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Our Mission...

Welcome to our site!  Our mission is to bring awareness and information to youth soccer players, their families and clubs regarding strategies that can be easily implemented to help prevent the increasing incidence of anterior cruciate ligament (ACL) injuries of the knee. After experiencing first hand how devastating an ACL injury can be to a young soccer player, and the increasing incidence among adolescent athletes, we decided to do extensive research and share what we found.

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A Little ACL Background Information

The anterior cruciate ligament (ACL) is one of the main stabilizers of the knee joint and controls how far the shin bone (tibia) can "slide" forward in relation to the thigh bone (femur) and helps in preventing rotation of the tibia. ACL tears are especially common in sports that require pivoting and jumping.

Some Stats:

ACL injury is the most common form of knee injury today in the United States, with estimates ranging from 100,000 to 200,000 per year. Statistics have revealed that females 12 - 19 years of age can be from 2 times to as much as 10 times more likely to experience an ACL knee injury. ACL reconstructive surgery peak incidence in females is in the 10 - 19 years of age group, and in males is in the 20 - 29 years of age group. Interestingly, studies show that as high as 88% of ACL injuries involved no direct traumatic contact to the knee but were due to sudden deceleration, jump landings, or change in direction forces.

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The reality and serious nature of ACL surgery:

ACL surgery is a serious endeavor and can result in a major blow to a player’s progress and confidence. Return to sports can often take up to 12 months or more, especially for females following ACL surgery, and can take up to 2 years to achieve full recovery. Even then not all will return to the same level of play, so it can be an especially devastating injury for athletes. Additionally, female soccer players with ACL surgical reconstruction had nearly a 5-fold-higher rate of new ACL injuries and a 2 to 4-fold-higher rate of other new knee injuries, quit soccer to a higher degree, and reduced their activity level to a greater extent as compared with knee-healthy subjects. As such, prevention is the key!!

What factors predispose one to suffering an ACL injury?

1) Medial Knee Collapse     2) Quad Dominance     3) Hormone Fluctuations     4) Improper Cleats on Artificial Grass

Biological and Mechanical Factors:

These factors contributing to ACL injury are truly multi-factorial involving biomechanical, anatomical, hormonal, and neuromuscular sub-factors, which tend to affect females much more frequently. For example, females generally and most commonly have a wider (gynecoid type) pelvis, which increases the quadriceps "Q" angle and alters the mechanics of how the thigh bone (femur) and shin bone (tibia) function as a unit. The result is more stress on the soft tissue structures that support the knee joint. Females on average have less muscle mass and strength to support their knees, and especially knees that may be under this increased mechanical stress. Additionally, strength imbalances involving the quadriceps, hamstrings and gluteal muscles are a common problem, which may lead to quadriceps dominance and medial knee (valgus) collapse. Lastly, females have much more naturally occurring of the hormone estrogen. Essential to bone growth, this hormone (along with others) fluctuates during the menstrual cycle, which affects the strength and stability of the ligaments and tendons of the knee and other joints. This appears to make one more prone to injury at specific times during their cycle. For more detailed information on this topic, see our blog post "Hormones & ACL Knee Injuries: Are they connected?"

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Artificial Grass (Turf) Fields and the Use of Improper Footwear Factor:

Physician-researchers from University Hospitals, Case Western Reserve University and UH Sports Medicine Institute analyzed data collected during the 2017-2018 athletic seasons. They found athletes were 58% more likely to sustain an injury during athletic activity on artificial turf. Although artificial turf quality has improved dramatically during the past 5 to 10 years, studies suggest athletes should take preventive measures when playing on artificial grass, which includes the importance of having the right cleats for the surface. We discuss the recommended outdoor artificial grass cleats below.

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What can be done to decrease the odds of suffering an ACL injury?

#1

Address Quadriceps/Hamstrings Muscle Imbalance and Medial Knee (Valgus) Collapse:

A main factor that predisposes one to ACL injury is that many athletes tend to be "quad dominant" - meaning the quadricep muscles in the front (anterior) of the thigh are stronger than the hamstring muscles in the back (posterior) of the thigh. It's great to have strong quadriceps! However, the hamstrings help to stabilize the knee as well, and when weak as compared to the quadriceps there is an increased risk of injury not only to the knee, but also to the lower leg, ankle and foot. Additionally, medial knee (valgus) collapse is another factor most commonly associated with a non-contact mechanism of injury to the ACL. The gluteal muscles play an interesting role in medial knee collapse and can help with diminishing it.  A good way to test for medial knee collapse is by performing a squat and checking if the knee(s) rotate inwards when coming down. You can also test by performing a lunge exercise, and again, the knee rotating inwards is a sign that specific gluteal strengthening exercises are needed.

