The STATE of Soccer in WASHINGTON
by Neil Chasan, PT, MMT / See other “Soccer Health” columns here.
Sports Reaction Center www.srcpt.com
Suffering an Anterior Cruciate Ligament (ACL) injury during a soccer practice or match is devastating to the athlete. The injury means a lost year of competition, a painful and expensive surgery and rehabilitation process, and an increased likelihood of reinjury. On top of that, only a quarter of the players who have an ACL repair ever achieve their previous level of competition, and to make it worse, ACL repair comes along with an almost certain development of degenerative arthritis within 5 – 10 years. An ACL injury is worth avoiding!
Interestingly, almost 75% of ACL injuries are NON CONTACT injuries. It turns out that girls are about 6 times more susceptible to the injury than boys, especially during the growth period during adolescence, but this does not excuse boys from injury. There are approximately 200,000 ACL injuries in the USA each year with as many as 1/100 high school girls, 1/10 college athletes being victims. During the past 10 years, there have been more than 1.4 million ACL injuries, making it the 6th most common surgical procedure. It is amazing to realize that around 75% of these injuries are non-contact injuries.
ACL injuries occur because of the way the forces add up during sudden changes of direction. Now while the mechanisms are unclear, we do have a really good idea about how to avoid these injuries. In fact, ACL injuries affect so many professional athletes as well as amateurs, that FIFA has made a commitment to minimizing the risk with the development of the FIFA 11 program, a well-researched and proven effective program, but more on that later.
The ACL provides stability to the knee that is lost when the ligament is torn. It is difficult, but not impossible; to go through life without an ACL, especially if one plays a jumping or cutting sport. Many people rely on bracing to substitute for the ligament. The braces are effective, but not great to wear while playing soccer. An ACL rupture occurs when there is a combination of a landing or cutting activity while in an off balance, upright position. Like the girl in black in this photo:
And the injury occurs more easily if there is flexion, abduction and internal rotation associated with the off balance trunk, like the leg position of the girl in orange in this picture:
An ACL injury requires an invasive surgical procedure to repair the damage. Often, there are other injuries that go along with the ACL injury. These include meniscus tears, and cartilage damage as well as ligament tears and bone bruises. Secondary injuries, like the bone bruise, can complicate recovery. The result of this is that over 1.5 Billion Dollars a year is spent in surgical cost alone. The rehabilitation includes a long and painful period of physical therapy, with return to play typically a year away after hard training. In addition to possibly never returning to play at a high level again, many people simply choose not to play at all. Some data shows that as many as 40% of post ACL injured players don’t return to soccer. Those that do, however, are more likely to reinjure with a second ACL tear. Because of the weakness and atrophy that goes along with the injury, poor rehabilitation often leaves the leg more vulnerable to a second injury, and sadly, as noted, osteoarthritis is pretty much guaranteed, even with a successful repair.
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Thanks to ongoing clinical research, there is a way to actually objectively predict risk of injury, and there is also to proven method to implement a progressive strengthening program that is preventive. At Sports Reaction Center, we offer a low cost risk assessment using video and a biomechanical analysis to predict risk. Prevention is next: We train athletes using a tested Prevention Program in our clinic. We also direct coaches of teams to implement the FIFA 11 program during warm ups to help reduce the general risk to their athletes and the incidence of ACL rupture in a meaningful way. We recommend the therapy we do because it works! (The scientific research our program relies on and includes is proven to be effective at reducing risk of ACL rupture, and it is statistically significant). Our ACL Risk Assessment and Prevention Program involves a pre-test, five phases of progressively more challenging exercise over three months of regular training to reduce the risk of ACL rupture objectively, and we conduct a post-test to verify that in fact the risk is reduced. The program is individualized with each participant coached to master each exercise progression before moving on to the next exercise or phase. Through this process, we help players who are at risk improve their biomechanics by attending to the details. In other words, each exercise has to be completely mastered in order to move forward.
