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Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players

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Abstract

Injuries reported in male youth soccer players most commonly occur in the lower extremities, and include a high proportion of ligament sprains at the ankle and knee with a lower proportion of overuse injuries. There is currently a paucity of available literature that examines age- and sex-specific injury risk factors for such injuries within youth soccer players. Epidemiological data have reported movements that lead to non-contact ligament injury include running, twisting and turning, over-reaching and landing. Altered neuromuscular control during these actions has been suggested as a key mechanism in females and adult populations; however, data available in male soccer players is sparse. The focus of this article is to review the available literature and elucidate prevalent risk factors pertaining to male youth soccer players which may contribute to their relative risk of injury.

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References

  1. Adrim TA, Cheng TL. Overview of injuries in the young athlete. Sports Med. 2003;33:75–81.

    Article  Google Scholar 

  2. Alentorn-Geli E, Mendiguchı´a J, Samuelsson K, et al. Prevention of anterior cruciate ligament injuries in sports—part I: systematic review of risk factors in male athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22:3–15.

    Article  PubMed  Google Scholar 

  3. Atkins SJ, Hesketh C, Sinclair JK. The presence of bilateral imbalance of the lower limbs in elite youth soccer players of different ages. J Strength Cond Res. 2015 (in press).

  4. Barber-Westin SD, Galloway M, Noyes FR, et al. Assessment of lower limb neuromuscular control in prepubescent athletes. Am J Sports Med. 2005;33:1853–60.

    Article  PubMed  Google Scholar 

  5. Barber-Westin D, Noyes FR, Galloway M. Jump-land characteristics and muscle strength development in young athletes. A gender comparison of 1140 athletes 9 to 17 years. Am J Sports Med. 2006;34:375–84.

    Article  PubMed  Google Scholar 

  6. Beard DJ, Kyberd PJ, Fergusson CM, et al. Proprioception after rupture of the anterior cruciate ligament. An objective indication of the need for surgery? J Bone Joint Surg. 1993;75:311–5.

    CAS  Google Scholar 

  7. Besier TF, Lloyd DG, Ackland TR, et al. Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sport Exerc. 2001;33:1176–81.

    Article  CAS  Google Scholar 

  8. Beynnon B, Howe JG, Pope MH, et al. The measurement of ACL strain in-vitro. Int Orthop. 1992;16:1–12.

    Article  CAS  PubMed  Google Scholar 

  9. Beynnon BD, Fleming BC. Anterior cruciate ligament strain in-vivo: a review of previous work. J Biomech. 1998;31:519–25.

    Article  CAS  PubMed  Google Scholar 

  10. Brophy R, Silvers H, Gonzales T, et al. Gender influences: the role of leg dominance in ACL injury among soccer players. Br J Sports Med. 2010;44:694–7.

    Article  PubMed  Google Scholar 

  11. Cloke D, Spencer S, Hodson A, et al. The epidemiology of ankle injuries occurring in English Football Association academies. Br J Sports Med. 2009;43:1119–25.

    Article  CAS  PubMed  Google Scholar 

  12. Croce RV, Russell PJ, Swartz EE, et al. Knee muscular response strategies differ by developmental level but not gender during jump landing. Electromyogr Clin Neurophysiol. 2004;44:339–48.

    CAS  PubMed  Google Scholar 

  13. Crosier JL, Crelaard JM. Hamstring muscle tear with recurrent complaints: an isokinetic profile. Isokinet Exerc Sci. 2000;8:175–80.

    Google Scholar 

  14. Daneshjoo A, Rahnama N, Mokhtar AH, et al. Bilateral and unilateral asymmetries of isokinetic strength and flexibility in male young professional soccer players. J Hum Kinet. 2013;36:45–53.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Daniel DM, Stone ML, Dobson BE, et al. Fate of the ACL-injured patient: a prospective outcome study. Am J Sports Med. 1994;22:632–44.

    Article  CAS  PubMed  Google Scholar 

  16. De Ste Croix MBA. Advances in paediatric strength assessment: changing our perspective on strength development. J Sports Sci Med. 2007;6:292–304.

    Google Scholar 

  17. Draganich LF, Vahey JW. An in-vitro study of ACL strain induced by quadriceps and hamstring forces. J Orthop Res. 1990;8:57–63.