Knee Stabilizing Muscles

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Medial Collapse       No Collapse

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The FIFA 11+ Injury Prevention Program for Soccer Players:

Many clubs incorporate the FIFA 11+ program components or similar programs in their warm-up and cool-down procedures. The program is highly recommended and geared for soccer players >13 years of age and comprises a complete warm-up procedure aimed at injury prevention for soccer players. It includes 15 structured exercises, is available as printed material or online, and is easily executed. The exercises consist of core stabilization, eccentric thigh muscle training, proprioceptive training, dynamic stabilization, and plyometric exercises, all performed with proper postural alignment. The program’s effectiveness was confirmed by various studies involving female and male players that revealed significant decreases in the incidence of non-contact injuries.

FIFA 11+
PDF Download

FIFA F MARC 11 Workbook
PDF Download

Below we have included additional specific hamstring exercises that can be performed at home to solve the common situation of quadriceps dominance and need to significantly increase hamstring strength, as well as specific gluteal exercises to diminish medial knee collapse.

#2

Outdoor Artificial Grass (Turf) Fields and the Proper Cleats Factor:

Regarding outdoor soccer, there are considered to be 3 main playing surfaces with 3 corresponding soccer boot (cleats) soleplate/studs versions (SG, FG, AG). SG = Soft Ground Cleats, FG = Firm Ground Cleats, AG = Artificial Ground/Grass Cleats.

SG Soleplate

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FG Soleplate

AG Soleplate

Soccer boots with SG soleplates/studs are designed for superior traction on soft, wet, watered down, or muddy fields. The studs are longer, often made with metal/aluminum-tipped and/or removable studs and are superior at keeping mud from getting stuck to the soleplate. SG cleats are the least used version and many international soccer academies ban the use of cleats containing metal studs.

Soccer boots with FG soleplates/studs are by far the most widely available and sold, as an outdoor pitch with firm soil and freshly-cut grass is considered the classic field type, and most cleats are designed for that purpose. Firm Ground or FG soccer cleats have rubber studs that are either conical or bladed in shape, or some combination of both. However, FG cleats are versatile enough to be used in many outdoor playing conditions. In fact, FG cleats are so common that if you have purchased cleats for your soccer player and don't know if they are SG, FG or AG, they are most likely the FG version.

Soccer boots with AG soleplates/studs are designed specifically for outdoor artificial grass, which is becoming increasingly popular. However, in the United States you will see the majority of players being uninformed and using FG cleats on artificial grass (AG), which is not particularly safe and has been shown to increase the likelihood of serious injury. Studies show that it can be very dangerous to play on an AG pitch, especially with FG cleats that contain bladed studs. The bladed stud pattern is incredibly aggressive and is very likely to get stuck in the very aggressive and very sticky AG pitch type, thus increasing the possibility of damaging knee structures. Additionally, it should be made known that using FG cleats on artificial grass fields can void their warranty. We have personally seen FG soleplates crack from overuse on AG fields, and the black marks left behind from the rubber pellets are a dead giveaway that the boots were indeed used on an AG field. The AG sole plate is very specialized and most commonly have shorter rounded/conical studs, often a higher number of studs and a thicker soleplate, which better disperses the increased pressure and radiant heat associated with artificial grass fields. Additional reinforcements built into the AG soleplate include stronger and stiffer plastic materials, and often an extended lip around the front of the toe box to better cope with the much more brutal AG surface. It should be noted that some brands also have hybrid FG/AG combo soleplates, MG (multi-ground) or FG/MG combo soleplates, if you are looking for only one pair of cleats that may be acceptable for both natural grass and outdoor artificial grass fields. However, they are not as common in the upper-end adult size models. For maximum benefit and safety, we recommend a separate pair of outdoor artificial grass cleats. See below on where to purchase.

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The problem:

Artificial grass models of boots/cleats are not as commonly available in the U.S. and the reason remains unclear as to why. It can be difficult, if like most, your soccer player uses a specific brand and model of soccer boot in the natural grass (FG) version, and you would like to obtain the same brand, model, and size in an artificial grass version as well.

The solution:

We've done an extensive search and provided links to highly rated websites where you can purchase artificial grass (AG) versions, as well as acceptable natural grass/artificial grass hybrid combo (FG/AG, MG, FG/MG) versions of boots/cleats.

Purchasing Artificial Grass (AG, FG/AG, MG, FG/MG) Cleats

This section includes affiliate links. If you follow one of the links below and make a purchase, we may receive a small commission from the retailer, but at NO additional cost to you. 

