Common Injuries From Kicking Over and Over Again

• Journal List
• Int J Sports Phys Ther
• five.10(one); 2015 Feb
• PMC4325295

Int J Sports Phys Ther. 2015 Feb; 10(1): 114–127.

AN INTERVAL Kick PROGRESSION FOR RETURN TO SOCCER FOLLOWING LOWER EXTREMITY INJURY

Amelia Arundale, PT, DPT, SCS, Holly Silvers, MPT,^1,2 David Logerstedt, PT, PhD, MPT, MA, SCS,^one,3 Jaime Rojas, MS, ATC, LAT,⁴ and Lynn Snyder‐Mackler, PT, ATC, SCS, ScD^one,iii

Holly Silvers

¹Academy of Delaware Biomechanics and Movement Scientific discipline Programme, Newark, DE, USA

²Santa Monica Sports Medicine Foundation, Santa Monica, CA, The states

David Logerstedt

ⁱAcademy of Delaware Biomechanics and Motion Science Program, Newark, DE, USA

³Academy of Delaware Physical Therapy Section, Newark, DE, USA

Jaime Rojas

^ivColorado Rapids Soccer Social club, Commerce Metropolis, CO, United states of america

Lynn Snyder‐Mackler

¹University of Delaware Biomechanics and Movement Scientific discipline Program, Newark, DE, Usa

³University of Delaware Physical Therapy Section, Newark, DE, USA

Abstruse

Background and Purpose

The majority of all soccer injuries bear upon the lower extremities. Regardless of whether the injured limb is an athlete'southward preferred kicking or stance leg, a lower extremity injury may affect their ability to impact the brawl. Sport‐specific biomechanical progressions to augment loading and gradually reintroduce a player to the demands of sport have been developed for upper extremity sports such as baseball game, softball, tennis, and golf. Generalized return to soccer progressions take too been published in order to assist clinicians in safely returning athletes to sport; withal, at that place are no specific progressions for the early stages of kicking designed to introduce opinion leg loading and kicking leg impact. Thus, the purpose of this clinical commentary was to review the existing literature elucidating the biomechanics of kicking a soccer ball and advise a progressive kicking program to back up clinicians in safely returning their soccer athletes to the demands of sport.

Description of Topic

The interval kicking program (IKP) describes clinical guidelines for readiness to brainstorm a kicking program besides equally possible readiness to render to sport measures. The programme is performed on alternating days integrating therapeutic exercise and cardiovascular fitness. The IKP gradually introduces a role player to the loading and impact of kicking. The progression increases kicking distance (using the markings of a soccer field every bit a guide), book, and intensity and uses proposed soreness rules, effusion guidelines, and player feedback in order to assistance clinicians in determining readiness for advancement though the stages. The IKP also recommends utility of specific tests and measures to decide readiness for return to sport.

Discussion

Gradual reintroduction to sport specific demands is essential for a prophylactic return to soccer. This return to sport progression provides a framework integrating injury specific therapeutic exercise, cardiovascular fitness, and the return to kicking progression, to assist clinicians in initiating an athletes' render to soccer.

Keywords: Kicking, Lower Extremity Injury, Soccer

INTRODUCTION

Approximately 265 1000000 people play soccer, making it the almost popular sport in the world.¹ Unfortunately, the demands of the sport place the lower extremities at high risk for injury.^two,3 Sport‐specific biomechanical progressions tin can augment loading, reducing the risk of re‐injury every bit an athlete attempts to return to sport. Interval programs, integrated as part of a return to sports progression, gradually expose upper extremity athletes to the demands of their sports every bit they return to baseball game, softball, golf, and tennis.^four‐6 Similarly, interval running programs are also mutual, gradually reintroducing the biomechanical and cardiovascular demands of running.^7,8 However, to the authors' noesis there are no published interval kicking programs to prepare soccer players for return to sport after sustaining a lower extremity injury. Therefore, the purpose of this clinical commentary was to examine the existing literature relevant to kick in soccer and suggest an interval boot programme (IKP) that can be used as a framework to return an athlete to kick a soccer ball post-obit lower extremity injury.