    Article  CAS  PubMed  Google Scholar 

  18. Faigenbaum AD, Farrell A, Fabiano M, et al. Effects of integrative neuromuscular training on fitness performance in children. Pediatr Exerc Sci. 2011;23:573–84.

    PubMed  Google Scholar 

  19. Ford KR, Shapiro R, Myer GD, et al. Longitudinal sex differences during landing in knee abduction in young athletes. Med Sci Sports Exerc. 2010;42:1923–31.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Guskiewicz KM, Perrin DH, Gansneder B. Effect of mild head injury on postural stability in athletes. J Athl Train. 1996;31:300–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Hewett TE, Paterno MV, Myer GD. Strategies for enhancing proprioception and neuromuscular control of the knee. Clin Orthop. 2002;402:76–94.

    Article  PubMed  Google Scholar 

  22. Hewett TE, Myer GD, Ford KR. Decrease in neuromuscular control about the knee with maturation in female athletes. J Bone Joint Surg Am. 2004;86:1601–8.

    PubMed  Google Scholar 

  23. Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33:492–501.

    Article  PubMed  Google Scholar 

  24. Hewett TE, Ford KR, Myer GD, et al. Effect of puberty and gender on landing force and jump height. Med Sci Sports Exerc. 2005;37:S66.

    Google Scholar 

  25. Hewett T, Johnson D. ACL prevention programs: fact or fiction? Orthopedics. 2010;33:36–9.

    Article  PubMed  Google Scholar 

  26. Hewett TE, Myer GD. The mechanistic connection between the trunk, knee, and anterior cruciate ligament injury. Exerc Sport Sci Rev. 2011;39:161–6.

    PubMed  PubMed Central  Google Scholar 

  27. Hewit J, Cronin J, Hume P. Multidirectional leg asymmetry assessment in sport. Strength Cond J. 2012;34:82–6.

    Article  Google Scholar 

  28. Holcomb WR, Rublet MD, Lee HJ, et al. Effect of hamstring-emphasized resistance training on hamstring: quadriceps strength ratios. J Strength Cond Res. 2007;21:41–7.

    PubMed  Google Scholar 

  29. Iga J, George K, Lees A, et al. Cross-sectional investigation of indices of isokinetic leg strength in youth soccer players and untrained individuals. Scand J Med Sci Sports. 2009;19:714–9.

    Article  CAS  PubMed  Google Scholar 

  30. Imai A, Kaneoka K, Okubo Y, et al. Effects of two types of trunk exercises on balance and athletic performance in youth soccer players. Int J Sports Phys Ther. 2014;9:47–57.

    PubMed  PubMed Central  Google Scholar 

  31. Imprezzilini F, Bizzini M, Dvorak J, et al. Physiological and performance responses to the FIFA 11+ (part 2): a randomised control trial on the training effects. J Sport Sci. 2013;31:1491–502.

    Article  Google Scholar 

  32. Ireland ML. The female ACL: why is it more prone to injury? Orthop Clin North Am. 2002;33:637–51.

    Article  PubMed  Google Scholar 

  33. Krosshaug T, Nakamae A, Boden BP, et al. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med. 2007;35:359–67.

    Article  PubMed  Google Scholar 

  34. Lee TQ, Anzel SH, Bennett KA, et al. The influence of fixed rotational deformities of the femur on the patellofemoral contact pressures in human cadaver knees. Clin Orthop. 1994;302:69–74.

    PubMed  Google Scholar 

  35. Le Gall F, Carling C, Reilly T, et al. Incidence of injuries in elite French youth soccer players; a 10-season study. Am J Sports Med. 2006;34:928–38.

    Article  PubMed  Google Scholar 

  36. Leetun D, Ireland M, Wilson J, et al. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sport Exerc. 2004;36:926–34.

    Article  Google Scholar 

  37. Li G, Rudy TW, Allen C, et al. Effect of combined axial compressive and anterior tibial loads on in situ forces in the anterior cruciate ligament: a porcine study. J Orthop Res. 1998;16:122–7.

    Article  CAS  PubMed  Google Scholar 

  38. Lloyd RS, Oliver JL, Hughes MG, et al. Age-related differences in the neural regulation of stretch–shortening cycle activities in male youths during maximal and sub-maximal hopping. J Electromyogr Kinesiol. 2012;22:37–43.

    Article  PubMed  Google Scholar 

  39. Lloyd RS, Oliver JL, Faigenbaum AD, et al. Chronological age vs. biological maturation: implications for exercise programming in youth. J Strength Cond Res. 2014;28:1454–64.

