How To Save Your ACL

By Dr. Dev Mishra

"You've torn your ACL." That's a phrase no player wants to hear. If you are a competitive soccer player, chances are fairly high that you know of a teammate (or perhaps yourself) who has sustained a tear of the anterior cruciate ligament (ACL).

The ACL is a ligament -- a tough fibrous structure that joins a bone to another bone -- that is a major stabilizer for the knee. In soccer it is critical in rotational movements such as planting, cutting and pivoting.

In the United States it is estimated that 250,000 people tear an ACL each year, and a substantial number of them will undergo reconstructive knee surgery. In my practice I am seeing ACL tears in girls as young as 12. Female athletes are particularly prone to injury.

In a study conducted at Duke University by Drs. Bing Yu and William Garrett a female athlete is more than seven times as likely to tear the ACL as a male athlete. A player unlucky enough to tear the ACL will have substantial lost playing time, and some players will not come back to the same level of play.

But recent studies suggest that specific training methods can reduce the number of ACL tears sustained by soccer players.

About 70 percent of ACL tears occur during non-contact movements such as decelerating or cutting while sprinting, or on landing from a jump. Improved mechanics for jumping, sprinting and cutting are at the heart of the programs designed to reduce the rates of ACL tears.

At a recent meeting of the American Orthopaedic Society for Sports Medicine, Drs. Julie Gilchrist and Bert Mandelbaum reported their results of a training program used on female collegiate soccer players. This free program was developed at the Santa Monica (Calif.) Orthopaedic and Sports Medicine Research Foundation, and goes by the name "PEP," which stands for Prevent Injury and Enhance Performance. (http://www.aclprevent.com) The PEP program has reduced ACL injury rates by 72 percent -- a very impressive number.

Click Here to download a PDF copy of the entire program.



Another program that is excellent is the Core Performance soccer training program designed by Mark Verstegen of Athletes' Performance.

The programs focus on form during jumping, sprinting, and cutting. They are also excellent for development of the "core" muscles -- large groups such as the abdominals, obliques and large leg muscles. They should be used at least three times per week.

The full program incorporates a warm-up, stretching, core strengthening, agility, and a form of jump training called plyometrics. As long as you adhere to the principles of proper form there is room to add variety to the program as your training progresses. For example, I like to emphasize more abdominal strengthening, and utilize small hurdles, rings and speed ladder. The programs can be used with any age group, male or female.

No training on earth can prevent the ACL tear that occurs from a vicious tackle, but I believe there is a great opportunity to reduce tears from non-contact events. At the very least, you will end up with better flexibility, power, speed and agility. Those are attributes any player would welcome.

Dr. Mishra is an orthopedic surgeon in private practice in Burlingame and Walnut Creek, Calif. He is a team physician for U.C. Berkeley, the California Victory USL-1 club, and the U.S. Soccer Federation. Mishra's Web site is www.thesoccerdoc.com.

Improving skills on your own, by Claudio Reyna

Improving skills on your own

By Claudio Reyna A player can always improve his fitness by working out hard. He can comprehend certain tactics by studying the game. But how far he goes will be determined mainly by how well he has mastered ball skills. Those are acquired by playing, day after day, year after year. A player who really wants to excel will spend as much time as possible playing small-sided games when he has playmates, and juggling and kicking against the wall when he's on his own. I spent a lot of time hitting the ball against the side of the house when I was a growing up. If my mother complained about the noise, I'd hop down the retaining wall at the end of our property to the office-building parking lot. I'd use that wall -- hitting the ball with both feet, seeing how long I could return the wall's passes without losing control. I found out later that so many pros spent lots of their childhood doing that. Dennis Bergkamp, the great Dutch striker who scored and set up hundreds of goals for Ajax Amsterdam, Arsenal, and the Dutch national team, said that when he was a youth player at Ajax, they had little three-foot-high walls. He would knock the ball against the walls for hours. Every time he hit the ball, he'd know whether it was a good touch or a bad touch. He'd do it over and over, trying to establish a rhythm. Whenever I saw Bergkamp slotting a perfectly placed ball past a goalkeeper or making a precise pass, I thought of him practicing against the wall. Kicking against the wall is an excellent way to work on improving your weaker foot. You can back up and practice shots on goal, or move close to the wall and work on passing, because where there's a wall, there's a teammate. You can practice trapping and work on your first touch by controlling the ball before you kick it, or hit it back first time. Passing the ball against a wall from close distance takes timing and coordination. Hit the ball faster, and you've got to react faster and get a rhythm going. It almost feels like you're dancing. Practicing the correct striking of the ball over and over helps it become second nature. It has to be, because in a game a player doesn't have time to think about his form or approach. Under pressure, everything is more difficult. Mastering technique while playing on your own is the first step to being able to do it right in a game. (Excerpted from "More Than Goals: The Journey from Backyard Games to World Cup Competition" by Claudio Reyna, courtesy of Human Kinetics.) (Claudio Reyna was named the U.S. Soccer Federations's Youth Technical Director in April 2010. Reyna played nearly 13 years in the top-tier leagues of Germany (Bayer Leverkusen, VfL Wolfsburg), Scotland (Glasgow Rangers) and England (Sunderland, Manchester City). He represented the USA in four World Cups, and captained the Americans to a quarterfinal run at the 2002 World Cup, where he became the first American selected to the FIFA World Cup all-star team.)

