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Simple (P)Rehab For Footballers - Better Prevention & Less Damage Control

15 Feb '2019

“Coach.” I turned around to face one of my newest soccer players behind me, standing awkwardly with both hands on her left hip. “My hip has been hurting since my game on Sunday.”

We ran through a brief assessment. I asked about the game, what happened, and what she had done the previous week that may have triggered this flare-up.

“There was nothing. It just started hurting after the match,” she said. “But it’s funny - now my ankle, knee, and my hip on my left side hurt!”

She was new to our gym, and we couldn’t run individual assessments on players who came for team training, so we had never addressed previous issues, nor had the coach said anything. We ran through her injury history quickly.

“It feels like ‘head, shoulders, knees and toes’”, she laughed.

“Well,” I shrugged. “Maybe it’s Back, Hips, Knees, Feet… Knees and Feet. They all go together!”

She looked shocked, but we finished our assessment and I assigned her a set of five exercises to be completed each morning and each evening for a total of five minutes per day for one week.

One week later, she came back to team training, looking even more stunned. “Coach,” she said this time, hands open in front of her this time. “I feel so much better!”

————

The human body is an absolute master of adaption. This means that, when something in the body is amiss, it can easily overcompensate for this… for a short time. If issues carry on for any length of time, they may take a toll on the body, especially in high-impact, high-volume, and contact sports like football.

In my role as a Return-To-Play specialist, I have seen all kinds of injuries - contact/non-contact, neurological, severe, acute, chronic, joint problems, bone breaks, tendonitis and -osis, biomechanical issues out the wazoo…

But it all comes down to this: instead of focusing on rehab and damage control when athletes are injured, we need to get better at foreseeing and correcting problems before they can even crop up.

In football, there are three main contributing areas that require respect and extra awareness from coaches and athletes: feet/ankles, knees, and hips.

Let’s go!

 

1) Your feet matter… a lot!

Excuse me for geeking out, but our feet and ankles are pretty AWESOME.

We run with them, we kick with them, we change directions with them, jump with them, land on them, pivot on them. They absorb force and then re-generate it at wicked speeds against the ground.

But what happens to our bodies when our feet don’t function as optimally as they should, especially because we rely on them so much? What’s really happening when we cannot properly absorb and create force?

Pronation vs. Neutral vs. Supination As compensatory masters, sometimes our feet and ankles overwork themselves in order to make up for something else in the body. This leads to vulnerability and the possibility of more serious problems.

One common issue I see is in the feet themselves, due to a lack of ankle mobility. The athlete begins to strike the ground while walking or running on the outside or inside of the foot, instead of the center of his or her mid-foot. This is called Pronation (in) or Supination (out).

Ultimately, the foot compensating one way or the other can lead to additional problems, such as shin splints, achilles discomfort, and unspecific knee or back pain. So how do we ensure that our feet remain neutral?

Barefoot training is a great tool, especially during single-leg and balance exercises. Strengthening the feet and gaining proprioception (or awareness) in the ankles is also vital.

Here is one of my favourite exercises for warding off an uncanny foot strike:

https://youtu.be/fnPbFTcW4OY

 

Poor Ankle Mobility & Stability This is a touchy subject for many coaches, because it’s riddled with misconception and Instagram fads.

Should you use a BOSU Ball? Do we need to train on a balance pad? Must we test single-leg jump height? Should you single-leg jump 400 meters? Does stretching help?

The quick answer to all of these things is “um… no”.

Ankle training is actually more simple than we often make it out to be. Because, in football, we never encounter uneven or wobbly surfaces like the BOSU or pads on the actual pitch, those exercises can be left in Rehab Phase 1 at the PT’s office.

Believe it or not, nearly every exercise, especially single-leg exercises, promotes ankle mobility and stability.

My go-to protocol for promoting ankle health includes the following:

Train without shoes Maintain ankle dorsiflexion (foot can flex toward shin at more than 90 degree angle) Single-leg (unilateral) squats   Bilateral THEN unilateral landing from jumps, then from drops Re-acceleration via multiple-jump sequences or tempo sprints  

Generally speaking, athletes who can successfully upkeep those movements with quality and without pain have great ankle mobility and stability… and I didn’t have to buy a BOSU!

