Return to Sport Following Anterior Cruciate Ligament Reconstruction: Women's Soccer

Abstract

Soccer is largely recognized as the most popular sport in the world. It involves speed, agility and endurance, requiring its athletes to sprint, explode to the ball, change direction and maintain high thresholds of work for prolonged periods. In the United States, as many as 80,000 high school female athletes experience ACL injuries each year. Females tend to be more at risk for ACL injury for a multitude of reasons including biomechanical, neuromuscular activation patterns, strength imbalances and hormonal factors. Athletes and their families are becoming increasingly aware of this risk and the subsequent risk of not returning to their pre-injury level of play; thus, necessitating both preventative and post injury rehabilitation programs aimed at maximizing function and minimizing subsequent injury. A program that focuses on neuromuscular activation patterns, proprioception and balance training, functional strength, agility, landing techniques and quality of footwork is best for mitigating risk of ACL injuries in female soccer players. This post-surgical ACL reconstruction rehabilitation program for the female soccer player has been divided into five phases, each phase a progression and building upon its preceding phase. The phases range from early post-operative care to late stage, pre-clearance to return to sport guidance and have been constructed based on evidence informed guidelines focusing on maximizing function post operatively in a safe, efficient manner while minimizing risk for re-injury.

Returning to Sport: A Level-Based Guide for Women’s Artistic Developmental Program Gymnasts

“…For example, Reinhold et al published RTP protocols for baseball, tennis, and golf athletes which incorporate many fundamental principles of rehabilitation that should be applied to gymnastics RTP. 25 Additionally, multi-phase RTP protocols for athletes returning from ACLR have been published for women's soccer, women's field hockey, women's indoor volleyball, and for female ballet dancers. [26][27][28][29] In 2014, May et al published return to gymnastics guidelines for athletes recovering from concussion injury.…”

Patellofemoral Disorders in Soccer Players

“…In female soccer players, rehabilitation can address neck and periscapular strength as this is needed when heading the ball, as well as lower trunk, abdominal and gluteal strength to redistribute and absorb forces sustained during contact, such as slide tackling or player-to-player contact during gameplay. 90 All of these can be implemented in the early phases of rehabilitation or during a period of immobilization. Exercises may include isometric exercises for neck, core, and trunk strength, and sit-ups with a medicine ball toss.…”

“…Exercises may include isometric exercises for neck, core, and trunk strength, and sit-ups with a medicine ball toss. 90 The type and length of postoperative rehabilitation depend upon the type of surgery performed. Isolated MPFC reconstructions can be safely put through an accelerated rehabilitation program with earlier weight-bearing and ROM.…”

“…97 Games of keepaway can also help simulate game-like situations by incorporating quick changes of direction, marking opponents, and a reintroduction to contact from an opponent. 90 As soccer players, athletes are constantly changing direction during gameplay, which requires deceleration control. This can be a great challenge for athletes participating in later stage return to sport rehabilitation.…”

“…With these properties as the focal point of early-stage rehabilitation, it is also important to address any proximal or global strength deficits that are pertinent to the sport while affected structures undergo healing. In female soccer players, rehabilitation can address neck and periscapular strength as this is needed when heading the ball, as well as lower trunk, abdominal and gluteal strength to redistribute and absorb forces sustained during contact, such as slide tackling or player-to-player contact during gameplay 90 . All of these can be implemented in the early phases of rehabilitation or during a period of immobilization.…”