Soccer is enjoyed both competitively and recreationally by all ages. Participation in any sport however can potentially lead to injury. Injury to the ACL, or anterior cruciate ligament, is a common injury to those participating in soccer. Rehabilitation and treatment following an ACL injury is costly and will most likely result in significant loss in playing time for the athlete.

Injury or rupture of the ACL can occur during contact or non-contact situations such as running and jumping. During running, injury most often occurs with quick directional changes, rapid decelerations and torsional or rotational movements. The landing phase of jumping with varus (outward) and valgus (inward) stresses at the knee accompanied by rotation also stress the ACL and can possibly result in injury.

In an effort to decrease the incidence of ACL injuries, a preventative training program should include neuromuscular training. Traditional lower extremity strengthening programs have utilized machines to exercise the quads and hamstrings. These programs do little to improve dynamic strength and stability which are very important in knee joint control on the soccer field. Neuromuscular training involves challenging the proprioceptive system via various balance and stability activities. Through neuromuscular training, dynamic joint stability can be improved and hopefully decrease injury.

Neuromuscular control or stability relies upon the proprioceptive system. This system consists of proprioceptors or sensory receptors within the ACL and the other soft tissue structures within and around the knee joint. These receptors are located throughout or body and provide our brain with information of position sense and joint stresses so that our muscles may respond appropriately and protect our bodies from injury.

A neuromuscular training program typically consists of balance exercises on the involved limb, dynamic joint stability exercises, plyometric exercises, agility drills and sports specific exercises.

Balance training may include double or single leg stance on flat surfaces, a wobble board or even a trampoline. Dynamic joint stability training involves controlled balance movements such as lunges, balanced reaching activities with the upper or lower extremities, step-up and step-down exercises, squatting with or without weights on different surfaces and single leg squats.

Plyometric or jump training involves quick and powerful movement involving pre-stretching of the muscle to produce a stronger muscular contraction. An example of a plyometric activity would involve jumping off of a box and then exploding up and over another obstacle. These exercises help to facilitate quick directional changes and control

in landing and jumping activities. Jumping exercises using plyometric training might include two and one legged jumping on a trampoline, 180° turning jumps and vertical jumps.

Sports specific skills training activities include running, lateral running, backward running, shuttle runs and agility drills. Agility activities may include figure 8 running, quick directional changes which are not preplanned but rather directed by a coach or trainer, passing, kicking and throwing activities.

The training program should include enough exercise to induce muscular fatigue for the athlete and train the appropriate muscular responses. Proprioceptive deterioration can increase with muscle fatigue; therefore the training program needs to include enough repetitions to create some fatigue in the athlete. The training should also be performed throughout the ROM of the joint to stimulate and train different receptors at different angles of joint motion.