INJURIES IN SOCCER

Injuries occur at a rate of 8.0 per 1000 histrion hours in European men's professional soccer for an average of 2 injuries per role player per season,^2,ix which for a team of 25 players, translates to fifty injuries of varying severity per season, resulting in significant medical costs, diminished social club performance, and lost playing time. Betwixt 60‐87% of soccer injuries involve the lower extremities.^2,three,10 The majority of injuries are acute or traumatic,^xi with chronic or reinjures accounting for only a small proportion of all injuries.^3,ten,12 Approximately 57‐lxxx%^two,9,11,12 of injuries occur in matches, up to 1 quarter of these^2,11,13 stemming from foul play. These rates of injury are like for amateur and youth players. Amongst youth players injury incidence increases with age, women between the ages of 15‐xix having the highest incidence.^14‐16 Goalkeepers at all levels have a lower injury incidence than field players.^{fourteen,17‐19}

Studies examining soccer injury incidence indicate that injuries occur more ofttimes in games than in preparation sessions,^{2,iii,10,11,thirteen} only some professional leagues have unique patterns of injury occurrence across a season. In European men'southward professional person soccer, for instance, injury occurrence increases both in the latter portion of the flavour and when game frequency increases.^2,ix,10 Women's professional soccer in Germany shows a similar trend, with a higher overall number of injuries occurring in the second half of the season.¹³ In dissimilarity, injury occurrence in US men'southward professional soccer spikes twice, once early in the season and then once more in mid to late season.^nineteen

Muscle strains account for 31% of all injuries in women's soccer,¹⁰ and approximately 35% in men'due south soccer.ⁱⁱ In men's soccer the risk of muscle injury increases with age,^12,17,20 history of injury,¹² and during the afterwards portions of a game.²⁰ Injuries to the thigh region are the most mutual, with hamstrings strains accounting for 16% of all reported injuries.^2,3,ixThe adductors are the next near ordinarily injured musculus grouping, followed by quadriceps and calf muscles.^ix Furthermore, patterns of injury occurrence vary by muscle group, with adductor strains stemming from overuse rather than trauma.²⁰ Quadriceps strains are more usually seen on the kicking leg,²⁰ frequently occurring during preseason, in dissimilarity to adductor and calf injuries which occur later in the season.¹² In European men'due south professional person soccer, hamstrings injuries are sustained more ordinarily belatedly in the season,²⁰ whereas in United states of america men's professional soccer hamstrings injuries are reported more often early in the flavour.¹⁹

Ligament sprains make up a smaller portion of all injuries; xix.1% in women'due south soccer¹⁰ and 18% in men'due south soccer.ⁱⁱ In men'southward soccer the majority of these sprains occur at the talocrural joint, representing 51% of all sprains and six.ix‐7.five% of all injuries.^3,9,x Knee sprains are less common than ankle sprains in both men'southward and women'south soccer, though often more than serious. In men's soccer, isolated medial collateral ligament (MCL) sprains are the virtually mutual knee ligamentous injury,^2,9 in contrast to women'south soccer where anterior cruciate ligament (ACL) injuries are the nearly common. ACL injuries are a pregnant problem in women'south soccer, with injuries in professional soccer occurring at a rate of 0.09 per 1000 playing hours^x and between 0.1‐0.31 per 1000 playing hours in amateur and collegiate soccer.^14,21‐24 The risk of ACL injury for adolescent female person players has been reported to be even higher, at 1.0 per 1000 playing hours.²⁵

Lower extremity injuries may impact the kinematics of kicking, as the kicking leg requires adequate range of motion (ROM), muscle strength, and neuromuscular control in order to move through the kicking motion, in improver to having the stability to withstand and dissipate the impact force of striking a ball. The health of the stance leg is of equal importance, as its ROM, strength and neuromuscular control are essential to stabilizing the body throughout the kicking motion. Regardless of whether the injury involved the stance or the kicking limb, both limbs should be analyzed for pathokinematic patterns potentially involved in the development of the initial injury.

OVERVIEW OF Kicking BIOMECHANICS

The three common kicking techniques in soccer are the instep kick, the curved kick (a variation of the instep kick which generates brawl spin and a curved flight blueprint of the brawl), and the side‐foot kick. During an instep kick (Figure 1b) a player strikes the ball with the laces of the shoe, along the first metatarsal. In contrast, during a side‐foot kick (Figure 1a) a player uses the medial side of the foot, striking the ball with the medial arch. Brophy et al describe five phases of kicking (Table 1 and Effigy 2) that are proportionally the aforementioned elapsing for instep and side‐foot boot; nonetheless, instep kicks occur at a higher velocity.²⁶

Instance of Side‐human foot and Instep kick. a.) Side‐foot kick: A kick using medial side of the foot, particularly the medial arch, to strike the ball. b.) Instep kicking: A kick using the dorsum of the foot, particularly along the first metatarsal, to strike the ball. Both techniques can be used for short or long altitude boot, however the instep kick is more than ofttimes used for long distances and/or college speeds.

Table 1.

