Football prevention symposium

It was the second online symposium of the VBG (statutory accident insurance Germany) which took place on October 22nd. Physio Restart took part and summarizes the most important information we took away from the excellent speakers. VBG – Homepage

We regularly participate in online and live courses and congresses to utilize this information and ensure that we can provide our patients with evidence-based, and if not already available in the literature, good quality treatment.

Anneke is a sports physiotherapist for a local soccer team in Zurich and started as a substitute sports physiotherapist for the SFV national teams. Oliver currently coaches a floorball team and has experience in ice hockey.

What is the most common injury in football?

The ischiocrural muscle group(hamstrings), which is located on the back of our thigh, is often injured in this sport. The biceps femoris in particular is predominantly affected at 79% (BJSM). However, the mechanism of injury, prevalence and treatment are“a major, as yet unknown problem“.

The most common injury to this muscle group occurs during the lunge movement (59%), along with kicking (30%) and landing (7%).

If a player is in a stretching position with the back of the leg (extended knee) and is about to slow down or stop the movement, he or she has a 52% risk of injuring this muscle group. In a sprint during the moment of acceleration, the risk is 48%.

What kind of training should be included in soccer training?

For sure: sprints! Most of a soccer player’s training sessions should include sprints with variations: Changing direction, slowing down and stopping.

Eccentric exercises should also be included. These exercises implement “force production during active muscle lengthening” (Harris-Love et al. 2021). One example is the Nordic hamstring curl for the back of the thigh(see image below). If we want to do this exercise on the sidelines, two players should fix the legs (not just one).

Nordic Hamstring Curl (NHE)

Important: only move forward far enough to avoid a hollow back. Otherwise, feel free to drop forward onto your hands. Feet must be well fixed.

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Train SMART!

Another factor is plyometrics, this type of training focuses on “repetitive rapid stretching and contracting of muscles (as by jumping and rebounding)” (Merriam-Webster).

An important factor to consider is how and when we incorporate these specific training components. Each performance of exercises should consider the individual player, especially if he or she has had an injury to the affected muscle group. Fatigue and pain should be taken into account. In addition, we must always incorporate variations with changes in: the type of exercise, repetition, duration, speed, resistance and range of motion. We must remember to perform increases if the player is performing well and is without compensation or discomfort. The same goes for regressions if the exercise is causing problems. And if the player has a game every Sunday, it makes sense to include the specific, more intensive and eccentric training in the middle of the week. To warm up before the game, it is recommended to perform isometric exercises that do not shorten or lengthen the muscle, for example:(see pictures below)

Supine bridge

Lift the pelvis only about 1 fist’s width from the floor and keep it straight, trying to prevent the left side from tilting.

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Prone Leg curl

For the isometrics of this exercise, we want to hold the leg at a certain angle (we like to test different angles). There is no movement.

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What other exercises are recommended for the back of the thigh?

Single leg romanian deadlift

Use little to no weight at first to learn the correct technique. The supporting leg is almost fully extended, look towards the floor, hips on one level, abdomen tensed to avoid a hollow back.

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Hip extension

When doing this exercise, many people make the mistake of moving their leg too far back and falling back into a hollow back.

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Romanian deadlift

To activate the back of the thighs more, we also stretch the legs in this exercise. Move the weight up and down along the legs close to the body.

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Note: The Nordic Hamstrings Exercise (NHE) is a widely discussed but proven injury prevention exercise for the back of the thigh in football. We must consider the potential to even cause an injury with this exercise if performed incorrectly. As it requires a lot of muscle strength and correct execution, experts recommend replacing the NHE with a guided push-up for the time being if necessary. The knees are placed on a towel and each hand on a football, while another person stabilizes the lower legs.

What are common mistakes in rehabilitation on the part of healthcare providers?

Neglect or absence of:

• correct diagnosis
• Adequate time management (late diagnosis and start of treatment)
• Tissue healing phases (too early or too late tissue loading)
• mental readiness (no teamwork with the patient)
• Individualization (non-specific treatment)
• Tests to check progress (incorrect progress or no progress at all)

Physio Restart ensures that we avoid precisely these mistakes. We do this with good cooperation from other specialists.

When is the time to return to sport after a muscle injury?

Everyone is different, it always depends on the type of person, the sporting and professional strain, age, previous injuries, treatment interventions (etc.), but we can assume the following: (VGB)

• Hardened muscle 1 – 3 days
• Sore muscles 2 – 5 days
• Muscle strain 3 – 5 days
• Torn muscle fiber 10 – 14 days
• Torn muscle bundle 6 weeks
• Muscle tear 12 – 16 weeks
• Muscle contusion 2 – 3 weeks

Last but not least:

We work with you, respect your thoughts and goals. We think outside the box and are ready for unexpected changes, modifications and customizations.

Author:

Anneke Klostermann and Oliver Penny

Book your appointment for physiotherapy, massage or group courses: here.