       Domestically:

If you are lucky enough to have the brand, model and size soccer cleats you are looking for in the recommended artificial grass versions available here in the U.S., the following are our recommended U.S. soccer website links to find them, as well as a link to Amazon's selection of artificial grass cleats.

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Link to Amazon artificial grass cleats
As an Amazon Associate, we earn from qualifying purchases.

Click HERE

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Links to Pro:Direct Soccer artificial grass cleats
Note: Some FG/AG, MG, FG/MG versions in adult sizes are mixed in with the FG cleats. Thus, multiple links are provided.

Click HERE for AG adult sizes

Click HERE for FG/AG, MG, FG/MG adult sizes

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Click HERE for FG/MG, FG/AG youth sizes

Link to WeGotSoccer artificial grass cleats

Click HERE

Links to Soccer.com artificial grass cleats
Note: Some FG/AG, FG/MG versions in adult sizes are mixed in with the FG cleats. Thus, multiple links are provided.

Click HERE for AG adult sizes

Click HERE for FG/AG, FG/MG adult sizes

Click HERE for FG/MG, FG/AG youth sizes

       Internationally:

If you cannot find the artificial grass version of boots/cleats you’re looking for domestically, ordering from Europe is your next best option. Extensive AG, FG/AG, MG, FG/MG versions of boots/cleats for artificial grass are available at the Unisport Store link below. We have personally placed orders on multiple occasions from this site in the past, and without any problems. Our advice is that you make sure to order the correct size. Returning items internationally can be a time-consuming endeavor. We recommend double checking that the European (EUR) size is correct on your order as Europe does not have separate shoe sizing for men, women and kids like in the U.S. Your child’s current soccer cleats should have the EUR size included on the size tag. Additionally, in our experience paying by credit card worked better when going through the PayPal payment option.

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Link to Unisport Store (International) artificial grass cleats

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Click HERE

THE EXERCISES

Visitors to our site who utilize the researched and recommended exercises in this section, do so at their own risk. See disclaimers.

Hamstring Exercises
(for knee stability by decreasing the ratio of quad dominance)

General Hamstring Exercises

Romanian Deadlift Exercise Progression

Single Leg Deadlift Exercise Variations

Nordic Curl Exercise Variations

Gluteal Exercises
(for knee stability by decreasing medial knee collapse weakness)

Bridge Exercise Progression

Split Lunge & Step Down Exercises with Power Band

Bridge Exercise with Band

Hip Thrust Exercise with Band

Two to One Leg Hip Thrust Exercise Progression

   Generally Recommended Frequency, Sets & Reps 

  • Perform exercises 2-3 times per week​

  • 2-3 Sets of the appropriate exercises

  • 8-15 Reps of each exercise per set                                *** If you are new to Nordic Curls and are not utilizing a power band to initially decrease the load on the hamstring muscles, we recommend starting with 2 sets of 3-5 reps and slowly increasing the reps over time as you get stronger with this specific exercise.

Recommended Exercise Aids 

  • Resistance/Power Bands​

  • Exercise Ball

  • Nordic Curl Home/Door Unit

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References

https://www.sportingnews.com/us/soccer/news/women-soccer-acl-tear-knee-injuries/rklvevdxqferlqfdtuxojkxp

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https://thescipub.com/pdf/ajeassp.2016.1150.1157.pdf

https://www.txortho.com/women-soccer-players-more-prone-to-acl-tears-than-men/


https://link.springer.com/article/10.1007/s00167-022-07093-1

https://lermagazine.com/article/footwear-traction-and-the-risk-of-athletic-injury

https://www.yalemedicine.org/news/sports-injuries-gender

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9382072/

https://journals.sagepub.com/doi/10.1177/03635465211008169

https://www.auctoresonline.org/article/gender-differences-in-anterior-cruciate-ligament-injury-a-review-of-risk-factors-mechanisms-and-mitigation-strategies-in-the-female-athlete

https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2019/08/artificial-turf-versus-natural-grass

https://www.mammothortho.com/pdf/pedi-acl.pdf

https://journals.sagepub.com/doi/full/10.1177/0363546518808006

https://soccercleatsportal.com/what-is-the-difference-between-ag-and-fg-soccer-cleats/

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ttps://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-017-0083-z

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https://pubmed.ncbi.nlm.nih.gov/20118526/

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https://pubmed.ncbi.nlm.nih.gov/19913961/

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https://www.sportsperformancebulletin.com/injuries-health/muscles-and-tendons/a-balanced-approach-to-leg-strength#:~:text=A%20ratio%20of%200.5%20or,equal%20hamstring%20and%20quadriceps%20strength.

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Physio Fitness | Physio REHAB | Tim Keeley: https://www.youtube.com/@physiorehab/about

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