Nov 2, 2018

Get the Ball Rolling

Tim McClellan, Jeff Decker, and Kelsey Kebric

As youth sports has expanded, so has the desire to incorporate sports medicine and strength and conditioning initiatives with these athletes. Here’s how one club kick-started such efforts.

Across the nation, millions of boys and girls play youth soccer every year. Those participation numbers don’t come without injuries.

However, unlike at the high school or college level, youth athletes don’t always have access to sports medicine or sports performance services for treatment. Whether due to cost or a lack of staff, these are features that many youth organizations are unable to provide, which leaves athletes vulnerable.

But at the Arizona Arsenal Soccer Club, we’ve made sports medicine and strength and conditioning a priority through our Health and High Performance Division. In the five years since its founding, we’ve been successful in reducing injuries and optimizing physiology with our youth athletes.

As a byproduct of these efforts, the results on the field have been exceptional. In this year’s Arizona State Cup, we had four champions, a runner-up, and two third-place finishes among our girls’ teams. Meanwhile, the boys’ side posted a champion and three semi-finalists the year before.

Now an established part of the club, our injury prevention and strength and conditioning program continues to evolve and enrich performances. We believe that by investing time and bringing a few dedicated individuals on board, other youth sports groups could follow our lead.

HOW IT WORKS

Arsenal was established in 1992 as the Gilbert (Ariz.) Soccer Club. The original number of participants was approximately 60. Today, our organization has over 750 players spread across more than 50 teams and ranging in age from under 10 to 18.

Five years ago, club President Jim Cope and long-time Director of Coaching Tim Barmettler started discussing how to improve the physical ability of the Arsenal players in a formal way, using the major college performance enhancement programs as a model. From those conversations emerged the Health and High Performance Division, and Jim asked veteran strength coach Tim McClellan to be involved.

To get the department off the ground, the first priority had to be developing an exceptional staff. McClellan has been in the community for 35 years and had gotten to know many talented performance enhancement coaches in the area. He reached out to a number of them, and, thankfully, several agreed to provide their expertise and talents. The Health and High Performance Division was incorporated with only a few Arsenal teams at first, but the desire to participate quickly spread throughout the rest of the club.

Now, the department is made up of sports medicine physicians, physician assistants, orthopedic surgeons, physical therapists, athletic trainers, and strength and conditioning coaches. The sports medicine care is provided via referrals, and our athletes typically receive same-day service. The doctors and physical therapists are amazingly accommodating.

Our strength staffers are all paid consultants. We pay for them with increased annual dues. Most of them work somewhere else during the day and just come to Arsenal’s sessions at night.

Our staffing model allows for a seamless integration of medical services with injury prevention and conditioning, which provides Arsenal players with care that rivals professional organizations. For instance, say an Arsenal player incurs an inversion ankle sprain during a Sunday game. It is not uncommon for them to see the Arsenal team physician first thing Monday morning, get an MRI and/or X-rays, have the results read, and then go to an appointment with an Arsenal physical therapist that afternoon.

AGE APPROPRIATE

With a staff set, we established our approach for training various age groups. Since many of our athletes play multiple sports and participate on multiple teams at the same time, we decided to make preventing overload/overuse injuries a big focus.

We started by dividing our players’ year into four distinct phases: the fall season, the winter season (when many are competing for their school teams), the championship spring season, and the summer. Most play for Arsenal in the fall and spring.

As you can see, the athletes rarely have a true offseason. So when programming, we need to be wary of overuse, especially with our high school players who come out of their school seasons over-fatigued, lacking strength, and more susceptible to injury. To address our concerns, we decided to follow a replica of the Long-Term Athletic Development training model.

We also knew that we wanted training to be age appropriate-the workouts for 10- and 11-year-olds had to be different than the ones for teenagers. As a result, athletes 10 and under are encouraged to discover training. Instead of following formal conditioning programs, they discover movement and have fun during skill acquisition.

Eleven- and 12-year-olds progress to learning to train for high-level sports. This means they work out once per week in the high-performance program, using a logical, systematic, graded exercise progression. They must show repeated mastery of a movement before they can advance to the next level. Thirteen-year-olds train once or twice a week based on their sport coach’s preference.

The goal for 14- to 16-year-olds is to understand and demonstrate elite-level fundamentals and skill sets, and the objective for 17- to 18-year-olds is to master training skills. Both of these groups train twice per week, as if on a college model, but are prescribed age-specific and physiology-specific progressions.