The Start and End Point of the Phases of Kick

Phase		First of phase*	Stop of phase*
1	Preparation	Heel strike	Toe‐off
2	Backswing	Toe‐off	Maximum hip extension
3	Leg Cocking	Maximum hip extension	Maximum genu flexion
4	Leg Acceleration	Maximum genu flexion	Brawl contact
v	Follow Through	Ball contact	Heel strike

Other important soccer‐specific techniques include dribbling, volleying, and juggling (for additional detail run across Appendix 1). Dribbling is the employ of numerous small touches of the ball with the foot/feet allowing a player to run with the ball at his or her feet. Players generally utilise the distal lateral dorsum of the pes to push the ball, though all surfaces of the foot tin can be used, especially when attempting to evade a defender. Volleying is a technique using the side or instep of the human foot in order to strike a lofted or airborne ball. Juggling uses the feet, thighs, chest, head, and occasionally other trunk parts to keep the ball in the air. Rarely used in games, juggling is commonly used to practice controlled and accurate touches of the brawl. In addition to each of the aforementioned techniques, Goalkeepers use one additional technique which will not exist covered in this paper, the drop‐kick or punt. The drop‐kick is similar to that used in Aussie Rules Football game, rugby, or American football, though at that place are slight variations due to the shape of the ball.

Players often have two to four steps at an angle of 42‐458^27,28 leading upward to a kick (with the last stride existence the longest, specially for long‐range kicks^29,30) with their bodies inclining posteriorly and laterally towards the side of the support leg by 258 (Figure 2: Grooming).³¹ This angle of approach coupled with the bending of the back up leg facilitates a steeper swing airplane for the kicking leg, allowing greater extension of the kick leg at ball contact, thereby creating higher foot velocities and meliorate brawl contact, likewise every bit a more than stable support‐leg position.³²

At backswing the arm of the support leg is abducted and gradually adducts as the body moves through leg cocking and leg dispatch (Effigy 2: Backswing). The body likewise rotates in training for the kick, returning to neutral as the athlete progresses towards the ball.³³ Elevation of the arm has been hypothesized as a technique for providing a counterbalance to stabilize the body or for creating an arc of tension to use potential energy. The arc is created past increased tension from abduction of the arm, rotation of the trunk, and extension of the hip in backswing. Through a stretch shortening bike potential free energy is converted as the leg swings forward and arm adducts.^32,33 Skilled players apply a greater hip and arm range of motility, allowing them to create greater brawl speeds without expending additional free energy.³³

Pelvic protraction and posterior tilting occurs equally the trunk progresses towards ball contact. During backswing, the pelvis of the boot leg begins lowered relative to the back up leg and rises to a position superior to the back up leg at ball contact facilitating greater knee extension of the kicking leg, greater foot speed (Effigy 2: Backswing, Leg Cocking, Leg Acceleration),^32,34 and avoidance of catching the toes on the footing.³⁵ Brophy et al report that women have significantly more hip adduction on the back up leg than men, specially during backswing, leg cocking, and leg acceleration; even so, overall pelvic obliquity remains the same.³⁶

At the beginning of backswing, the back up leg knee is flexed at approximately 26° and continues flexing until ball contact in order to absorb the strength of landing and provide stability (Effigy 2: Backswing, Leg Cocking, Leg Acceleration). Immediately following ball contact the knee begins to extend slowly, allowing for stability, muscle fiber recruitment, and the generation of additional force (Figure 2: Follow Through).³⁷ This eccentric activity of the quadriceps during nearly of the opinion phase allows the opinion leg more stability and thus generation of greater kicking speed.³⁵

During an instep kick the hip is the primary mover, contributing more to the angular acceleration of the shank than the articulatio genus.³⁸ In a side‐pes kick, however, the knee has higher power, probable due to the effort required at the hip to maintain the pes position.³⁸ A strong relationship exists betwixt foot‐swing velocity and resultant ball velocity. The findings of Nunome et al indicating that the foot continues to accelerate through ball contact³⁹ are consistent with traditional coaching advice to "boot through the ball."³²

Ball impact lasts 10ms and occurs near the middle of gravity of the foot.³⁹ For a ball moving at xvi.3 yard/due south the superlative bear on force at the foot is 1200N,⁴⁰ simply peak foot affect strength can attain as high every bit 2900N.^41,42 Upon impact the pes is passively plantarflexed (unless barefoot, in which instance the foot is already in maximal plantar flexion),⁴² everted and abducted.^32,42 Men feel less plantar flexion angular deportation during brawl touch than women.⁴² Some studies accept reported men also attain college average brawl velocities^36,43 and ball‐to‐pes velocity ratios.⁴³ This may be due to smaller plantar flexion displacement, such a mechanism would be similar to the college velocities achieved when kicking barefoot as compared to shod. Nevertheless, because there is no normative information on kicking, further research is needed in order to fully understand all mechanics involved in this action.