Keys to the Game: When to Eat and Drink

Posted on 04/30/2011 by Dev Mishra MD

By Dev K. Mishra, M.D., President, Sideline Sports Doc, LLC
In the last three posts we’ve covered water, sports drinks, and food choices.  The essential theme in all of those was to choose the least processed and most natural foods and beverages you can find.  For the best athletic performance, when you eat or drink is very important.  For the food or drink to provide energy and nutrients for your body they need to be absorbed properly in the stomach and digestive tract.  When taken at the right times you’ll have your body in the best possible condition, but taken too soon before a practice or game and you’ll end up with low energy, poor performance, stomach cramps, nausea, or worse.  Let’s go through some specific scenarios you’re likely to face.  And just to be clear, I have no financial relationship with any of the products I mention in this post.  I’ve found them to be easily available at most supermarkets and I like what’s in the products.
The very early morning game
In almost any tournament or league setting you’re likely to find yourself with the dreaded 8 a.m. (or earlier!) start time once in a while.  Some of the keys for these games are to prepare the night before the game and to at least have a small snack the morning of the game.

• Eat well the night before the game. Include large portions of grains or pasta, vegetables and small to medium portions of beans, chicken, fish, or lean meat.
• Have a snack before bedtime.  Good choices would include fruit, yogurt, cheese, an oatmeal cookie, or fruit smoothie.
• Take a “mini-breakfast” an hour to hour and a half before game start time. This is really important and often skipped.  You can choose a bagel, muffin, scone, or toast; yogurt and/or piece of fruit; and have a big glass of water, Vitamin Water®, sports drink, or Propel®.

Regular game times
Have a main meal with enough time before the practice or game to digest the food.

• Have the main meal about two hours before start time.
• You can have a small snack about an hour before start time if you’re hungry, similar to the “mini-breakfast” I outline above.
• Have water, flavored water, or sports drink until about 30 minutes before start time, as I wrote in the earlier posts.

After the game, and preparing for a second game the same day in a tournament
The most efficient time to begin refueling after a game is ideally within the first 30 minutes after the conclusion of the first game.

• If you have 3 hours or more between games, choose a regular main meal such as the one I’ve outlined above for the night before an early morning game.  Keep processed foods to an absolute minimum, and leave yourself at least 2 hours from the end of your meal to the start of game time.
• If you have less than 2 hours between games, choose simple foods such as the “mini-breakfast”.
• If you have a very short time, perhaps less than an hour, choose fluids only. A sports drink is a good choice.  I like the Gatorade Recover 03® sports drink because it contains protein in addition to carbohydrates and electrolytes, and does a good job of replacing what was lost during exercise as well as promoting recovery for the next event.

When you eat or drink during a competition can be the critical difference in fitness during the next game that will give you an edge on your opponents.

Player Development

by Paulo Barreto

How do you develop to your ultimate as a soccer player

A lot of players focus on correcting weaknesses, but as any good coach can tell you, to develop into a great player you have to highlight your strengths.

When forming great teams, a coach tries to expose the collection of remarkable traits of the players, and hide their weaknesses.

That doesn’t mean that you stop working on your weakness, but you want to focus on getting even better at what you are already good at.

Seek to become truly excellent in a least on or two areas of the game. After all, what sets you apart is what makes you great to begin with.

If you are going to rise to the highest possible level, you need at least one quality that permits you to dominate in some aspect of the game.

If you want to be truly extraordinary , then you need to add more and more qualities.

Aspiring to greatness is always an evolution. To achieve it, you have to put the time and effort into all areas of your development.

You progress on a continuum of ability. Hopefully, in a addition to greater skill and a strong fitness base, you can gain more flair, more experience, and more understanding of the game.

Also you can become psychologically harder, an ideally, a great leader as well.

Modern Coaching

Many coaches, of course, already observe moder philosophy and practice, showing positive enthusiasm, possessing high-self belief, demonstrating fairness and belief in their players, and always recognizing individual effort. These new leaders liberate their players, creating and environment in which players can take responsibility for their performance knowing they will receive care and support if the going get tough.