    Article  PubMed  Google Scholar 

  40. Malliou P, Gioftsidou A, Pafis G, et al. Proprioceptive training (balance exercises) reduces lower extremity injuries in young soccer players. J Back Musculoskelet Rehabil. 2004;17:101–4.

    Google Scholar 

  41. Maulder P, Cronin J. Horizontal and vertical jump assessment: reliability, asymmetry, discriminative and predictive ability. Phys Ther Sport. 2005;6:74–82.

    Article  Google Scholar 

  42. McGuine TA, Greene JJ, Best T, et al. Balance as a predictor of ankle injuries in high school basketball players. Clin J Sports Med. 2000;10:239–44.

    Article  CAS  Google Scholar 

  43. McGuineTA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34:1103–11.

  44. Meylan C, McMaster T, Cronin J, et al. Single-leg lateral, horizontal, and vertical jump assessment: reliability, interrelationships, and ability to predict sprint and change-of-direction performance. J Strength Cond Res. 2009;23:1140–7.

    Article  PubMed  Google Scholar 

  45. Michaud PA, Renaud A, Narring F. Sports activities related to injuries? A survey among 9–19 year olds in Switzerland. Inj Prev. 2001;7:41–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Mickle KJ, Munro BJ, Steele JR. Gender and age affect balance performance in primary school-aged children. J Sci Med Sport. 2011;14:243–8.

    Article  PubMed  Google Scholar 

  47. Moore O, Cloke DJ, Avery PJ, et al. English Premiership Academy knee injuries: lessons from a 5 year study. J Sports Sci. 2011;29:1535–44.

    Article  PubMed  Google Scholar 

  48. Myer GD, Ford KR, Hewett TE. Rationale and clinical techniques for ACL injury prevention among female athletes. J Athl Train. 2004;39:352–64.

    PubMed  PubMed Central  Google Scholar 

  49. Myer GD, Ford KR, Palumbo JP, et al. Neuromuscular training improves performance and lower extremity biomechanics in female athletes. J Strength Cond Res. 2005;19:51–60.

  50. Myer GD, Ford KR, McLean SG, et al. The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. Am J Sports Med. 2006;34:445–55.

    Article  PubMed  Google Scholar 

  51. Myer GD, Brent JL, Ford KR, et al. Real-time assessment and neuromuscular training feedback techniques to prevent ACL injury in female athletes. Strength Cond J. 2011;33:21–35.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Myer GD, Faigenbaum AD, Chu DA, et al. Integrative training for children and adolescents: techniques and practices for reducing sports-related injuries and enhancing athletic performance. Phys Sportsmed. 2011;39:74–84.

    Article  PubMed  Google Scholar 

  53. Myer GD, Faigenbaum AD, Ford KR, et al. When to initiate integrative neuromuscular training to reduce sports-related injuries in youth? Curr Sports Med Rep. 2011;10:155–66.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Nesser TW, Huxel KC, Tincher JL, et al. The relationship between core stability and performance in Division I football players. J Strength Cond Res. 2008;22:1750–4.

    Article  PubMed  Google Scholar 

  55. Noyes FR, Barber-Westin SD, Fleckenstein C, et al. The drop-jump screening test: difference in lower limb control by gender and effect of neuromuscular training in female athletes. Am J Sports Med. 2005;33:197–207.

    Article  PubMed  Google Scholar 

  56. Opar D, Timmins R, Dear N, et al. The role of neuromuscular inhibition in hamstring strain injury recurrence. J Electromyogr Kinesiol. 2013;23:523–30.

    Article  PubMed  Google Scholar 

  57. Padua D, Arnold B, Perrin D, et al. Fatigue, vertical leg stiffness and stiffness control strategies in males and females. J Athl Train. 2006;41:294–304.

    PubMed  PubMed Central  Google Scholar 

  58. Padua DA, Marshall SW, Boling MC, et al. The landing error scoring system (LESS) is a valid and reliable clinical assessment tool of jump-landing biomechanics. Am J Sports Med. 2009;37:1996–2002.

    Article  PubMed  Google Scholar 

  59. Philippaerts RM, Vaeyens R, Janssens M, et al. The relationship between peak height velocity and physical performance in youth soccer players. J Sports Sci. 2006;24:221–30.

