How And When To Use An Injury Prevention Intervention In Soccer

How And When To Use An Injury Prevention Intervention In Soccer
Advertisement2. Prevention techniques used in soccer

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The majority of injury prevention training studies have generally examined the effects of individual components on injury incidence. However, this is not representative of a soccer specific environment where the time constraints dealt necessitates the development of a mixed conditioning approach that allows for the simultaneous development of several fitness qualities. From a practical perspective, injury prevention programs are implemented with the expectation that they will elicit improvements in performance (through increasing players’ availability and reducing lay-off durations when injury occur) and reduc

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e the incidence of injury, however, this is not always representative of research findings. Recently, it has been suggested that a multicomponent injury prevention intervention may increase motivation through an integrated approach within a team sport environment (Owen et al, 2013b). This particular investigation recently reported that significantly less muscle injuries were observed during integration of a 4-part injury prevention program concomitant with a bigger squad size (large effect, pOwen et al, 2013). It was reported during this investigation that high levels of contusion injuries were apparent within this study, which led the author to suggest that the multicomponent prevention technique is beneficial when integrated in order to reduce muscle injuries but may not be able to prevent other types of injuries (contact injuries). Prevention exercise is commonly included before, during or/and after the training sessions and matches. Within this chapter, we are going to describe the most common prevention technique used in soccer specific, especially by fitness coach. Sometimes one out of these is enough to reduce the injury occurrence, sometimes it is the combination of 2 or more that appears necessary.

2.1. Functional strength
Muscular strength is an important component of physical performance in sport, in terms of both performance and injury prevention (Fousekis et al, 2010). As a factor contributing to success in soccer, the quadriceps muscle plays a fundamental role in jumping, ball-kicking, and to a lesser extend, in sprinting, whereas hamstring contributes to the knee flexion, which is a major factor in stride power (sprinting or accelerate and decelerate). In addition to their direct contribution to athletic performance, the hamstring muscles are of paramount importance during running and stability activities (Zakas et al, 1995), which are continually required in intermittent team play such as soccer, which induces many short, explosive actions, directional changes and decelerations. Impairments in the eccentric muscle contractions involved in explosive phases of elite level soccer such as accelerations and the aforementioned decelerations may be linked to an increased risk of joint and muscle injury (Greig and Siegler, 2009). As a result, training interventions are continuously evolving in order to address this issue, for example Askling et al (2002) suggested that the addition of pre-season strength training for the hamstrings through eccentric overloading brings significant benefits for elite soccer players, both from an injury prevention and performance enhancement viewpoints.

A recent large scaled randomized controlled trial by Petersen et al (2011) addressed the efficacy of the Nordic hamstring exercise program (NHE, see more details here under in the eccentric strength section of the present chapter) for preventing acute hamstring injuries in soccer players. They found that introducing this ten-weeks program to reduce eccentric weakness, a common intrinsic factor associated with hamstring injuries, reduced the incidence of these injuries by 70%. This backed-up previous findings by Arnason et al (2008). Using a larger sample size Arnason’s study looked at a total of 24 teams, with over 650 soccer players, over a four years period. These players professional belonged from soccer teams in the Icelandic and Norwegian leagues. The study showed that teams combining the Nordic eccentric exercise protocol and the stretching program were on average undergoing 65% fewer hamstring injuries. When discussing functional strength within a preventative structure it is important that a gradual overload with the primary aim of increasing muscle strength through soccer specific movements is adhered to. Consequently, it is reasonable to suggest that a multicomponent approach to function strength is followed as a closer analysis of the Nordic hamstring exercise that only involves movement at the knee joint. The fact that the hamstring involves work over two joints (hip and knee), the Nordic hamstring exercise clearly doesn’t replicate any of the functional activities used in football specific training and therefore should not be used in isolation, but as part of a preventative strength program. In this context, Owen et al (2013b) had suggested that implementing a functional strength program as part of a multicomponent injury prevention structure may significantly reduce muscle strains/tears.

Since the physiological demands of soccer combine repetitive high-speed bouts with constant change of directions as well as physical contact with opposition players on a continuous basis, the fact that muscle injuries are accounted for a significantly high percentage of all injuries should not be unexpected. The hamstring muscle groups are responsible for accelerating and decelerating during high-speed running and sprints. Previous research has suggested that several reports from European elite soccer leagues revealed how hamstring strains are the most common type of injury in male soccer players (Junge and Dvorak, 2004). This is the reason for the functional strength aspect of prevention programs to include unilateral exercises that stress the hamstring and gluteal muscle groups through various ranges of lengthening. Figure 2 provides different possibilities of functional strength exercising.

Figure 2.

Functional strength program (fromOwen et al, 2013b)

2.2. Eccentric strength
Eccentric strength is considered as an important component of muscular strengthening. Despite complex eccentric strengthening protocols do exist, some simple on-field exercises have been implemented and proposed as a means to reduce injury risks. One of these is the famous ‘’Nordic Hamstring Exercise (NHE)’’ (mentioned above in the functional strength section of the chapter) that have been proposed to deal with the high injury and re-injury rates of soccer players’ hamstrings. The reasons of this muscular group for getting injured has been proposed by Proske and Morgan (2001), with the heterogeneous arrangement of individual muscle sarcomeres inducing microscopic damage coming from non-uniform stretching during eccentric actions. If eccentric movements are repeatedly performed, such as in soccer, this might provide a weak point at the level of muscle architecture, inducing a higher injury risk. Hamstrings are susceptible to injury during terminal swing phase of the leg while sprinting (Schache et al, 2009) because firstly, peak hamstring musculo-tendinuous stretch seems to occur during the swing phase before the foot contact with the ground; and secondly, hamstrings are undergoing an active lengthening contraction during late swing, producing the potential conditions or a strain injury to occur.

The interest of the NHE lies in the fact that it has been shown that it elicits higher activation of the hamstrings compared to a selection of exercises that are routinely used in classical “strength training” or injury rehabilitation (Ebben et al, 2006). In this context, it has been suggested that an eccentric peak torque increase could improve the capability of the hamstrings to absorb energy prior to failure, therefore, reducing the risk of injury (Stanton and Purdham, 1989). Therefore, Arnasson et al (2008), have prospectively investigated over four consecutive soccer seasons ( ) the number of hamstring strains vs. players’ exposure for 17 to 30 elite soccer teams from Iceland and Norway. They reported a lower incidence of hamstring strains amongst teams utilizing the eccentric training program vs. the controlled group of players. It was revealed