 

2) It could be your knees… but is it really?

Unless you live under a rock, you’ve probably heard the phrase “I have bad knees!” uttered begrudgingly more than once.

You’ve also probably noticed the incredible rate of knee injuries in the sport of football, and how ACLs, MCLs, and Meniscus issues tend to come suddenly, unsuspected, and indiscriminately. A quick Google search will clue you in to the ridiculously high rate of ACL injuries in this sport on a regular, non-contact basis.

So what can we do?

As is so often the case, “where it hurts is likely not where the problem is”.

Although I promised to keep this article as lively, non-scientific and un-boring as possible, research and practice have begun to inform us of some possible solutions to this Knee Injury Crisis in football. Accordingly, I recommend all football players add these moves to their (p)rehab repertoire:

Your stability matters = single-leg squat, single-leg jumps and landings, skater jumps (the ankle protocol will help you here!) Learn to decelerate quickly = literally! Practice decelerating from different speeds and directions of running Game-specific running translates = in training, run forward with the head and torso looking another direction Strong hamstrings win the long game = hamstring curl, glute bridges, deadlift/RDLs, and hip thrusts  

Also, if you’ve got nagging knee pain, check your feet, your hamstring strength, and your hips… more on that next!

 

3) Hips don’t lie.

If the musical queen of football Shakira said it, then it’s true, right?

Think of your hips and glutes as your engine. Although your legs function as your wheels, motion starts at and is largely controlled by your pelvis. The hips also connect your lower body to upper body, which, as you could guess, is a pretty important job for any type of moving!

Here’s the thing: hips are foundational and need a lot of upkeep.

Your hips keep your knees and lower back safe, among other things. Think of them as a buffer for absorbing and generating force toward your powerful movements and as essential for speed.

If you lack the ability to recruit your hips of to rotate internally and externally, for example, that can impact the speed of your sprint or heigh or your jump, how you push off the ground with every step, and your ability to change direction efficiently and in less steps.

Additionally, poor hip mobility and glute strength will reduce the strength and efficiency of your lateral movements. Ever had your knees dive inward on a squat, sprint, or side-step? Ever taken an extra second to change directions because your knee wobbled? GLUTES!

As your glutes are made up of a heap of rotational muscles that essentially control your ability to move side-to-side and open and close your legs, you owe it to your pelvis to keep it in check.

To keep your hip and glute health up to speed, incorporating the previously listed exercises will help - especially glute bridges, RDLs, deadlifts, and hip thrusts - but lateral lunges, lateral jumping, and abduction/adduction exercises can also maintain your pelvis’ integrity and help you get the most performance benefits from your hips.

Here’s one exercise I use for my athletes in their warm-up, especially before training and games:

https://youtu.be/YBgcOawgOso

 

Bio:

 

Julia Eyre (cand.MSc, CSCS, USAW) is a soccer strength coach and sport psychology consultant. 

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Benefits of Barefoot Training for Soccer Players

8 Nov '2018

This blog is the second guest blog from Erica Suter. Erica discusses why she is an advocate of barefoot training and where she got the idea from.

 

“Why are you wearing those?” a Brazilian kid asked me before we played pick-up soccer in the streets. “Soccer shoes,” I replied with conviction. The look he gave me was similar to someone being attacked by a herd of zombies: flabbergasted. Shocked. Confused. It was one of those ‘what-the-heck’ moments on his end. Looking back, I’m sure he thought I was some entitled, spoiled American who was too good for barefoot shenanigans.

Alas, what I was wearing around my feet was foreign to him. In his town, Rio de Janeiro, they grew up playing soccer one way: barefoot. So after seeing his lack of footwear, I removed my soccer shoes and assimilated myself into the Brazilian culture. Even though I felt naked and vulnerable, I also felt liberated and free. For the year I lived in Brazil and coached kids, I immersed myself in their barefoot soccer ways. At first it was uncomfortable and totally out of my norm, but eventually, I fell in love with it.  