Instep kick ground reaction forces (GRF) through the stance leg accept been reported every bit follows: vertical GRF 2.1‐ii.iv times the player's body weight (xBW),^31,44 posterior GRF ane.nine‐2.four xBW, and medial GRF 0.5‐1.2 xBW.^45,46 The vertical and posterior GRFs of kicking are larger than running at a speed equivalent to the arroyo steps (vertical 1.7 xBW, posterior 0.39 xBW).³⁵ Instep kicking vertical GRF is smaller than that observed in other sporting activities such equally javelin throwing,⁴⁷ basketball layup or jump shot landing,⁴⁸ and cricket fast bowling.^35,49

Muscle activity varies by musculus group as well as by leg (Tables 2 and ​ three).²⁶ A side‐foot kick requires greater hamstrings activation (62% of maximal volitional isometric contraction‐MVIC) during follow through than an instep kick (50% MVIC), while the instep kick requires greater overall iliacus, vastus medialis, gastrocnemius, and adductor activation (Tables 2 and ​ 3). On the support leg, a side foot kick requires higher gastrocnemius activation (84% MVIC) during leg dispatch than an instep kick (74% MVIC).²⁶ Overall, men have greater gluteus medius (124% MVIC) and vastus medialis (139% MVIC) musculus activation (women have 55% MVIC and 69% MVIC respectively) on their support limb and greater iliacus activation (123% MVIC) on their kicking limb as compared to women (34% MVIC).³⁶ Although greater iliacus activation may be protective at the knee joint it may contribute to a higher take a chance of hip and groin pathology.³⁶ Hip extension during an instep kick not generated from college gluteus maximus activation, may necessitate increased iliacus activation in order to flex the hip farther and faster.²⁶

Table 2.

Musculus activeness as a percent of maximal volitional isometric contraction (% MVIC) every bit measured by electromyography during each phase of an instep boot, based on data from Brophy et al (2007).

% MVIC	Preparation	Backswing	Leg Cocking	Leg Acceleration	Follow Through
Iliacus	57	96	149	131	95
	46	17	thirty	36	30
Gluteus Medius	104	75	57	71	89
	74	84	109	119	82
Gluteus Maximus	148	74	73	114	129
	65	78	99	94	seventy
Hamstrings	63	39	26	33	fifty
	xxx	72	104	94	64
Vastus Lateralis	60	36	50	87	52
	37	38	93	107	49
Vastus Medialis	128	23	78	100	69
	37	60	202	228	90
Gastrocnemius	99	33	42	57	67
	fourteen	40	75	lxx	41

Kicking Leg	0‐10%	11‐xx%	21‐thirty%	31‐xl%	41‐50%	51‐60%	61‐70%	71‐eighty%	81‐90%	91‐100%	>101%*
Support Leg	0‐10%	eleven‐20%	21‐30%	31‐40%	41‐50%	51‐sixty%	61‐seventy%	71‐lxxx%	81‐90%	91‐100%	>101%*

Table 3.

Muscle action as a percent of maximal volitional isometric contraction (% MVIC) as measured by electromyography during each phase of a side‐pes kick, based on data from Brophy et al (2007).

% MVIC	Preparation	Backswing	Leg Cocking	Leg Dispatch	Follow Through
Iliacus	28	65	128	106	95
	51	nineteen	34	37	26
Gluteus Medius	100	63	72	106	82
	73	70	103	114	79
Gluteus Maximus	127	57	77	115	120
	59	59	109	96	69
Hamstrings	59	35	20	41	62
	26	78	108	74	55
Vastus Lateralis	48	24	58	90	47
	34	28	87	96	57
Vastus Medialis	115	15	l	99	71
	38	54	182	228	99
Gastrocnemius	82	22	19	34	68
	12	32	84	56	37

Kicking Leg	0‐10%	11‐20%	21‐30%	31‐40%	41‐50%	51‐60%	61‐70%	71‐80%	81‐ninety%	91‐100%	>101%*
Back up Leg	0‐10%	11‐20%	21‐30%	31‐40%	41‐50%	51‐threescore%	61‐70%	71‐eighty%	81‐90%	91‐100%	>101%*