DEFINING OUR FOCUS

Once we knew how we wanted to approach each age group, we determined the goals for our sports medicine and strength and conditioning program. This helped narrow our focus and prioritize what was most important. We established two main objectives for Arsenal’s Health and High Performance Division:

• Reduce the potential for injuries.

• Maximize physical performance.

To reach these goals, we identified the injury patterns and performance demands for soccer. This was tackled by Alex Onofrei, MD, Arsenal Team Physician and physician at Arizona Family Medicine and Sports Medicine in Mesa, and Matt Midkiff, DPT, PT, CSCS, owner of Foothills Physical Therapy-Mesa, who works for Arsenal in the evenings. They shared the youth soccer injuries they’ve observed the most over their more than 35 years of combined private practice.

Lower-extremity injuries were revealed to be the most prevalent, including hip flexor and groin strains (especially early in the season), ankle sprains, contusions from contact, and ACL tears. As a result of this injury analysis, we made sure to target these areas with proper prehab and strengthening exercises.

Additionally, our performance enhancement staff observed the physical deficiencies in Arsenal players as they moved. Some of the issues identified were tightness and restriction in ankle dorsiflexion, asymmetrical hip shift in squatting movements, unilateral tightness in the groin and iliotibial band that restricted economy of movement when running, and inadequate hip musculature stabilization, which led to insufficient eccentric decelerating ability. All of these deficiencies would lead to increased injury risk if left unaddressed.

With this information, we then turned to existing research to define the traits needed to excel in soccer. Especially at the youth level, this is an important step to take before designing a program for injury prevention and strength and conditioning. You want to make sure you have a solid foundation for training.

We took a lot of guidance from the August 2014 Strength & Conditioning Journal article “Strength and Conditioning for Soccer Players.” Its authors say soccer players “must develop and retain a high level of aerobic and anaerobic conditioning, speed, agility, strength, and power.” Around 96 percent of sprints in the sport are less than 30 meters in length, with the majority of them less than 10 meters in length. Changes in direction occur every two to four seconds, with a total of 1,200 to 1,400 per game.

Further, a number of studies have examined the relationship between strength training and soccer performance. Strength training has been found to:

• Correlate highly with improvements in initial acceleration and change-of-direction activities, as well as repeated sprinting abilities.

• Correlate highly with buffering capacity of hydrogen and delays in fatigue.

• Increase hopping height while reducing ground contact time at all running speeds.

• Increase rate of force development.

• Increase muscle, tendon, ligament, and cartilage strength and bone mineral density, which improves structural integrity of all joints involved.

• Address muscular imbalance.

• Improve neuromuscular skill, coordination, movement mechanics, and efficiency.

PROGRAM DESIGN

From our research, we came up with a number of priorities for our training. Many of them involve building strength and power to improve performance and prevent injury.

Our first objective was reducing or eliminating the ACL tears that run rampant in the sport. To accomplish this, we focused on reducing force in eccentric landings. Sagittal, frontal, and transverse plane movements were devised for every workout, and exercises included double- and single-leg forward, backward, and side hops with varying landing instructions. As athletes got accustomed to these drills, we would progress by having them hop over hurdles, and then hop while tethered to a resistance cord.

The second priority was implementing resistance training for all actions initiated and governed by the hamstrings, groin, and glutes. Since soccer injuries often occur when these muscle groups cannot handle decelerating loads eccentrically, we emphasized training these movements with differing speeds of concentric and eccentric contractions. We used variations of squats, lunges, bridges, and dead lifts to develop this area.

A third priority for our program was strengthening all of the hip-stabilizing muscles, since we identified weaknesses here during our initial evaluation of soccer needs. An often overlooked and under-valued method for increasing stabilizer strength in the lower body is isometric training, which we incorporate, along with power position holds, lateral squat holds, pause squats, pause trap bar dead lifts, and plank holds.

Core strengthening is also an objective of ours because soccer players must engage their cores to change directions without losing proper biomechanics. We break core strengthening exercises into five categories. Here are sample exercises from each one:

Stabilization: Supermans, plank variations, hollow body holds, flutter kicks lying supine, and forearm rollout on ball

Extension: Superman repetitions, back extensions on ball, reverse extensions, and swimmers

Rotation: Russian twist variations, rotational medicine ball twists, bicycle crunches, windshield wipers, and twisting crunches

Flexion: 30s, 60s, 90s, leg lifts, toe touch crunches, tuck-ups, hip-ups, and leg raises

Lateral flexion: Side bends, bridges, and side crunches.

