Category Archives: soccer

Prevention and Treatment of Groin Injuries in Athletes Sheddon Physio Mississauga

Prevention & Treatment of Groin Injuries in Athletes

Groin injuries affect roughly 20% of soccer players due to the nature of the sport, which involves lots of kicking, inside passing and changes of direction. These movements put a large eccentric force on the adductor muscles, which puts them at risk for injury. As such, roughly 70% of soccer related groin injuries involve the adductor muscles, with the adductor longus being the most frequently injured. Injury to these muscles is usually due to overuse and muscle imbalance, two factors that can be modified with a good prevention program.

The adductor muscles consist of a group of muscles in the inner thigh that work together to move one leg in towards the other. They also assist with other hip movements, as well as balancing the pelvis. They are injured during soccer from kicking, changing direction, reaching and sprinting. Risk factors for injury include:

  • Athletes with muscle imbalances around the hip/pelvis/core;
  • Adductor muscle tightness or weakness;
  • Higher level of play;
  • Previous groin injury;
  • Hip adductor to abductor muscle imbalance.

Treatment will initially be focused on controlling pain and maintaining range of motion. Depending on the severity of the injury, your therapist may also teach you how to wrap the groin in order to relieve pain. As the pain subsides other treatment strategies will be implemented such as soft tissue techniques, modalities to encourage healing, as well as a strong emphasis on exercise. Exercise will focus on the adductors, as well as the core and pelvic musculature. Reintegration into sport specific training will focus on cutting, sprinting, passing and progressive kicking exercises to improve stance leg loading and kicking leg impact. At Sheddon we use the SKLZ Star Kick Elite, a solo soccer trainer,  that returns the ball with true rolls and bounces to help players build passing, receiving and shooting skills.groin injuries in soccer players sheddon sports clinic mississauga

No athlete wants to be sidelined with an injury. Be proactive and follow the injury prevention recommendations below to ensure you stay injury free:

  • Work your CORE: core and pelvic stability can prevent groin and many other injuries;
  • Make sure your hip/pelvis muscles are well balanced in terms of flexibility, coordination and strength.
  • Following the FIFA 11+ warm up program can prevent many injuries, including to the groin.
  • Slowly integrate large amounts of isolated inside passing and kicking into training, as too much has been shown to increase the risk of groin injuries.
  • Specific exercises to strengthen the adductor muscles pre-season have been shown to reduce groin injuries. One of the exercises researchers have focused on is the Copenhagen Adduction exercise (see photo below). Completing this exercise 2-3x/wk, 3 sets, with 6-15 reps per side can significantly increase eccentric adductor strength, thereby reducing the likelihood of groin injuries.Copenhagen Adduction exercise Sheddon Physio Oakville
  • If the Copenhagen Adduction exercise is a little too advanced for you, other researchers showed benefits from strengthening with a theraband. See photo below. This exercise should be completed 3x/wk, 3 sets, 15 reps.injury prevention strengthening with a theraband

If you have been suffering from groin pain or want to prevent groin injuries, contact one of our therapists at Sheddon Physiotherapy and Sports Clinic, who will assess and treat your injury and get you back on the field pain-free.

Haroy et al., (2017). Including the Copenhagen Adduction Exercise in the FIFA 11+ Provides Missing Eccentric Hip Adduction Strength Effect in Male Soccer Players. A Randomized Control Trial. The American Journal of Sports Medicine, 45;13;3052-3059.

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Soccer and Injury Prevention in the Lower Extremity Oakville sport clinic

Soccer and Injury Prevention in the Lower Extremity

Soccer is one of the most widely played sports by children, teens and adults. It also has one of the highest injury rates among all sports and across all levels from beginners, weekend warriors to professional athletes. The majority of these injuries occur in the lower extremity due to the amount of footwork required during twisting, turning, jumping, landing and tackling. In this article we will discuss the most common lower extremity injuries in soccer, as well as prevention strategies that coaches, trainers and athletes can start implementing right away to keep athletes healthy on the field.

Common Lower Extremity Injuries

ACL Injuries

ACL injuries continue to be one of the most common and devastating sporting injuries. They are frequent in soccer, and 80% of the time they occur during non-contact activities such as cutting, pivoting and landing. Once an athlete has suffered an ACL injury, they are 25% more likely to injure the opposite ACL or reinjure the same one. The good news is that ACL injuries are preventable. Research has shown preventative ACL programs can decrease the risk of ACL injuries by 24-82%, with these rates being higher in females and younger athletes.

What can you do right now to keep your ACL injury free?

