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The Soccer Injury Movement Screen (SIMS)

20 February 2019 Ben Cartwright
A Review of Research: Using SIMS, Could Fitness Professionals Develop More Efficient and Personalized Unilateral Training Programs?

 

The Soccer Injury Movement Screen (SIMS) could possibly be used as a performance assessment tool or limb asymmetry assessment tool. A strength coach or athletic trainer could use SIMS as a pre-training assessment to identify weaknesses and asymmetries in order to create a more efficient and effective training program for the athlete.  

McGunn, Aus Der Funten, Whalan, Sampson, and Meyer (2018) suggested that the development of a soccer specific movement quality assessment has the possibility of benefitting performance by identifying athlete limb asymmetries along with strength and flexibility weaknesses. The Soccer Injury Movement Screen (SIMS) looks to fill this void in the soccer performance industry. The screen is comprised of five movements: Anterior Reach (AR), Single Leg Romanian Dead Lift (SLRDL), In Line Lunge (ILL), Single Leg Hop for Distance (SLHD) and Tuck Jump (TJ) (McGunn, 2018). Each of the 5 movements is assessed on a 10-point scoring system with the maximum number of points and worst possible score being 50. The best possible score, displaying no flaws in movement is 0. The entire scoring criteria and description of SIMS, including rationale for each movement and script for administration, is displayed below.

The Soccer Injury Movement Screen was first researched by McGunn et al. The Intra-and Inter-rater Reliability of The Soccer Injury Movement Screen (SIMS) was studied after initial development of the screen. It was concluded that present results indicated sufficient reliability for the SIMS to be considered useful for further research and applied practitioners. Due to the promise of this study, McGunn then used the SIMS in another study on 306 male semi-professional soccer players in Wales who agreed to participate. The purpose of this research was two-fold: First, to investigate the relationship between SIMS composite score and injury risk; second, to investigate the relationship between individual subtests comprising SIMS and injury risk. The question that this study worked to answer was: Is there a relationship between a soccer specific movement quality assessment and injury risk among semi-professional male soccer players. Researchers analyzed all noncontact, time-loss lower extremity injuries for the subjects and compared them to their initial SIMS composite score. They concluded that results indicated that SIMS composite score was not associated with any of the injury categories involved and that SIMS should not be used to categorize players into high and low risk groups. However, researchers suggested that SIMS could be used to help practitioners identify limb asymmetries or used for developments in performance enhancement.

Maly, Zahálka and Malá (2014) stated that leg dominance is common in soccer. While athletes train to be proficient using both feet, most will have a preferred side. The muscular compensation to leg dominance is an increase in muscle mass and strength in the dominant leg, as well as flexibility differences between legs. Researchers suggested that more than 50% of soccer players have a lower limb strength asymmetry. For example, the knee extensors and flexors showed significant bilateral deficits in knee flexion strength compared to knee extensor strength. These findings support the common notion that soccer players are “Quad Dominant” athletes and thus are deficient in posterior muscle strength. The increased extensor activation during deceleration and explosive movements within the sport increases the anterior leg muscles’ strength and overall mass. These bilateral and anterior-posterior (AP) strength asymmetries have the possibility of leading to imbalances and injuries (Maly, Zahálka and Malá, 2014).

Most soccer (football) fitness experts would agree that unilateral and plyometric training is a necessity in a wholistic soccer training program due to the dynamic and chaotic nature of the sport. Unilateral training is not a new concept. However, are the unilateral training protocols being used efficient for each individual athlete? The Soccer Injury Movement Screen (SIMS) could possibly be used as a performance assessment tool or limb asymmetry assessment tool. A strength coach or athletic trainer could use SIMS as a pre-training assessment to identify weaknesses and asymmetries in order to create a more efficient and effective training program for the athlete.

A research study done at a University in Indiana, United States looked at the Soccer Injury Movement Screen (SIMS) performance by female collegiate soccer players and its possible future benefits in identifying bilateral and anterior/posterior lower extremity asymmetries. They asked “What are the results of the Soccer Injury Movement Screen (SIMS) for Collegiate Women’s Soccer Players?” By conducting the SIMS on twelve Division One women’s soccer players, researchers were able to find that the average composite score for the screen was a 7.5 out of 50 with 0 being the best possible score and 50 being the worst. They also asked if SIMS can identify bilateral and anterior-posterior limb asymmetries. None of the unilateral movements showed a significant difference between the performance in right and left legs overall. There was a large range of scores on the Single Leg hop for Distance between our sample of 12 subjects. The Tuck Jump test showed one flaw that was shown in all 12 subjects.

