It should be no surprise that most injuries seen in soccer players involve the lower body.
Unless you are a goalkeeper, the main movements include using the legs to kick, jump, run and do slide tackles.
Knees are central to all this movement, and as players enter teenage years, knees overcome ankles as the most common joint injury in soccer players.
Read on for expert sports medicine tips to protect knees to keep yourself or your favorite soccer player(s) on the field.
ACL (Anterior Cruciate Ligament aka “All too Common Ligament” Injuries)
Let’s start with the big one, the serious type of knee injury that can keep players off the field for up to a year if not longer. The Anterior Cruciate Ligament (ACL) connects the thigh bone to the shin bone in the center of the knee and provides stability with landing from jumps or changing direction.
ACL injuries can occur from direct contact to the knee, but in soccer, and especially with adolescent female players, non-contact awkward single-leg cuts, turns or landings are often the culprit.
Defensive tackling (often with a sidestep movement) to reach out to separate an opponent from the ball and cutting to track an opponent have been shown as other potential risk factors for ACL injury.
Not only are ACL tears immediately painful, they also are selfish and can cause problems years after the original injury.
Tears to other ligaments or of the menisci (shock absorbing pads on the inside and outside of the knee) often come with ACL tears. Most players who tear their ACL (and other structures) need surgical repair and that prolonged recovery period.
Even after that extended rehabilitation, going back to soccer increases the risk (by 25-33%) of another ACL tear to either the injured or non-injured knee. Whether or not a player returns, having an ACL tear carries a close to 50% risk of early arthritis (knee joint breakdown) within 10-20 years of the injury. That’s a lot of relatively young 30 somethings maybe needing knee joint replacement surgery.
With all this doom and gloom, there is a glimmer of good news on the ACL front. There are practical and proven ways to reduce non-contact ACL injuries.
If you have 10-15 minutes, you have the time to complete a proper evidence-based ACL Injury Prevention Program. Yes, a mere 10–15-minute investment 3 times a week can help reduce a major injury, major rehab period and major risk of arthritis. Then we’ll throw the bonus of increasing strength and efficiency of running and jumping.
Kneecap (Patella) Instability
Any disruption to how the kneecap communicates with the thigh bone can lead to knee pain during running, jumping, and kicking.
The most dramatic type of disruption is called a patellar dislocation where the kneecap comes completely out of usual position and can be found on the outside of the thigh bone. Sometimes the kneecap can be repositioned on the field with a particular relocation movement, while other cases require an emergency room and special medication to relax the knee (and patient).
The kneecap can also partially come out of joint. This is known as a patellar subluxation. This abnormal motion toward the outside of the knee joint can occur on a recurrent basis and lead to lasting episodes of pain and limited bending/straightening of the knee.
The odds of increased kneecap motion (aka patellar laxity) can be reduced by learning the same landing and cutting skills taught in those ACL Injury reduction programs.
When seeing players with kneecap instability (and I recommend specialist sports medicine evaluation for any type of patellar laxity problems), I tend to look at things like increased motion in other joints, abnormal muscle function in the front and outside of the knee, and single-leg squat technique.
Treatments can include strengthening exercises for hip, upper leg, and knee regions along with stretching of muscle groups. Knee sleeve braces with padding/support for the outside of the kneecap can help. I’ve learned that some soccer players find them too bulky for quick movements while others want to wear one on each knee (so opponents must guess about the injured knee).
Anterior Knee Pain
Yes, patellar instability is indeed one cause of pain in the front of the knee, but there are several other flavors that affect soccer players.
Younger players who haven’t reached full adult height may commonly report pain at growth regions (aka the aphophyis) of the tibial tubercle and lower part of the patella. Osgood-Schlatter is the medical name for irritation of the tibial tubercle while pain at the lower patella is known as Syndig-Larson-Johansson syndrome.
The diagnosis is straight forward. The athlete can use a fingertip to point out the location of pain with local swelling, usually with more of a gradual onset. A prominent bump may be seen at the tibial tubercle on the shin bone just below the knee joint. That bump usually goes away after growth is finished, but not always.
Once a player finishes growing, we tend to see more issues with either the patellar tendon (connects the 4 quadricep muscles in the front of the thigh through the kneecap to attach at the shin bone) or more general patellofemoral pain between kneecap and thigh bone.
Relative weakness of the muscles behind the hips and upper thigh can contribute to excessive forces in the front of the knee. Once again, those same ACL injury prevention exercises as discussed previously (and in the link above) can also reduce other forms of anterior knee pain.
So, if you’ve experienced a knee injury, call your sports medicine physician to help get you on the road to recovery and back on the field.