  • Start a prevention program at an early age and stick with it. Those who started an ACL neuromuscular training program young (pre-puberty), and actually stuck with it on a regular basis (3x/week for 20-30 min at a time) were less likely to sustain an ACL injury.
  • Fix your biomechanics. Faulty movement patterns during landing and cutting put a lot of strain on the ACL and are one of the main risk factors for injury. A dynamic assessment can identify any biomechanical errors and help establish an individualized exercise program to fix them.
  • Do a variety of exercises. There isn’t one magical exercise that will strengthen your ACL. A typical program will focus on balance, proprioceptive exercises, single leg stability, jump training, plyometrics, and agility drills.
  • Strength training! Key muscles play a role in preventing knee injuries, including the core muscles, hip abductors and hip external rotators.
  • Rehab your injuries. Whether it’s your hip, ankle or knee, you need to address the injury sooner rather than later in order to prevent long-term problems and further injury. For example, ankle instability (i.e., from ankle sprains) can put you at an increased risk for ACL injury. More specifically, if your ankle is unstable during landing and cutting, the knee will be loaded abnormally, putting more strain on the ACL.
  • Start using a warm up program like FIFA 11+, which consists of a dynamic warm up combined with strengthening, balance exercises, and plyometric drills. It has been shown to be effective in decreasing all lower extremity injuries, especially ACL injuries. However, its maximum benefit is with athletes who perform the program on a regular long-term basis.

Hamstring and Calf Injuries

Injuries to the hamstring and calf muscles are common among soccer players due to the repetitive kicking, sprinting and jumping involved in the sport. Re-injury of these muscles is also an issue affecting many athletes long term, with roughly 30% of athletes suffering a re-injury to the hamstring, and 63% to the Achilles within 2 years after initial injury. Continue reading more here.

Ankle Injuries

Roughly 35% of all soccer injuries occur in the ankle, with an average time lost from play of about 48 days. With the high prevalence and long recovery time associated with ankle injuries, identifying modifiable risk factors and prevention strategies is key to keeping athletes healthy on the field. Continue reading more here.

If you’re currently injured, book an appointment with one of our physiotherapists, chiropractors, athletic therapists or massage therapists in order to help get you back on the field healthy and pain-free. If you’re not currently injured, the therapists at Sheddon can get you started on an injury prevention and strengthening program by working on your specific weaknesses and imbalances to help prevent any future injuries. If you’re looking for a sports medicine clinic in the Oakville and Mississauga area that has great therapists AND will get you results quickly, contact Sheddon Physiotherapy and Sports Clinic at 905-849-4576.

Nessler et al. (2017). ACL Injury Prevention: What does the research tell us? Curr Rev Musculoskeletal Med. 10:281-288.

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Future Girls Soccer

With yesterday being International Women’s Day, what better time to announce Sheddon Physiotherapy and Sports Clinics sponsorship of a new soccer academy led by female coaches inspiring young female athletes – Future Girls Soccer. Future Girls Soccer is the first and only ALL GIRLS soccer academy in Ontario. Their all-female coaching staff has decades of coaching and playing experience in the NCAA and at the international level. They have programs for girls aged 4-14 years old across all skill levels, including development house leagues, goalie training, skills development, competitive programs and summer camps. Their mission is to develop all their players into strong young ladies, impressive soccer players and healthy athletes. For more information check out their website here.

Sheddon is excited to be working with Future Girls Soccer and assisting with education, injury prevention, sport specific rehabilitation and performance both on and off the field. Sheddon’s Athletic Therapist Anson Ly recently gave a presentation with the U12 girls. He discussed injury prevention and basic nutrition guidance for young athletes, as well as demonstrating the “PAIRS Program,” a Prevention Program to Assist with Injury Reduction in Sport. If you would like a handout of Anson’s presentation, including a downloadable copy of the PAIRS program, click here.

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Soccer Players and Sports Hernias

Groin injuries affect roughly 20% of soccer players due to the nature of the sport, which involves lots of kicking, cutting, sprinting and explosive movements. Research has shown that 50% of soccer players suffering from groin pain lasting longer than 8 weeks may be due to an injury called a sports hernia (Kopelman et al., 2014, Munegato et al., 2016). Unlike a traditional hernia, a sports hernia does not involve the protrusion of an organ through the muscular wall. Instead, it is characterized by weakness in the deep abdominal wall, and only occasionally will a bulge be felt during abdominal straining, as the organs push up against the abdominal wall (without pushing through). A sports hernia can also involve weakness, stretching or tearing of the abdominal muscles, fascia and/or the adductor (inner thigh) muscles on the pubic bone.

What causes a Sports Hernia?