To that end, my curiosity about barefoot soccer was piqued from the Brazilian people. Beyond it just being a cultural norm, I asked myself, ‘what are its benefits?’ After all, there had to be some physiological gain from removing my soccer boots and allowing my feet room to breathe. Of course, as a soccer performance coach and nerd, I’m always asking myself if there’s a functional benefit to anything I do. Without further ado, here are the benefits of barefoot training after extensive research in Brazil as well as practical experience with my athletes for seven years: 1. Strengthens the foot. This much I know: the foot is complex. Made up of 26 bones, 33 joints, and over 100 muscles, tendons and ligaments, the foot needs to activation to continue to function and grow. And sometimes, wearing shoes or insoles that support the foot too much can hinder the strengthening process, and put our feet to sleep. As an example, try deadlifting heavy with shoes, then barefoot. You might find that deadlifting barefoot will provide you with more balance, stability, and ability to push your heels into the ground with confidence. Additionally, you know how we always say, “activate the glutes” to people who sit at a desk all day? The same applies to the foot. Activate the muscles in the foot by walking around without shoes, and the results will be nothing short of amazing. 2. Improves adaptability. Last I looked, soccer is a game that requires a tremendous amount of adaptability. With different surfaces, styles of play, weather conditions, and opponent capabilities, soccer athletes must be able to adapt to any scenario. This is when barefoot training becomes so powerful: it forces athletes to develop their touch, think quicker in high pressure scenarios, and feel the sensory input from different playing surfaces. With that said, being exposed to a variety of training environments evades athletes from being crippled by the law of diminishing returns. Athletes, therefore, must be exposed to adaptation in order to grow. 3. Increases training enjoyment Now, I don’t have a plethora of peer-reviewed studies to back this up, but with the hundreds of youth athletes I’ve worked with, not one has protested barefoot training. Rather, all my youth athletes look forward to it, and ask, “coach Erica, can we take off our shoes for training today?” Do you really think I’m going to say, no? HAHAHA. There’s something magical about being shoeless that turns training into a fun, carefree experience for youth athletes. I’d also argue that adult athletes would enjoy the same. If you don’t believe me, give barefoot training a whirl and just watch everyone’s faces light up with excitement and joy. Before I conclude, some things to keep in mind with barefoot training: - Gradually ease into it when it comes to playing barefoot soccer. I would say once a week is a great start to see how everyone does, and feel that out for a few months. Get feedback, especially in terms of how athletes are feeling. - Barefoot soccer in a small-sided game setting is more about inspiring athletes to play quick one and two touch soccer, with a ton of movement off the ball for a better conditioning effect. It is not meant for going all out into tackles and hurting one another, so let your players know this before you start a barefoot game. - Initially, avoid plyometric exercises barefoot, especially if the muscles in the foot aren’t strong enough to absorb force. - Start with strength and balance movements barefoot first for at least 10-12 weeks, then incorporate jump progressions gradually. Here are a few strength and balance drills to try:

https://www.youtube.com/watch?v=e7CTaIanLFA https://www.youtube.com/watch?v=X64zagVuapQ https://www.youtube.com/watch?v=RbdQrrm3W18 https://www.youtube.com/watch?v=hd7u7HXE5nU&t=8s https://www.youtube.com/watch?v=ib2R4DgmFrI   Erica Suter is a certified strength and conditioning coach, soccer trainer, and soccer performance blogger who has worked with soccer athletes for over six years in the realms of technical training and physical fitness. She is currently a strength coach at JDyer Strength and Conditioning, and also runs her own soccer performance training business in Baltimore, MD. Her wheelhouse is youth soccer players ages 10-18, and has worked with over 1,000 players across the state of Maryland in-person as well as worldwide through online consulting.  
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Factors of in-season strength training:

5 Nov '2018

This weeks blog is written by Lew Coldham, Academy Strength & Conditioning coach at West Ham. Lew has written about 4 factors to consider when planning strength training in-season.

