A Soccer Player s Journey to Reducing Ankle Injuries Through Pilates Roshan F. Rodriguez 18 NOV 2016 2016 Course Herndon, VA
Abstract With a pitch even larger than a regulation NFL field and few substitutions allowed, it is no wonder that soccer players are well known for their athleticism. The average midfielder will run 9.5 miles in one 90-minute game with only a 15-minute break at half time (Fox). During a game, it is common for players to run a continuous moderate pace with bursts of sprints and dead stops. This constant pressure combined with sudden movements creates a ripe environment for ankle injuries to occur. Strengthening the ankle and lower limbs and increasing balance and body awareness through Pilates training can help players reduce their chances of injuries. 2
Table of Contents Abstract...2 Anatomical Description...4 Case Study...5 Conclusion...8 Sources...9 3
Anatomical Description The ankle is found between the lower leg and the foot and is made up of three main bones: the fibula, tibia and talus. The talocrural joint is located between the talus and is the bone that connects the medial malleolus of the tibia and lateral malleolus of the fibula (the bony protrusions on either side of the ankle). The joint is a uniaxial hinge joint and is responsible for plantar flexion and dorsiflexion. The muscles primarily responsible for plantar flexion include the gastrocnemius, commonly known as the calf, and the soleus, a flat, broad muscle that runs below the calf. Other muscles that assist with plantar flexion include the peroneus longus and peroneus brevis, which are located on the outside of the lower leg. The tibialis posterior, flexor halluces longus and flexor digitorum longs, which located on the inside of the lower leg, are also secondary plantar flexion muscles. The dorsiflexor muscles, which are located in the front of the lower leg, include the tibialis anterior and extensor digitorum longus. The extensor halluces longus and peroneus tertius are secondary dorsiflexors muscles. 4
The subtalar joint, which can be found where the talus and calcaneous (heel bone) meet, allows for lateral movement of the ankle-foot complex. This aids in walking, particularly on uneven surfaces. Clients with subtalar joint pain commonly report their pain as being located in front of the Achilles tendon. The deltoid ligament connects the tibia to the medial side of the ankle and provides stability for that side of the ankle. The lateral ligament complex supports the outside ankle. This complex is made up three ligaments: the anterior talofibular ligament (AFTL), which tends to be weakest and most injured ligament, the calcaneofibular ligament, which stabilizes both the ankle and subtalar joint, and the posterior talofibular ligament (PFTL). Case Study Ale Rodriguez is a 39-year-old male who has played soccer since he was 5 years old and even played for his college. Now an active duty member of the U.S. military, he plays in a highly competitive military sponsored recreation league. 5
Ale has experienced several sprains in both the left and right ankles. In 2005, he suffered a gruesome injury, which broke his right ankle in three places and tore several ligaments. A metal plate and 7 screws were installed. The plate and 5 of the screws have never been removed and may be a contributing factor to the persistent weakness of his ankle. After playing a full 90-minute soccer game, he experiences tenderness, weakness and sometimes, slight swelling around both ankles, but particularly in the right one. Most recently, Ale experienced an injury to the Achilles tendon, which resulted in him resting the ankle for several weeks before the pain subsided. Possibly due to the deficiencies in Ale s ankle strength, he has moderate supination and holding a parallel position is challenging for him. Conditioning Program The goal of the conditioning program is to strengthen all of the muscles of the lower leg with a specific focus on the ankle-foot complex to provide greater stability. By keeping these muscles strong, we hope to help reduce the tenderness Ale currently experiences after heavy exertion on the ankle and prevent future injury. Precision while doing the exercises is key in ensuring that he practices each move with proper alignment to improve the mechanics of his ankle utility in accordance with the SAID Principle. We also worked on enhancing Ale s balance so he is more aware of where his body is in space. Proprioceptive training may help him avoid future injuries as he learns greater control over his body and is able to react more quickly and efficiently to potential risks during soccer games (Riva). 6