If the scoring system for SIMS were adjusted, then it could be used as a pre-participation screen for fitness professionals to better understand their athlete’s weaknesses and asymmetries. Developing this screen to become a norm in the performance industry could help develop a consistent way to identify and correct athletes to prevent injuries due to imbalances. They concluded that SIMS, currently, does not possess the ability to accurately assess limb asymmetries. The updated scoring system would need to include identification of which limb (right or left) displayed the flaw and a system of calculating the score for each side of the body. There also would be value in reducing the number of flaws identified. This is because a higher number of scoring criteria comes with lower accuracy in the repeatability and consistency of scoring between scorers.

 

I would be VERY excited to discuss these research studies, the pre-participation screen idea or just soccer/fitness with anyone that has questions, thoughts or feedback! You can reach Alex via his email: CoachAlexNg@gmail.com Twitter: @CoachAlexNg Linkden: @alexng1997

 

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

15 February 2019 Ben Cartwright

“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

08 November 2018 Ben Cartwright
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:

05 November 2018 Ben Cartwright
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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Dispelling the myths surrounding youth resistance training

17 October 2018 Ben Cartwright
This weeks blog comes from Joshua Dragone. Josh is a member of our Football Fitness Online Community & is a performance coach working with many players. Josh has written a blog to dispel the myths surrounding youth resistance training.

 

Youth resistance training come a long way in recent years and there is now compelling evidence to support strength training amongst youths.

However, having worked in youth sport I often noticed that the myths surrounding youth resistance training are still out there.

This post will identify a number of questions/myths that I have received during my time working with youth athletes.

 

 

Myth #1: Strength training will stunt the growth and cause injury to children

 

This is always one of the first questions I get asked and tends to be based on opinion or what’s been heard. In fact, strength training actually inflicts less compressive force on the joints compared to other sports involving running and jumping. Strength training has been shown to prevent injuries to bones and growth plates by strengthening bones, ligaments and tendons. Also there have been a number of studies that show injuries associated with strength training are less common than injuries occurred when playing sports such as football, rugby, basketball or gymnastics.

See what your body can go through in these sports below:

https://www.youtube.com/watch?v=o7GWGHTkMlM

 

Myth #2: Strength training is unsafe for children

 

This misconception comes from extremely poor and misinterpreted data from the 1960s and 70s and has had a serious negative impact on youth strength training since.

I also believe that there is a misconception as to what S&C in youths looks like most people tend to think that strength training has to mean lifting extremely heavy weight. However, this isn’t the case, particularly for youth programmes. Training with bodyweight or light free weights with proper lifting technique can provide a great, safe, effective foundation of strength.

 

Myth #3: Strength training is only for young athletes

 

It’s a common one I hear in that ‘oh, my son/daughter isn’t that serious about the sport just yet so there is no need for strength training’ Youth strength training is highly beneficial for developing physical qualities such as strength, power, speed etc. which can help kids be involved in life long sport. Even though there is a huge amount of evidence around the physical development of adolescence, having worked with youth athletes for a number of years there are also huge psycho-social benefits. Adolescence don’t just benefit from getting bigger and stronger but also gain improvements in their self-confidence, self awareness, develop social skills to name a few.

 

 

As coaches when we hear these common myths it can be very frustrating as the time and effort that has been put in can often be disregarded. However, these situations can be an ideal time for coaches to educate parents, players and coaches on the potential benefits of resistance training whether it be via workshops for parents or even just a conversation.

Times are slowly changing in my opinion and parents, teachers, coaches are beginning to recognize the potential physical and psychosocial benefits that resistance training bring.

 

Regular participation in a S&C programme is a perfectly safe and an enjoyable type of training for adolescents. As long as training is focused on development technical competency and age-appropriate guideline are met and followed by qualified coaches.

 

 

Josh is a 24-year-old strength and conditioning coach with a specific interest in youth athletic development. He graduated from the University of South Wales and is currently studying a Masters in Strength and Conditioning at Cardiff Metropolitan University. He is currently the lead S&C coach at Swansea Tennis Academy and previously worked at Cardiff City FC, Aberystwyth Town FC and Cardiff Devils Ice Hockey Juniors.

 

Twitter - @JoshDragone1
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