics sparingly and associated with proper training. Explosive Squat Standing with your feet slightly wider than your hips and your toes forward, bend your knees so that they are right over your toes, pushing your butt back a little, and with your hands in between your knees, touch your finger tips on the floor with your hands between your feet.

With the weight on your heels, jump and reach your hands up, land softly on the ball of your feet and touch your fingers tips on the floor again.

Technique

Take care over your technique to ensure that your knees don’t collapse inwards and the feet don’t turn out. Perform three sets of 20 reps.

Lateral and Forward/Backward Hops Standing with a small object on your left as a marker, hop over it with your feet together landing softly on the balls of your feet and bending the knees, hoping back to the right afterwards. Gradually build up from smaller to bigger jumps.

You can then hop forwards and backwards over the object using the same landing technique, always keeping the knees slightly bent. Perform each exercise 20 times.

To increase difficulty you can do single leg hops. If you feel any pain in your joints when performing Plyometrics stop immediately.

Everyone is different and exercises that suit some might not suit others. I recommend seeking a professional athlete trainer, a coach or even a personal trainer that could assess how you are performing these exercises and add to your program with more suitable exercises for your body type.

Stretches

The use of stretches when you are trying to prevent knee injuries is controversial. I would recommend you only stretch after your match or exercise program.

Stretches that are held for 30 seconds or longer are proven to 'switch off' the muscle. For that reason it would be better to perform them after your workout, not before.

Also excessive flexibility in athletes who are prone to such injuries can lead to joint laxity, causing instabilities, which may in turn cause injuries. Any excessive flexibility should be balanced with strength training exercises.

These exercises are only a small sample of the vast range of exercise programs available.

For additional exercises I would strongly suggest you seek professional advice from a coach or personal trainer that can tailor a program specific to your body type and form.

By Bruno C. de Jongh - Bowen, Emmett and Shiatsu Practitioner

After completing studies in Shiatsu Massage and acquiring a degree in Physiotherapy in Brazil, Bruno de Jongh came to England and embarked on a successful career as a fitness instructor, teaching in health-clubs across London. During this time Bruno discovered The Bowen and Emmett Techniques which have proven to be valuable tools when treating conditions that previously have not responded well to conventional treatments. Bruno opened his own practice The Calm Blue Room in 2009 in Waterloo, London, and has already aided over 600 people with a vast array of ailments and conditions, enabling them to recover a life full of energy, physical health and emotional well-being - www.thecalmblueroom.com


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