The Risk Assessment involves video analysis and assessment of several objective factors to determine one’s personal individual risk of suffering a high load injury at the knee. Depending on where your team is located, we can actually come to you to assess your players at the field, but our restoration program is typically offered under supervision in our clinical setting under supervision. Our program offers a range of attendance opportunities.
The exercise program we implement to correct for ACL risk includes balance challenges, landing skills, plyometrics, muscle imbalance fixes, core strength, leg dominance fixes, and power development. These exercise progression have been tested in the laboratory and proven to make the difference in a lowering ACL injury risk.
If you look like this girl when you land, then you are a good candidate to participate in our Risk Assessment and Prevention Program because you are at high risk to suffer an ACL injury.
On the other hand, the FIFA 11 program, if properly implemented by coaches will reduce the risk of the whole team. I highly recommend that all coaches implement the FIFA 11 program as part of the warm up sequence for their teams. You can read about the FIFA 11 program here and see the videos of the exercises and even download the manual. The FIFA 11 program represents a major effort by FIFA to reduce unnecessary and preventable injuries in all age groups.
Regardless of which strategy you choose, a personalized scientific approach in the clinic, or a team based approach, it is clear that there are well understood strategies to prevent this devastating injury. The best strategy to deal with ACL injury on the field, is to avoid it all together. By doing so, you can anticipate a long playing career!
Neil Chasan, PT, MT is the founder of Sports Reaction Center, a Physical Therapy Clinic for Active People, in Bellevue, WA.
Neil was born in South Africa where he played soccer from the time he could walk. As a young lad, Neil was coached by Sir Stanley Mathews, the legendary English player. In High School, Neil put together and coached the high school team (he went to a rugby school where even the word “soccer” was forbidden). On his arrival in the USA, Neil coached an introduction to soccer workshop through the Experimental College at the University of Washington, and he played GSSL Division 1 with the Mueller Barons. As his first of four children came of age in 1993, Neil started coaching youth soccer and joined the Board of Directors of the Mercer Island Youth Soccer Club in Washington where he served for 7 years, and most importantly, where he created the Micro-Soccer program which introduces soccer to over 400 five and six year old kids each season. In addition, Neil coached 12 seasons of Recreational soccer, 3 seasons of Club Select and Premier soccer, and 5 seasons of High School soccer. Along the way, Neil earned his National “C” coaching license from US Soccer. His passion for the game extends to his status as a fan, first of “Highlands Park”, perennial South African champions, and now of his favorite, Sounders FC.
About the Sports Reaction Center
Based in Bellevue, Washington and attracting athletes of all levels from the Bellevue, Seattle, Kirkland and Redmond areas—as well as around the United States—the Sports Reaction Center (SRC) was founded by Neil Chasan in 1997. SRC performs sports physical therapy services that incorporate innovative technologies such as Dynavision and the NASA-developed Alter-G. The clinic additionally offers concussion management and a comprehensive ACL Risk Management Program. SRC’s clients also include many athletes who have qualified for the Olympic Trials in Track and Field, as well as World Championship marathoner Mike Sayenko, Olympic hurdler Virginia Powell, and NFL, NBA, MLS and MLB players. The clinic also works with area organizations such as Club Northwest, VO2 Multisports and the Seattle Rugby Club and several youth soccer teams. A graduate of the University of Washington’s physical therapy program in 1982, Chasan is a consultant to the U.S. Olympic Training Center, U.S. Rugby Sports Medicine, and Alter G. Neil is the author of the book Total Conditioning for Golfers, and the creator of the video “The Swing Reaction System”. Neil also published “Pain Free Back,” an iPhone application, and the eBook “It’s Only a Game: A Handbook for Youth Soccer Coaches”. Neil serves on the Bree Collaborative Spine and Back Pain work group, and Seattle Rugby Club Board of Directors. A published clinical faculty member of the University of Washington’s physical therapy program since 1990, Chasan teaches and consults with physical therapists around the world.