The majority of sports hernias occur as a result of repetitive overload to the area, as opposed to a single traumatic event. Hockey, soccer and football athletes are most at risk, due to the sudden changes in direction, kicking, and sprinting seen during these sports. Other risk factors include:

  • Athletes with muscle imbalances around the hip/pelvis/core;
  • Individuals with a significant leg length difference;
  • Athletes with decreased hip range of motion (especially internal/external rotation);
  • Athletes with other underlying hip pathologies, such as labral tears and femoroacetabular impingement;

Symptoms of a Sports Hernia

  • There is usually pain with activity/sports, which improves with rest;
  • Pain is localized in the lower abdominal/inner thigh and groin area;
  • Generally there is pain with certain movements, such as abdominal curls and resisted hip adduction;
  • There is tenderness over the pubic bone and abdominal muscle insertions.

Treatment

Most sports hernias can be treated conservatively with physiotherapy and rest. Physiotherapy will generally consist of manual therapy and exercise in order to address muscle imbalances, as well as core stabilization exercises. A sports hernia may lead to an inguinal hernia, and if conservative treatment is not successful, surgical repair may be necessary. Surgical repair has a high success rate; most athletes will return to sport pain-free.

What can you do to prevent a sports hernia and groin injuries?

  • CORE, CORE, CORE – core and pelvic stability cannot be overlooked;
  • Get your minor injuries addressed ASAP!! Soccer players tend to overwork their hip flexors and adductors, which gradually lead to minor groin strains. If left untreated, they can eventually lead to a sports hernia. Don’t let that nagging pain develop into something much bigger;
  • Make sure your hip/pelvis muscles are well balanced in terms of flexibility and strength. For example, just stretching the groin muscles and letting everything else stay tight will lead to more injuries than if you didn’t stretch at all. You want to be symmetrical in all directions.

If you have been suffering from groin pain for longer than 8 weeks and think you may have a sports hernia, contact us and one of our therapists at Sheddon Physiotherapy and Sports Clinic will assess and treat your injury and get you back on the field pain-free.

Kopelman et al., (2014). The management of sportsman’s groin hernia in professional and amateur soccer players: a revised concept. Hernia.

Munegato et al., (2016). Sports hernia and femoroacetabular impingement in athletes: A systematic review. World Journal of Clinical Cases. 3(9) 823-830.

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Heading in Soccer: Is it Safe for the Brain?

Concussions make up roughly 22% of all soccer related injuries. As such, concussion prevention is a main focus, with efforts being made to help recognize how and why concussions occur, and if aspects of the sport can be changed to decrease the prevalence of head injuries. Lately, attention has been focused on whether or not heading in soccer can lead to concussion directly or if the cumulative effects of sub-concussive impacts, as seen with multiple headers in one game, can result in brain injury.

Research has shown that the majority of concussions in soccer occur as a result of player to player contact or player to ground contact, with roughly 30% of concussions occurring during heading. However, the majority that occurred during heading (60-78%) were not related to ball contact; they were related to contact with another player. Furthermore, studies have looked at the acceleration forces (linear and rotational) required to sustain a concussion, and soccer headers produce a mean acceleration well below the concussion threshold. 

If heading the ball generally doesn’t produce enough force to cause a direct concussion, can the cumulative effects of repetitive heading lead to brain injury? A review of 7 high quality studies, all examining the effects of heading on cognitive functioning immediately following practices or games, found no significant effects between heading and neurocognitive functioning. However, research that has examined long term effects of soccer participation and heading is less understood. Some studies have shown that high level soccer players who have played for a number of years have cognitive deficits related to attention, memory, visual processing and concentration when compared to non-soccer athletes. However, most of these studies examining long term effects of playing soccer and heading on brain injury are not well done. For example, most studies were completed retrospectively and relied on the athletes memory of their heading and concussion history. There was usually no history taken into account for mental health issues, drug abuse, stress, education, pre-soccer baseline testing, or other factors that could have caused the cognitive deficits. As such, current research regarding the long term effects of heading in soccer is inconclusive. 

Take home message:

  • There is no evidence that heading in soccer causes permanent brain injury or neurocognitive dysfunction.
  • There is limited evidence that heading causes concussion.
  • No definitive research exists to show long term effects of heading on cognitive impairment.
  • In order to decrease the prevalence of concussion in soccer, coaches and trainers should focus on teaching safe and proper heading techniques, with a reduction of athlete-to-athlete contact.

Maher et al., Concussion and heading in soccer: A review of the evidence of incidence, mechanisms, biomarkers and neurocognitive outcomes. (2014). Brain Injury; 28(3): 271-285.

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