Soccer season is just a few weeks away for those who play seasonally. Soccer above any other sport has been scrutinized for knee injuries and the abuse knees take in the game.
For decades it was thought that the cleats were too long/stiff or the fields were uneven/bad. It's such a problem that many shoe companies have actually put research dollars to help aid against serious knee injuries.
Knee injuries have been serious career enders and big issues in rising young stars. Anterior Cruciate Ligament (ACL) and meniscus (the cartilage between knee bones) tears are, unfortunately, a dime a dozen for soccer players. Many of our adult patients who had these reconstructive surgeries on these structures suffer another one doing routine activities like running, lifting and moving boxes. Many even still have pain and swelling years after and full recovery has not happened. Knee surgeries increase the likelihood of ending up with 1 or 2 total knee replacements in their life's future.
Although the environment and shoewear have some contribution to knee injuries, it's most often compensations that lead to the breakdown of the knee. And since nothing is better than the original parts, it is up to us to take care and reinforce a seemingly vulnerable joint that really isn’t meant for a lot of torque and compression.
Today we will discuss the issues that surround meniscus and ligament injuries. There are other knee injuries such as patellar (kneecap) dislocations and fractures (growth plate or tibial plateau) which we can discuss at a different time.
Causes of Soccer-Related Knee Injuries
Aside from possible environmental or external causes and freak accidents (like falling on the knee) we will examine the top 3 causes of "preventable" knee injuries.
1. Weakness in support structures
This is probably the most important thing we can do for ourselves. Structures like the hip gluteus group and hamstrings can provide the best chance to combat rotational forces that could happen at the knee. The ankle muscles, specifically the soleus muscle, will combat lateral and medial stresses incurred in cutting. The knee itself could always use strength but if I were to pick two groups to strengthen to benefit the knee it would have to be the hip and ankles above any other combination.
2. Running and kicking mechanics
How we run and move can give us excess rotations at the thigh and shin bones. Let’s say if your hips were 1mm off-axis (which would be the equivalent of 4-5 degrees off) its efficient placement could be up to 1-2 inches off when the foot hits the ground. Therefore, when you perceive your foot to be right under you, it is, in fact, 1-2 inches off its most stable placement for pivoting or propulsion.
3. Excessive load and use
It has been shown that for every pound you gain whether it is muscle or fat that there are upwards to seven times per pound one carries at the knees. Let’s take a 150-pound player. The knees would have to accept in excess of 1050 lbs of force per step...imagine that! So it could be the straw that cripples one’s knee. If one or two pounds is added, the knee may not be prepared to handle that extra ten to fifteen pounds of load.
The top 3 exercises to give a soccer player’s knees some love
Although it isn’t a perfect system to work on these three issues above, I decided to devise a simplified plan that included exercises for the hip, ankle, and then the knee. These should encompass all the weak areas one MOST commonly has.
Heel Slides: the hamstring is one of the only muscles that cross three major joints. This isn’t your granddaddy’s heel slide exercise either. This is R+’s revamped way of keeping these puppies fired up all day long. Hamstrings are endurance/stabilizing muscles to the pelvis, hip, and knee more than it is used for power and strength. Hamstrings do have some strength properties but that should be their secondary use.
Lateral step-ups: provides the best stability in keeping the ball and socket hip joint healthy. It helps most of the gluteus muscles but, specifically, the gluteus medius which also gives lateral stability. Keeping the hip inside its socket greatly impacts issue #2 above. When the glutes handle more stress it addresses the capacity needed to compact the loads mentioned in #3.
Ankle Clocks: helps with your awareness of where your body and foot are in relation to each other. Therefore, it helps address issue #2. More strength and stability in the ankle is only going to take away those loads one could get when planting and pivoting as mentioned in #1 and #3.
Terminal Knee Extension and Reverse Knee Extension: this is a neat exercise created at R+. We discovered this by accident but it was an ingenious one. We believe it works on the small endurance and stability structures that affect and protect the ACL. Also, it's another awareness-based exercise that provides feedback on the possible harmful stresses from the front to the back of the knee. It is also great for strengthening and stabilizing the planting leg in a kick, which, in turn, helps address issues #1 and #3.
And there you have it: our nuts and bolts to this particular sports injury. Hopefully, you realize that all knee injuries aren’t created equal and much can be done to prevent the continued misuse and abuse of the knee structures. Being a recipient of a new ACL and shaved meniscus life has not been the same since I tore it and had it repaired in 2010. My knee swells and these exercises have helped improve the stability but the sturdy strong and powerful feeling I had once has yet to come back.
Wishing you all healthy knees in 2021,
Dr. Justin C. Lin