A modern coach, teaches.

The Psychological side of the game

Mental Game: The players who get the most out of their ability recognize the mental games’s importance and find ways to improve their mental skills. Part of what makes theses players successul is their ability of adjust.
They are conistently at or near their best even when they don’t feel their best. Unfortunately most players leave the mental game to chance, not realizing a strong mental game can be developed.

Confidence: Confidence is a choice-You have to choose to become confident.
Once you have made the choice, and it may be an everyday decision, you must take responsibility for your actions. Successuful player build strong inner confidence by concentrating on their contribution to success or failure. Rather than blaming someone of something else.

Visualization: Visualization is a mental tool that some players and teams find helpful in preparing their minds to meet the challenge of the game. A clear link has been established between positive thinking and the likelihood of positive action, so players are encouraged to spend time visualizing themselves performing with excellence. What you see, is often what you get. What you visualize, is often what you attract.
Visualization is recommended for building confidence, developing strategies to cope with stress, understanding tactics and strategy, and assisting recovery from injury.
Of great importance is the link between visualization- How we see ourselves, and our emotional state, our energy state, and therefore our potential for performance.
As we exercise the mind, it grows stronger. The more the player pictures success, the more energy he or she creates to achieve it.

Methods for maximizing flexibility

By Dev K. Mishra, M.D.

We tend to think of young athletes as naturally flexible but in truth athletes of all ages can improve performance for sports by maximizing flexibility. In very simplistic terms, think of your muscles and tendons as elastic structures like rubber bands.

A stretchy rubber band is generally capable of greater motion and power than a cold, stiff rubber band. You want your muscles and tendons to be as long and flexible as possible, which usually leads to better strength, power, speed, agility, and even lower injury rates.

But there is considerable debate about what the “best” and safest method is to improve flexibility for young athletes. Back in the 1960s and 1970s we started every practice session with a series of stretch-and-hold moves (called “static stretches”), and then went on to activities involving movement. But over the past several years the pendulum has moved the other way. It’s now known that “flexibility” is much better and safer through exercises done with movement, called “dynamic stretching.” We also know that it’s harmful to stretch a cold muscle.

Here are some general guidelines for dynamic stretching that can be useful in most sports and age groups:

1. Start with a 3-5 minute easy jog. The purpose of this part of your activity is to get the body warmed up and reduce risk of injury. As I said above, don’t move to stretches without doing a warm-up first.

Depending on the sport and your environment you could also do a line-to-line jog, a lateral shuttle run, and backward running.

1. Move next into dynamic stretching. There are many, many different types of dynamic stretches. Coaches of different sports will have their favorites for their sport, so what is outlined here is a very general guideline:

A. Straight-leg marching -- for hamstrings and glutes.
B. Butt-kicks -- for quadriceps.
C. Forward shuffle with hip rotation -- for groin/adductors.
D. Scorpion cross-over stretch lying on your back -- for lower back and hip abductors.
E. Handwalks -- for shoulders, core abdominals.

If you’d like to see some photos of a simple version of dynamic stretching for adults take a look at the Core Performance website. The folks at Core Performance refer to this phase as Movement Preparation and you can get a good idea of the types of movements we’re talking about above. (I have no relationship with Core Performance, I just really like what they do.) For soccer players, I highly recommend the Santa Monica Sports Medicine PEP program.

And finally, old-fashioned static (stretch and hold position) stretches can be done as part of the cool-down after activity.

Static stretches haven’t disappeared completely, they just come at the end of the training session rather than right at the beginning. There are literally hundreds of ways to do static stretching, and many sport-specific stretches. Here’s a bare minimum of stretches that target most of the muscle groups. For each of these you want the kids to hold for about 30 seconds and do 2 or 3 repetitions of each stretch.

1. Upper-body stretches
A. Across body shoulder stretch
B. Triceps back-scratcher stretch
C. Lower back stretch
i. Rocking on all fours
D. Lower body stretches
i. Calf/Achilles stretch
ii. Quadriceps stretch -- standing
iii. Figure four hamstring stretch
iv. Inner thigh/adductor stretch
v. Hip flexor stretch

Right now you might be saying “this would be a lot better with pictures and more detailed descriptions …” And you're right! So I encourage you to take a look at Core Performance and the PEP program.

(Dev K. Mishra is the creator of the SidelineSportsDoc.com injury management program for coaches. He is an orthopedic surgeon in private practice in Burlingame, Calif. He is a member of the team physician pool with the U.S. Soccer Federation and has served as team physician at the University of California, Berkeley. This article first appeared on SidelineSportsDoc.com.)