Greater human foot speeds and ball speeds are achieved kicking with the dominant leg;^35,50 nevertheless, in that location are no differences between the dominant and non‐dominant limbs in support limb vertical, braking, or medial‐lateral GRF.³⁵ The linear velocity of the boot leg knee is similar, for both the dominant and not‐dominant leg, only the shank angular velocity is greater on the dominant leg, pregnant more work is done on the shank of that leg.⁵⁰ In any example, there is no difference in muscle moment or rate of force evolution.⁵⁰ Clagg et al establish that women kick with their not‐dominant leg used greater amounts of braking torque (hip, knee, and talocrural joint extension, external rotation, and abduction); in dissimilarity, greater pulling torque (flexion, internal rotation, and adduction) was exerted when boot with their ascendant leg.⁵¹ While at that place seems to be fiddling kinematic differences between the dominant and non‐dominant legs when kicking a stationary ball as compared to a rolling ball, farther research is needed to assess kinetic differences.⁵²

PROPOSED CLINICAL MEASURES

Although some objective measurements related to kicking exist, many are not relevant to an IKP. Thus, the authors accept separated clinical measures into two categories; readiness for a return to boot program and readiness for return to sport.

Readiness for a render to kicking programme

Because the IKP is designed to be performed in conjunction with rehabilitation and cardiovascular training it should only exist initiated when an athlete has been cleared to begin running, cutting, pivoting, and sport‐specific rehabilitation. Athletes should take no pain, full range of motility, and no effusion as measured by reliable techniques such as the Modified Stroke Test⁵³ for the knee or the Effigy 8 circumferential measurement method for the ankle.⁵⁴ There are currently no valid/reliable tests for measurement of effusion in the hip. Muscle strength, if measured past transmission muscle testing should be equal bilaterally. Due to the decreased sensitivity of manual musculus testing as an authentic determinant of strength, the authors recommend quantifying muscle forcefulness using manus‐held or electromechanical dynamometers.^55,56 80 percent strength performance of the involved limb (compared to the functioning of the uninvolved limb) is recommended every bit a goal when considering readiness for running, a gradual initiation of light plyometric (e.grand. hopping), agility, and return to sport activities.^57,58 Because running is integral to the atomic number 82 steps of a kick and the GRFs of kicking are slightly larger than those of running,³⁵ it is critical that an athlete be able to run with even footstep lengths and without hurting prior to kicking. Footstep length and bear upon forces should be assessed for symmetry either clinically, by visually examining step symmetry and ball speed, or if available in a laboratory.

Readiness for return to sport

The decision to allow an athlete to return to full team preparation sessions, contact, and eventually game‐play is multifactorial, and, all too frequently made with few or no objective measures. Objective measures, particularly those with normative values, are essential for making an informed conclusion concerning an athlete's readiness. While many objective criteria for return to sport take been discussed in the literature at that place is fiddling understanding on standardization, thus many institutions and practitioners employ their own criteria or some combination of criteria. The authors recommend that before returning to total squad preparation with contact an athlete should encounter objective criteria that include both performance‐based and patient reported outcome measures. An example of such criteria used after ACL injury or surgery is greater than or equal to 90% (performance of the involved limb compared to the performance of the uninvolved limb) on the single, triple, and cross‐over hop for altitude and the six‐meter timed hop test; greater than or equal to xc% isokinetic quadriceps forcefulness; and a score of greater than or equal to ninety% on the Global Ratings Scale, and Knee Outcomes Survey‐ Activities of Daily Living Calibration (KOS‐ADLS).^58,59

Patient reported outcome measures are of import objective tools in order to understand a players' perceived function. Some measures helpful in assessing function include: the Global Ratings of Change Scales,⁶⁰ Knee Injury and Osteoarthritis Outcomes Calibration (KOOS) (particularly the sports subscale),^61,62 the International Knee Documentation Committee 2000 Subjective Knee form (IKDC2000),⁶³ and the Foot and Ankle Ability Measure.^64,65 Further, scales that appraise kinesiophobia, such as the Modified Tampa Scale of Kinesiophobia‐xi (TSK‐11),⁶⁶ or conviction and risk appraisal, such as the Anterior Cruciate Ligament‐Render to Sport subsequently Injury Scale (ACL‐RSI),⁶⁷ may also exist valuable in assessing an athlete'southward readiness and likelihood to return to sport.⁶⁸ Past comparing a player's current scores to baseline scores and normative data, these cocky‐report measures tin can allow the rehabilitation squad to estimate a player's progress every bit well as readiness for sport.