 

Here I present four factors which I believe are key to the successful planning and delivery of in-season strength training for youth players to maximise physical performance within the football environment.

 

1. Understand the environment

The first factor to consider is that we must fully understand and even embrace the environment that we work in as practitioners. The football environment is one of constant fluctuations in training and match load, heavily influenced by decision-making processes such as players playing up and down age groups, tournament match play opportunities, as well as alterations in match and training schedules.

The strength programme must be adjustable in accordance with the varied wellbeing of the players, as well as the evolving schedule, in order to bring about physical improvement while allowing players to focus on their primary sporting practice. Embracing the uncertainty of the environment that we work in allows us to develop highly adaptive skill sets, methods of management and development, as well as finding ways to enhance the players potential for success.

 

2. Minimal Effective Dose

Whether we admit it or not, the common protocols and typical weekly templates we use are traditionally adopted from strength-training-determined sports such as weightlifting, powerlifting and bodybuilding. These common prescriptions have not changed much since the creation of such protocols and is dictated by the fact that the gym IS their sport.

If we think about the football environment, the focus is on the performance of football training (in its various forms) and match play. The footballer has many other competing demands and performs multiple hours of physical training, on and off the pitch, to prepare them for the vast array of skills and qualities required. The overall volume of work as well the general guidelines regarding intensity, volume etc. need to be adapted based on their sporting requirements and individual needs.

From my experience, young players who are new to strength training can still enhance physical output through strength training in as little as one 30-minute session per week. This is largely due to the adaptability of their bodies, as well as how potent the new stimulus is as a stressor. Why use 5 sets of 5 when 2-3 sets will still produce improvements in near untrained individuals due to the relative potency of the new stimulus; once these low volumes of work cease to produce improvements then more may be required.

 

3. Embrace submaximal Loading

All notable resources regarding the pursuit of maximal strength and its many benefits advise that the best parameters of maximal strength include loading of 8o-85% of 1RM and above. While this is true, these recommendations are in their origin taken from strength-determined sports and usually for well-trained populations.

I would advise that when working with youth players that the use of submaximal lifting strategies e.g. 50-80% of 1RM are the mainstay of the program as they can elicit improvements in strength qualities, but also can be managed more easily within an in-season plan. For the young player these intensities can be reduced even further depending on their age, maturation and training level as well as allow a diverse range of movements to be trained.

Overall the primary objective of strength training methods is to develop strength qualities in the players without impeding too greatly on the performance of their specific sports training. Significant improvements from submaximal methods can be achieved before more maximal forms of lifting are even required. The mainstays of my programs are sub-maximal loads performed with explosive concentric phases and through compensatory acceleration training (CAT) to produce high outputs with relatively low loads (40-80%). This has repeatedly produced increases in strength with players without the need to load the body greater than 80% of 1RM.

 

4. Movement Variability

One of the primary goals of developing physical ability and robustness of players should be on creating a diverse range of movement experiences and competencies that they can tolerate and perform successfully. Simply getting players to lift resistance implements in a select few movements may be a short-sighted view of movement preparation and by allowing a more diverse and varied program, especially for young players, we may be able to create a more physically robust athlete for the field of play.

By looking at the number of types of training stimulus and number of movement tasks on your players’ plans, you should be able to see the diversity within your own framework. For example, if one player between the ages of 12-18 has experienced 40 different exercises within their strength program, and another has experienced 80 different exercises within this same time frame, the second player may have had greater opportunity to develop the necessary physical abilities for a wider range of skills and proficiencies.

 

Closing Thoughts

These four factors I believe are crucial in managing the strength programme for youth footballers to successfully develop athleticism, while accounting for the diverse needs of players in a constantly fluctuating environment.

 

 

Lew Coldham is an accredited strength & conditioning coach who graduated from UCLAN university currently working as academy strength & conditioning coach with West Ham United FC. His main area of expertise are on the topic of movement and strength development for youth athletes.
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