    Article  PubMed  Google Scholar 

  60. Plisky PJ, Rauh MJ, Kaminski TW, et al. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36:911–9.

    Article  PubMed  Google Scholar 

  61. Powell JW, Barber-Foss KD. Sex related injury patterns among selected high school sports. Am J Sports Med. 2000;28:385–91.

    CAS  PubMed  Google Scholar 

  62. Price RJ, Hawkins RD, Hulse MA, et al. The Football Association and medical research programme: an audit of injuries in academy youth football. Br J Sports Med. 2004;38:466–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Quatman CE, Ford KR, Myer GD, et al. Maturation leads to gender differences in landing force and vertical jump performance: a longitudinal study. Am J Sports Med. 2005;34:1–8.

    Article  Google Scholar 

  64. Ross S, Guskiwicz K. Assessment tools for identifying functional limitations associated with functional ankle instability. J Athl Train. 2008;43:44–50.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Rumpf M, Cronin J. Injury incidence, body site, and severity in soccer players aged 6–18 years: implications for injury prevention. Strength Cond J. 2012;34:20–31.

    Article  Google Scholar 

  66. Russell PJ, Croce RV, Swart EE, et al. Knee muscle activation during landings: developmental and gender comparisons. Med Sci Sports Exerc. 2007;39:159–69.

    Article  PubMed  Google Scholar 

  67. Simonsen EB, Magnusson SP, Bencke J, et al. Can the hamstring muscles protect the anterior cruciate ligament during a side-cutting maneuver? Scand J Med Sci Sports. 2000;10:78–84.

    Article  CAS  PubMed  Google Scholar 

  68. Small K, McNaughton L, Greig M, et al. The effects of multidirectional soccer-specific fatigue on markers of hamstring injury risk. J Sci Med Sport. 2010;13:120–6.

    Article  CAS  PubMed  Google Scholar 

  69. Tursz A, Crost M. Sports related injuries in children: a study of their characteristics, frequency and severity with comparison to other accidental injuries. Am J Sports Med. 1986;14:294–9.

    Article  CAS  PubMed  Google Scholar 

  70. Van der Sluis A, Elferink-Gemser MT, Coelho-e-Sliva MJ, et al. Sports injuries aligned to peak height velocity in talented pubertal soccer players. Int J Sports Med. 2014;35:351–5.

    PubMed  Google Scholar 

  71. Volpi P, Pozzoni R, Galli M. The major traumas in youth football. Knee Surg Sports Traumatol Arthrosc. 2003;11:399–402.

    Article  CAS  PubMed  Google Scholar 

  72. Zazulak BT, Hewett TE, Reeves NB, et al. The effects of core proprioception on knee injury: a prospective biomechanical epidemiological study. Am J Sports Med. 2007;35:368–73.

    Article  PubMed  Google Scholar 

  73. Zebis MK, Andersen LL, Bencke J, et al. Identification of athletes at future risk of ACL ruptures by neuromuscular screening. Am J Sports Med. 2009;37:1967–73.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. School of Sport, Health and Applied Science, St Mary’s University, Waldegrave Road, Twickenham, London, TW1 4SX, UK

    Paul J. Read

  2. Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, Cardiff, UK

    Jon L. Oliver & Rhodri S. Lloyd

  3. Exercise and Sport Research Centre, School of Sport and Exercise, University of Gloucestershire, Gloucester, UK

    Mark B. A. De Ste Croix

  4. Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Gregory D. Myer

  5. Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA

    Gregory D. Myer

  6. The Micheli Center for Sports Injury Prevention, Boston, MA, USA

    Gregory D. Myer

  7. Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand

    Jon L. Oliver & Rhodri S. Lloyd

  8. Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA

    Gregory D. Myer

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  1. Paul J. Read
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  2. Jon L. Oliver
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  3. Mark B. A. De Ste Croix
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  4. Gregory D. Myer
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Correspondence to Paul J. Read.

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No sources of funding were used to assist in the preparation of this article. One author (Gregory Myer) would like to acknowledge funding support from National Institutes of Health Grants R21-AR065068.

Conflicts of interest

Paul Read, Jon Oliver, Mark de Ste Croix, Gregory Myer and Rhodri Lloyd declare that they have no conflicts of interest relevant to the content of this review.

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Read, P.J., Oliver, J.L., De Ste Croix, M.B.A. et al. Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players. Sports Med 46, 1059–1066 (2016). https://doi.org/10.1007/s40279-016-0479-z

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