Numerous assessments of passing, shooting and kicking are available to assess an athlete's power to perform soccer‐specific tasks. Withal because of the speed of play, the force per unit area from opponents, and the endurance soccer requires information technology is difficult to create an objective measure out that accurately captures the behavior, accuracy, or performance of a actor in competition. Furthermore, many soccer tests require prohibitive amounts of equipment, space, and thespian/tester preparation. Two of the most researched tests are the Loughborough Soccer Passing Test and Loughborough Soccer Shooting Test. These were the outset, and currently only, tests validated for adolescents and women.^69,70 The Loughborough Soccer Passing Exam is used to assess a player'south performance when drawn, equally well as a thespian's perception and cognitive decision making processes.⁷¹ No normative data exists on either test and no validated "passing" cutting‐off score has been established.

Similar to its employ in assessing the performance of a baseball pitcher, a radar gun can determine the velocity of a kicked brawl, providing data on a player'south ability to contact the brawl and whether or non hurting occurred. This mensurate requires baseline data for comparison, and is not generalizable to either exercise or game play. Due to the limited apply of juggling in an actual game, counting the number of times a player tin juggle, has poor construct validity;⁷² similarly counting the times a player can volley a ball against a wall without its hitting the ground can exist used to assess passing accuracy and control, but lacks ecological validity.⁷² Testing a player's ability to distill in a effigy eight pattern is a valid and reliable indicator of technique.⁷² In the instance of return to kicking, such a test could be used to assess speed, agility and readiness for higher level dribbling activities. Other soccer‐specific tests include shooting at a plywood target covered in carbon newspaper. Though a reliable measure of accurateness,⁷³ this test is limited considering it requires extensive equipment. Russell et al developed a reliable and valid measure of ball speed and precision involving dribbling, passing, and shooting.⁷⁴ The examination has more reliability than the Loughborough Soccer Shooting Exam, but is circuitous in administration requiring both thespian and tester grooming.⁷⁴

Finally, a qualitative cess of a histrion'due south actual performance during boot is crucial both during the IKP and prior to return to sport. Knowledge of a player'due south prior abilities and playing style is useful, but general knowledge of what a soccer kick should look similar is sufficient to observe for antalgic gait or abnormal movement patterns. In a highly competitive atmosphere this qualitative assessment should be performed by unbiased individuals whose principal concern is the role player'south health rather than a timeline for their expected return to playing.

THE INTERVAL KICKING PROGRAM

The IKP is designed to be performed in conjunction with rehabilitation exercises and cardiovascular training. Della Villa et al⁷⁵ and Bizini et al⁷⁶ provide examples of broad return to soccer progressions within which the IKP could be integrated. Systematic progression through the IKP (Tabular array 4) should be individualized and based on a player'due south response, feedback and injury. In particular, soreness of the surrounding musculature, is to be expected afterwards initiating a kicking program and the proposed soreness rules should be observed in society to determine readiness for progression (Table 5).⁶ Similarly, effusion guidelines such as those in White et al⁵⁸ should also guide progression. Clinicians may too adapt the IKP based on a player's injury. For example, a clinician may subtract the number or the intensity of side‐foot kicks performed past a player recovering from a MCL injury or adductor strain where as a player with deltoid ligament injury or iliopsoas/rectus femoris strain may require an even more gradual introduction to in‐step kicking.

Table 4.

