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

“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!”

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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.