Some of the muscles that we focused on strengthening to achieve our goals included the dorsiflexors, plantar flexors, gastrocnemius, anterior tibialis, soleus, posterior tibialis, peroneus longus and peroneus brevis. Roll down Roll up Exercise Spine Twist Supine Double Leg Stretch Single Leg Stretch Crisscross Parallel Heels Parallel Toes V Position Toes Wide V Heels Wide V Toes Calf Raises Single Leg Heels Single Leg Toes Short Box Series (Round back, Flat back, Tilt and Twist) Extended Frog (and Reverse Extended Frog) Bottom Lift Bottom Lift w/ Explanation Warm Up (Mat) Watch for any imbalances such as pronation or supination; anklefoot dorsiflexors are accompanying muscles in this exercise. Keeping the legs straight adds additional work for the tibialis anterior and extensor digitorum longus To help warm up the spine Feet are in plantar flexion, which works the gastrocnemius and soleus; accompanying muscles include hip flexors and extensors as well as knee extensors. Footwork (Wunda Chair) Wunda Chair exercises help promote proprioception as client battles to maintain proper posture; also builds strong legs, which will support ankle stability. (We placed a ball between his knees and big toes during Parallel Heels and between his heels during Parallel Toes to help maintain the parallel position.) Maintaining plantar flexion during this exercise strengthens ankle. Key to developing overall leg strength. Direct work for the plantar flexor muscles; Stabilization in this exercise is more challenging on the Wunda Chair, which is important in our proprioceptive training. Abdominals (Reformer) Hip flexor control is developed, but there is secondary work for the ankle-foot complex as the feet in the straps help anchor the body during movements. Hip Work (Reformer) Part of the work to strengthen the legs overall. Spinal Articulation (Reformer) The foot s position on the footbar demands stability in the feet and precise alignment of the ankle. 7
Extension Kneeling lunge Stomach Massage (Round, Flat and Reaching) Kneeling Arm Series (Chest Expansion, Up Circles, Down Circles Triceps, Biceps) Side Split Single Leg Skating Side over box Breaststroke Prep Breaststroke End with a roll down Stretches (Reformer) Stretching the muscles is important to preventing injuries and reducing soreness Full Body Integration I (Reformer) Keeping the plantar flexion in the beginning of the exercise and the deliberate dorsiflexion and plantar flexion movement in the middle helps build strength in plantar/dorsiflexor muscles Arm Work (Reformer) Great addition for proprioceptive training, this position also makes it easy to see when the body is out of alignment as the client will not be able to maintain stability when it is. Legs (Reformer) Focus on the lower leg muscles to help build overall strength; important to proprioceptive training as client learns to trust their bodies while standing on the reformer. Lateral Flexion/Rotation (Reformer) Provides work for the dorsiflexors because the foot is a tool in keeping the body stable. Back Extension (Reformer) Legs are active in this position with the feet in a gentle plantar flexion. Conclusion The exercises in the conditioning program were all selected with the express purpose of strengthening the muscles of the ankle-foot complex and legs and increasing the client s awareness, balance and stability. Ale reported that the conditioning program has been challenging but he has started to see a difference in his ankle strength. Since Ale has begun his Pilates training, he notes that his ankles feel more stable and reports less tenderness during and after his soccer matches. 8
Sources Foot and Ankle Conditioning Program. American Academy of Orthopaedic Surgeons. October 2012. Web. 4 NOV 2016. Fox, Kit. The Distance Run Per Game in Various Sports. Runner s World. 29 June 2016. Web. 20 OCT 2016. Isacowitz, Rael, and Karen Clippinger. Pilates Anatomy. Champaign, IL: Human Kinetics, 2011. Print. Isacowitz, Rael. Pilates. Champaign, IL: Human Kinetics, 2006. Print. Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, 2013. Print. Maffulli, Nicola, Umile Giuseppe Longo, Nikolaos Gougoulias, Dennis Caine, and Vincenzo Denaro. "Sports Injuries: A Review of Outcomes." British Medical Bulletin. Oxford Journal, 22 July 2010. Web. 06 NOV 2016. Riva, D., R. Bianchi, F. Rocca, and C. Mamo. "Proprioceptive Training and Injury Prevention in a Professional Men's Basketball Team: A Six-Year Prospective Study." National Center for Biotechnology Information. U.S. National Library of Medicine, Feb. 2016. Web. 11 Nov. 2016 Subtalar Arthroscopy. American Orthopaedic Foot and Ankle Society. N.d. Web. 28 OCT 2016.. 9