Interval Kicking Plan

Basic Kicking and Passing
Step 1: Warm‐up dribbling or juggling (5 min) Two bear upon passing, five.5 meters (5 min) Rest (5 min) Warm‐up dribbling or juggling, performing opposite activity from kickoff (five min) 1 bear on passing, 5.5 meters (5 min)	Pace two: Warm‐upwards dribbling or juggling (5 min) Two affect passing, maximum sixteen.5m (5 min) Residuum (5 min) Warm‐up dribbling or juggling, performing contrary activity from beginning (5 min) One touch passing, maximum 16.5 meters (5 min)	Stride 3: Warm‐upwards dribbling or juggling (5 min) Two touch passing, maximum 16.5 meters (5 min) Rest (5‐10 min) Warm‐up dribbling or juggling(v min) One touch passing, maximum sixteen.5 meters (5 min) Rest (5‐10min) Warm‐upwards dribbling or juggling (five min) One or 2 touch passing with a maximum 16.five meters (five min)
Passing and Basic Shooting
Step 4: Warm‐upwards dribbling or juggling (5 min) Ii bear on passing, maximum 36 meters (5 min) Residuum (5 min) Warm‐up dribbling or juggling, performing contrary activity from beginning (5 min) One bear upon passing, maximum 36 meters (five min)	Step 5: Warm‐up dribbling or juggling (5 min) 2 touch passing, maximum 36 meters (five min) Rest (5‐10 min) Warm‐upwardly dribbling or juggling (five min) Ane touch passing, maximum 36 meters (v min) Rest (5‐10min) Warm‐upward dribbling or juggling (5 min) One or Two bear upon passing with a maximum 36 meters (5 min)	Step 6: Warm‐upwards dribbling or juggling (5 min) One or two bear on passing, maximum 36 meters (five min) Remainder (5‐10 min) Warm‐upwardly dribbling or juggling, (v min) Shooting (10 shots) and chipped/lofted balls, maximum xi meters (2‐3 min) Residual (5‐10 min) Warm‐upward dribbling or juggling, (5 min) One or 2 touch passing, maximum 36 meters (5 min)
Advanced Shooting
Step vii: Warm‐up dribbling or juggling (5 min) I or 2 impact passing, maximum 36 meters (5 min) Rest (5‐10 min) Warm‐up dribbling or juggling, (5 min) Shooting (x shots) and chipped/lofted balls, maximum 11 meters (two‐3 min) Residual (five‐ten min) Warm‐up dribbling or juggling, (5 min) Shooting (ten shots) and chipped/lofted balls, maximum xi meters (2‐iii min)	Pace 8: Warm‐up dribbling or juggling (5 min) Ane or two touch passing, maximum 36 meters (5 min) Residual (v‐x min) Warm‐up dribbling or juggling, (5 min) Shooting (x shots) and chipped/lofted balls, maximum 16.5 meters (2‐three min Rest (5‐10min) Warm‐up dribbling or juggling (v min) One or Two affect passing with a maximum 36 meters (5 min)	Footstep 9: Warm‐upwards dribbling or juggling (5 min) I or two touch passing, maximum 36 meters (five min) Rest (five‐x min) Warm‐up dribbling or juggling, (5 min) Shooting (10 shots) and chipped/lofted balls, maximum 16.5 meters (2‐3 min Rest (5‐10min) Warm‐up dribbling or juggling (v min) Shooting (x shots) and chipped/lofted balls, maximum sixteen.5 meters (2‐three min
Increased Intensity and Altitude
Step 10*: Warm‐up dribbling or juggling (5 min) I or two touch passing, maximum 36 meters (v min) Rest (5‐10 min) Warm‐up dribbling or juggling, (5 min) Shooting (10 shots) and chipped/lofted balls, maximum 36 meters (2‐3 min) Residuum (5‐10min) Warm‐up dribbling or juggling (5 min) Shooting (ten shots) and chipped/lofted balls max xvi.5m (2‐3miin) or One or two touch passing, maximum 36 meters (5 min)	Step eleven: Warm‐upwards dribbling or juggling (five min) 1 or 2 bear upon passing, maximum 36 meters (5 min) Residual (five‐10 min) Warm‐upwards dribbling or juggling, (5 min) Shooting (ten shots) and chipped/lofted balls, maximum 36 meters (2‐3 min) Remainder (five‐10min) Warm‐up dribbling or juggling (5 min) Shooting (ten shots) and chipped/lofted balls, maximum 36 meters (two‐3 min)	Footstep 12: Warm‐upward dribbling or juggling (five min) Ane or two bear upon passing, maximum 36 meters (5 min) Remainder (five‐x min) Warm‐upwards dribbling or juggling, (5 min) Lofted driven ball maximum 45 meters (25 times) Rest (5‐10 min) Warm‐up dribbling or juggling, (five min) Shooting (10 shots) and chipped/lofted balls, maximum 36 meters (2‐3 min) or Ane or two touch passing, maximum 36 meters (v min)
Initiating Return to Sport
Step 13: At this point goalkeepers should begin piece of work on punting and driblet kicking Field players may begin to perform >twenty min technical portions of practices with their teams likewise every bit shooting and other drills.	Step 14**: When cleared by medical team histrion may begin full practices with their team, initially not‐contact and progressing to contact.	Pace 15***: Reintroduce game‐play first through scrimmages in practise and so with gradually increasing periods of game time.

Tabular array 5.

Proposed Soreness Rules for Progression through the Interval Kicking Program, adjusted from Axe et al (2001).

If no soreness:	Advance to next stage
If sore during warm‐upward only soreness is gone during dribbling and juggling warm‐upwards:	Repeat previous phase.
If sore during warm‐upward and soreness continues through dribbling and juggling warm‐up:	Stop; accept 2 days off, and upon return to IKP, drop down one stage
If sore more than 1 hour afterward kicking, or the side by side day:	Take 1 24-hour interval off; repeat most recent phase.

