Whenever we work with soccer teams, particularly women’s teams, one question constantly comes from parents. “What are you doing to protect her ACL?” It’s a very valid question, considering over 50% of collegiate women’s soccer players have at least one ACL tear during their careers. Before we can answer it though let’s define our risk factors.
Your #1 predictor, as always, is previous injury and I can’t do much about that one. Your secondary predictor though is the tendency for the knee to collapse or go “valgus”, particularly when landing or serving as a plant leg during cutting or kicking. So let’s try to understand a valgus knee. If you look at the video you can see that the knee begins to cave simultaneously to the greater trochanter rotating up and away from the hip socket. If you look a little further down the line you can see the ankle collapsing as well. So we have now linked our foot and hip to the knee problem, but how do we fix the knee issue?
At the hip either our internal rotators are a bit tight, or our external rotators aren’t quite strong enough to create the requisite stability at the hip. So if you look at our scorpion position in the photo you can see we are using our external rotators (the GLUTES) to increase mobility at our internal rotators(groin). Judging by the picture I’m guessing we’re looking at more of a stability issue with these girls. They look pretty mobile.
Now it’s time to strengthen the hip (primarily the piriformis) and stabilize that foot (nine times out of ten it turns out to be the piriformis too). We find that single leg exercises done BAREFOOT are the best way to teach this. We focus our athletes on “listening to your foot”. As the athlete begins to figure out how to move their body in a way that prevents ANY shifting of weight at the foot, they will 1) re-center their femur within the socket 2) their glutes will burn significantly 3) their knee will NOT collapse in.
So if we have eliminated the valgus knee have we bullet-proofed your daughter’s knee? It’s actually arguable, depending on the research you’re reading, ACL prevention comes down to either the right mobility/stability ratio at the hip (which we’ve now dealt with) or it has nothing to do with the strength or ability to stabilize the knee, it has far more to do with the timing of the firing pattern and how quickly the brain is receiving proprioreceptive (3D GPS) input from the ankle, knee and hip. Here’s the cool part though, the two best ways to speed the relay from the foot to the brain are… 1) increasing stimulus on the foot itself (like running barefoot outside or on turf) 2) centering the joints that the message has to travel through (particularly the hip). Both of which are already staples in our program.
So after way too much talking, here is your takeaway. Good training should absolutely be built around joint centrification and improving the foot’s relationship with the ground. As it turns out those two primary concepts are how you prevent the non-contact ACL injury as well. So a good, fundamentally sound training program has the same focuses as a good, fundamentally sound ACL prevention program. Once again, move well and things tend to work themselves out.
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