Back in December of 2016 I started to post on Women's Football with my very first post being a Needs Analysis of a Women's Footballer which had some basic information on what types of things females need to train for in preparation for Aussie Rules Footy.
Later on in February of 2017 I put together a far more comprehensive article on ACL Injury Prevention in Women Footballers that went into more detail on the points made in the Needs Analysis article as well as 2 session warm up protocol teams could use with their players.
I know there are Footy First warm up programs available but the program was made for mass production and usage and although it hit various weak points all footballers face, it's not actually specific to anything in particular.
The warm up in the ACL article is specific to ACL prevention and has videos for all exercises as well.
This morning the report that Geelong rookie and #Draft Pick Nina Morrison did her ACL in training this week which is again absolutely devastating for her, her family, the Geelong Women's football team and the AFLW at large.
She'll miss this season and probably the next season as well which is a real shame as she dominated in her very first game last week.
Let's also not forget Shae Slone also did her ACL in her first game last weekend as well and that's 2 ACL tears before round 2 even starts.
I'm probably also leaving out a player or 2 that has done an ACL during pre-season training.
My thoughts quickly as to why ACL injuries are still happening, especially non-contact one's at that include:
- Too much training volume too soon
- Not enough, or possibly any, actual training of the foot
- I've always had an issue with ankle taping and personally have only had it for 2 quarters of my entire 33 year playing career that's still going
- The very different emotional make up of females compared to males
- Not enough mechanical output training vs operational training
That's a fair intro but today I want to add some new information I've gathered since these 2 articles in the hope that this NEVER happens again that will touch on some stuff in my original articles, my thoughts on ACL's and more.
FOOT / ANKLE (DEAN SOMERSET)
- Limited Dorsi Ankle Flexion leads to pronation/inward rolling and will also present as feet turning out when running to gain the range of motion that dorsi flexion should be giving you that means the knee has to move around more than normal as well which isn't the end of the world, but not heaven either
- In a standing posture, that often tells us next to nothing of what will happen in moving posture, it will present rear foot eversion of the calcanous which is the back of your foot rolling in when you're standing still from a back view
- Decreased ankle dorsi flexion correlates with ACL injury risk where Q- angle doesn't so maybe all that banded glute work isn't what we should be focusing on?
- Ankle bracing/taping restricts range of motion like it's supposed to but that forces the knee to potentially move into range of motions that aren't desirable and I'd rather risk a rolled ankle than an ACL any day (like I said I never tape my ankles). It can also cause running mechanic alternations which may have implications on how your foot hits the ground with each step which can also cause problems all up and down the body
- The lateral muscles of the lower leg are just as important as any in preventing pronation so they need to be strong and with flat feet these muscles DO NOT WORK AT ALL
- Short foot exercises, something I've been doing for about 5 years now, is the introductory exercise to strengthening the intrinsic muscles of the feet and instilling actual change in the action of the feet - not the glutes or knees.
You can read the full article here.
ACL REINJURY (JANICE WOOD)
- Parts of the brain associated with leg movement lagged during ACL recovery
- Brain scans show that instead of relying on movement/spatial awareness, ACL injury sufferers relied more on the visual systems in the brain and thus knee movement doesn't happen as naturally or instinctively as those who had not been injured much like walking in the dark or on slippery surfaces
You can the full article here.
LOADING DYSFUNCTION (GREG LEHMAN)
- You can run with a tonne of valgus if there is no pain
- Don't catastophrise over movement impairments that don't cause pain because by doing so you;re setting them up to stay sensitive
- For ACL prevention neuromuscular training can decrease risk without any actual change in movement quality
You can read the full article here.
ACL PREVENTION v PERFORMANCE (STUDY)
- A fore-foot footfall pattern along with trunk rotation and lateral flexion in the intended cutting direction is a biomechanical strategy that could reduce potentially hazardous knee joint movements and enhance change of direction speed
- Minimising knee valgus (knees caving in) during change of direction may also prevent ACL risk but has no impact on actual performance
- Certain biomechanical strategies used to reduce ACL injury risk are linked to reduced change of direction performance such as narrow foot placement and soft landings with greater knee flexion
You can read the study abstract here.
ACL v PAIN (GREG DEA)
- Pain can reduce ankle dorsi flexion upon landing from not being able to absorb landing force properly which will result in a sort of "stiff legged landing". What happens here is that something has to "give" you that range of motion missing from the ankle and it's the knee or the hip but the knee is weaker and often takes the brunt of it and breaks. This landing will present as a "stiff" lower leg and then the knee shoots inwards to provide the range of motion the ankle doesn't/can't give and femoral internal rotation/knee valgus under load is the mechanism of an ACL tear in most cases
You can read this full article here.
ACL INJURY FACTORS (MASSAGE AND FITNESS MAGAZINE)
- Running distance, Q-angle, shoe type, lower leg flexibility/strength and gait patterns are NOT significant predictors of an ACL injury within a 2 year period
- Factors more reliable in predicting higher risks of injury include being female (physical factors mentioned in the 2 previous blogs above), having higher negative emotions than positive one's and knee stiffness at a higher bodyweight (80kgs +)
You can read the full article here.
Lastly there is a treatment type I use called Be Activated popularised by Douglas Heel. It involves a set of muscle tests combined with hitting activation points by hand and retesting the muscle tests to see what type of compensation you're in at that present time.
In BA terms a 223 Leg is the mechanism of an ACL injury.
What this means is that your psoas is struggling and it's job is being performed by the quad. The quad while "being" the psoas is still doing the quad's job as well and the tibialis anterior is doing the tibialis anterior job.
Obviously the quad is being pounded and this results in fatigue faster then if all 3 muscles were doing their own jobs like they should be.
Testing and treating this could take as little as 5mins and could you literally save you from an ACL tear.
Now I'm not gonna make out that I'm professional on the female psyche but here's what I think might be happening in Women's Football.
At the lower leagues we have a lot of females who have either not played any sport at all or have come off a long lay off from sport in the past so players are missing basic preparation such as running mechanics, strength and endurance.
For the most part covering the big rocks will be enough injury prevention work as the speeds they play at and thus the loading they put through their body's is on the low end.
That's not to say don't do any other ACL prevention work with them as a coach you need to know who's doing what outside of training in terms of training and other sport so you can plan a an ACL strategy for your players.
At the top end of Women's Football we MIGHT have players over-eager to perform/impress in "at all costs" mentality which might be causing varying degrees of anxiety which counts as stress.
This new and "heavier" dose of psychological stress is laid on top of whatever physical stress those players are already going through from relation to training and games.
This extremely high level of stress can cause emotional "instability" (for a lack of better word) which equates to mental fatigue (even at training) and with this comes a decrease in mechanics which is where these innocuous, non-contact ACL injuries can pop their dirty heads up.
What this means is that as a coach you need to be ON TOP of all players physical and mental status for all training nights and game days which can be done though various channels (1-on-1 chats, wellness surveys etc).
I'd love your thoughts on all of this so please don't hesitate to let me know.
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