Similar to upper extremity interval sports programs the IKP is designed to be performed on alternate days.⁴ The IKP, injury specific strengthening, plyometrics, and neuromuscular command drills should be performed on one solar day and cardiovascular grooming and cadre strengthening performed on the off days. This alternating structure is designed to allow the lower extremities to recover from the re‐introduction of kick, therapeutic exercises, and any plyometric or neuromuscular drills completed. The authors recommend that the IKP be performed prior to other exercises so that information technology is performed prior to the lower extremities becoming fatigued and to ensure proper class. Swimming, puddle running, cycling, or AlterG treadmill running can exist used for cardiovascular conditioning to decrease the repetitive impact of running.

A soccer ball should be integrated into exercises at the initial stages of rehabilitation. Once an athlete can demonstrate proper biomechanical movement in bones and simulating exercises, adding a ball increases caste of difficulty. Activities such as unmarried‐leg balance while gently pushing a brawl anteriorly‐posteriorly or medially‐laterally with the contralateral human foot, are low chance/low force exercises that help progress a thespian's proprioception while maintaining touch on/experience for the ball. Incorporating heading, or in the case of goalkeepers catching/throwing, tin also make rehabilitation exercises sport specific and enjoyable. Farther, soccer related exercises may improve an athlete's mood, confidence, and motivation; all factors linked to a higher likelihood of an athlete returning to sport.⁶⁸

When a player is deemed ready to begin the IKP it is crucial that all kick techniques are performed with proper biomechanics. Coaches may aid the rehabilitation team in observing a actor's ability with respect to length of passes, lofting balls, and shooting in order to forestall aberrant compensation patterns from being learned, adopted, or reinstituted. A player should perform the IKP in soccer‐specific cleats or shoes, as shoes designed for running ofttimes accept a larger, more than elevated sole that may impede stability in landing on the support foot thereby placing the ankle and knee at take a chance for injury. A soccer ball is required to perform the IKP, but multiple balls are recommended every bit this allows for more continuous kicking every bit opposed to time spent retrieving balls. The IKP is based on soccer field distances (Appendix two), thus performing on a lined a soccer field volition reduce prepare fourth dimension. A goal is besides useful for the after stages when a player resumes shooting.

Proper warm‐upward of the muscles and cardiovascular system is necessary; the authors recommend a dynamic warm‐upwards that integrates stretching, low‐level strengthening, and movement. The FIFA 11+ is a soccer‐specific warm‐upwardly developed equally an injury prevention tool.⁷⁷ The FIFA11+ is designed to warm up all of the major muscle groups in the lower extremity, and can serve also as a teaching tool to reinforce proper alignment and mechanics. Proper absurd‐down is also important following performance of the kick program. This may include stretching, light jogging, and cryotherapy.

Position specific modifications

Unlike rehabilitation in sports such every bit baseball and softball, petty position‐specific rehabilitation is needed in soccer. Goalkeepers must be confident and good with a ball at their anxiety, thus in these initial stages of returning to soccer the IKP is every bit of import for goalkeepers every bit it is for field players. The rehabilitation team may change later stages of the kicking program for goalkeepers, omitting shooting in favor of similar distance goal kicks (long/lofted instep kicks) or punts. Goalies may as well add jumping, catching, diving for and retrieving balls from the air every bit role of their dribbling or juggling warm‐ups. One example of an alternative for goalkeepers is side shuffling forth a line 11m long. Each time the goalkeeper reaches the end of the line they receive either a brawl on the basis, which they must laissez passer back with their feet, or a ball in the air, which they must catch and throw back. Calculation plyometric and diving activities, still, is at the discretion of the rehabilitation squad.

The cardiovascular and intensity demands of soccer differ by position. During games mid‐fielders, oft wide midfielders, cover the most distance of any field player and cover the well-nigh distance at loftier speeds.^78,79 In dissimilarity, central defenders cover the least distance and least distance at loftier intensities.^78,79 Attackers and central defenders may likewise accept more than recovery time between their bouts of high intensity.⁷⁸ Consequently the rehabilitation team should modify cardiovascular training to prepare a player for return to sport taking into consideration position, fettle prior to injury, and age.

CONCLUSION

Regardless of whether an injury effects an athlete'southward dominant kicking or stance leg, any lower extremity injury may influence the power to boot. The IKP presents a novel render to kicking framework specific to the sport of soccer. Similar to return to throwing progressions adult for athletes in upper extremity sports,^4‐6 this return to kicking progression guides clinicians from readiness to brainstorm kicking through an athlete's return to sport. The IKP format integrates a render to kicking into therapeutic do and cardiovascular fitness in order to accost the broader needs of an athlete. While the IKP presents a starting point for athletes to brainstorm their render to soccer, future research is needed to determine the optimal rehabilitation techniques and additional outcome measures and criteria that will ensure a rubber return to sport.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325295/

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