Assessing the Female Soccer Player
I think it's about time we get away from training soccer players as small football players and training women as little men. Soccer and football are not the same and neither are females and males. You think this would be obvious but I seem to be amazed. One of the most important aspects of sports performance is initially assessing an athlete. When I assess athletes the assessment is more similar than it is different, but there are always a few “musts” and emphasized indicators that I pay attention to depending on the individual athlete. This article is pertaining to female soccer players.
The game of soccer is full of cutting, landing, kicking, jumping and sprinting but in which how an individual athlete does so differs from athlete to athlete. For example, female soccer players have a greater chance of having a non-contact ACL injury compared to male soccer players, but why? Both male and female players perform the same movements in order to excel and if anything, males perform these movements quicker and at higher velocities. Hint: It goes deeper than just having a weak Gluteus Medius. There are a plethora of asymmetries, imbalances and malalignments in the human body and being an athlete can enhance all of these, which down the road may increase the risk of injury if not initially accounted for. Based on my experience and through research I tend to highlight a couple specific categories when assessing a female soccer player.
Hip Range of Motion
The normal ranges of passive hip internal (IR) and passive hip external rotation (ER) are about 45 degrees each which result in 90 degrees of total range of motion. Some research shows that hip IR around 35 degrees may be normal in some athletes. I have found that the majority (90 percent) of my female soccer players (16 years and older) do not have normal ranges of motion in the hip and in fact, I hardly have any of my athletes regardless of sport around the normal ranges of passive range of motion. In short, female soccer players usually lack total hip range of motion and interestingly enough female soccer players tend to have more IR then ER but again both are somewhat limited. With an increase in hip IR and slight limitation in hip ER it is hypothesized that this will put a greater vulnerability on the knee increasing the chance of an injury. Now, just because a player's hips are tight does not mean we can just crank them into some hip ER and IR stretches. Limited hip range of motion can either be caused by muscular restrictions, capsular restrictions and BONY restrictions so we need to decipher these three different factors before programming. If anything we will want to perform hip strengthening exercises, but that will only take an athlete so far. I will explain why in the next section.
Hip Anteversion
Range of motion and hip anteversion seem to go hand in hand when it comes to assessing the hips. Naturally, those with increased hip anteversion will have more hip IR and less hip ER compared to those without hip anteversion. Majority of my female soccer players I’ve trained have come in with enhanced hip anteversion to a certain degree. Hip anteversion is simply the femur being more internally rotated in the hip socket which can give the view of knee valgus or a “knocked-kneed” position. With hip anteversion being somewhat common (about 10 percent of the population) and being naturally more prevalent in females, measuring hip anteversion using the Craigs’s test is a must. Due to playing years of soccer there are constant torsional forces combined with active muscle contractions on the growth plate that result in bony and soft tissue adaptation changes over time. Just like baseball players gain humeral retroversion over the years from throwing, a similar concept happens to the hips with female soccer players. Both are normal adaptations, but both should be accounted for and programmed accordingly so no issues arise. This is where hip stability plays a huge role. As I mentioned above, athletes with hip anteversion should not stretch the hip into ER or perform any exercises that put the femur into such an externally rotated position as it is counterproductive. Remember that limited hip range of motion can be caused by bony restrictions which is why exercises that promote such positions will only create impingement and more imbalance.
Hip Flexors
If you ask a soccer player the question, how are you feeling today? They will usually reply with, my hip flexors are a little tight today. The tight feeling comes from the hip flexors being extremely short and they become short because of the demands of the game. Soccer is full of constant hip abduction/adduction, hip extension/flexion, hip ER/IR, and knee flexion movements. Think about a soccer kick, as the kicking leg goes back the knee is flexed and the hip extends creating an anterior pelvic tilt with extremely short hip flexors. When you add up every kick that athlete does on top of everything else, there is going to be an extreme feeling of tightness in that area. We know that an excessive anterior pelvic tilt shortens the hip flexors and causes an excessive lumbar extension which then can cause multiple low back injuries like spondylolysis. An anterior pelvic tilt also plays a role in increased hip IR, knee valgus and subtalar joint eversion, which all leads to a nicely paved road for an non-contact ACL injury. Anterior pelvic tilt is normal but an excessive anterior pelvic tilt is not. I always go by the phrase, they should be doing things in the weight room that they don’t do on the field. This way we will be able to correct imbalances and manage any potential pathologies.
Hamstring Muscles
The most frequently injured muscle in soccer is the hamstring muscles, specifically the Biceps Femoris Muscle. Research has shown that there is a correlation with hamstring length and hamstring injuries. Female players on average don’t have as tight of hamstrings compared to male soccer players, but any tightness in the hamstrings should not go unnoticed. I tend to see (research as well) a slightly longer hamstring in the dominant leg compared to the non-dominant leg, which should not be ignored and goes to show another great example of imbalances within the body due to the demands of the sport. Measuring hamstring length is crucial when assessing any athletes, especially male and female soccer players. To decrease the chance of injury and enhance performance, training the hamstrings should focus on lengthening the muscle fascicles and not the hamstring muscle itself in order to increase the muscle-tendon complex.
Core Stabilization
It would make sense that a soccer player should already have a strong core, but it still surprises me by the number of female soccer players I get in and most of them lack basic core strength. Having a strong core is possibly the most important factor in not only getting injured and improving movement quality but also enhancing on-field performance. I have to add the fact that you cannot get a strong core by doing 1 million crunches, but instead use exercises to help strengthen what the core is meant to do, stabilize. In the sport of soccer an athlete needs to be able to stabilize their spine, sometimes even on one leg. The lack of core strength is mostly due to the fact that they have tight hip flexor muscles and have an over usage of their rectus abdominis. I can usually tell if an athlete has a problem with the over usage of the rectus abdominis during a simple prone plank because they tend to show an excessive kyphotic posture. By enhancing core strength through the posterior fibers of the external obliques and the rectus abdominis we will be able to aid an athlete into controlling any unwanted flexion and with any hip ER limitations.
Assessing an athlete has to address not only the needs of the sport but also the needs of the individual athlete.These are only a couple of the main categories I look at when assessing a female soccer player as other assessing tools should also be looked at. Female soccer players have different imbalances than football players, female volleyball players and even their counterpart male soccer players. Generalizing all different athletes together can result in potential injury and a lot of wasted chances on improvement. It might take a little more work to assess an athlete fully and address the needs but that's how it should be done. Again, assessing an athlete properlery is only part of the puzzle as we need to use that information to create an effective program with smart exercise selection.The smallest changes can make the biggest differences when it comes to enhancing performance and reducing the chance of injury.
References
Chiaia, T. A., Maschi, R. A., Stuhr, R. M., Rogers, J. R., Sheridan, M. A., Callahan, L. R., & Hannafin, J. A. (2009). A musculoskeletal profile of elite female soccer players. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 5(2), 186–195. https://doi.org/10.1007/s11420-009-9108-9
Hogg, J. A., Schmitz, R. J., Nguyen, A. D., & Shultz, S. J. (2018). Passive Hip Range-of-Motion Values Across Sex and Sport. Journal of athletic training, 53(6), 560–567. https://doi.org/10.4085/1062-6050-426-16
Mangine RE, Noyes FR, Mullen MP, Barber-Westin SD. A physiological profile of the elite soccer athlete. J Orthop Sports Phys Ther. 1990;12(4):147-52. doi: 10.2519/jospt.1990.12.4.147. PMID: 18796878.