Finally, because of the sheer volume of running in soccer, running power is highly prized. Therefore, we incorporate movements for increasing explosive power. Our favorite exercises include resisted sleds, resisted cords, hills, partner-resisted rope sprints, and lateral-resisted cord shuffles. (See “Put It Together” below to see how we combine all of our priorities into a sample workout.)

You might have noticed that we provide a number of different exercise options for each training focus. That’s because today’s youth athletes need the intellectual stimulation of varied exercise modalities more so than those of decades ago, due to the cultural environments they grow up in. Other ways we provide intellectual stimulation involve building stress into drills, having athletes complete complex tasks, giving directions only once, and pitting athletes in competitions against each other.

As far as loads and volumes in our workouts, we use a graded progression in choice of exercise and prescribed intensity and volume. From there, the athletes’ bodies govern the rest. If there is significant mastery, we advance. If there is breakdown, we regress. Much of it comes down to coaches being great observers.

We do, however, like to include supersets into our workouts. This allows us to complete double the amount of work in a given time period.

Although it requires a slightly different focus and more flexibility, creating a sports medicine and performance plan for youth athletes can be done. And when done correctly, it enables them to thrive in a healthy, supportive system.

BUILT UP

Over the past year, the Arizona Arsenal Soccer Club constructed a state-of-the-art strength and conditioning center, and it opened this summer. Before we had this facility, all of our performance training was done on the soccer field.

To make the building a reality, we partnered with nearby Paloma Church. The congregation was looking to serve the community by purchasing fields that a youth organization could use. We were fortunate to be the organization they chose. Providing access to an indoor facility was the next step.

The new center has a 3,200 square foot weightroom that adjoins a 6,400 square foot outdoor turf training area. These are both conveniently located just off a gymnasium, which doubles as a sanctuary for Paloma Church on Sundays. Modeled after the Arizona Cardinals’ practice facility, the weightroom and open turf areas are easily accessible via a 20-foot glass doorway that can be opened up to provide acclimatization during strength training.

A donor, who insisted on remaining anonymous, purchased all the weightroom equipment the Arsenal players needed, and Samson Equipment tailored every piece to the exact specifications of our purchase order. With the equipment in and everything ready, a facility unrivaled in youth sports was born.

OVERDOING IT

There’s been much debate recently about the relationship between single-sport specialization and overuse injuries-especially in youth sports. With this in mind, the coaching and support staffs at the Arizona Arsenal Soccer Club are being proactive about addressing these issues.

“I believe overuse inherent in sport specialization may increase the risk of overuse injuries, slow development in the chosen sport, and diminish the necessity of becoming creative both on and off the field/pitch/court,” says Alex Onofrei, MD, Arsenal Team Physician and physician at Arizona Family Medicine and Sports Medicine in Mesa.

However, the problem does not necessarily come from only playing one sport, explains Tim McClellan, MS, CSCS, CES, CLC, CSH, who heads the Health and High Performance Division for Arsenal. “The fact that a child chooses to like and play one sport does not by itself cause physical disability, such as overuse syndrome,” he says. “It is overusing an area not strong enough to handle such a high demand. It becomes a lack of rest and proper training issue.”

“For instance, years ago, a baseball pitcher got to rest his arm during basketball and football season because he was too busy during those times to throw full pitching workouts,” McClellan continues. “In more recent years, the pitcher is coming out of a high school baseball season and proceeding directly into club baseball. Rest is inadequate, and overuse injuries increase rapidly.”

Although these issues can’t always be prevented entirely, they can be minimized, says Matt Midkiff, DPT, PT, CSCS, an Arsenal physical therapist and owner of Foothills Physical Therapy-Mesa. This starts with proper training and player management.

“The issue is managing overuse, game minutes, and rest,” says Dr. Midkiff. “I’d advise coaches and sports medicine professionals to monitor game numbers, build in rest, do functional training and injury prevention to take the body out of repetitive overuse patterns, and create balance.”

Being tuned in to your athletes’ needs can help, as well. “A coach has to be a great observer,” says McClellan. “We have our staff ask players pertinent questions prior to workouts, such as: Are you playing other sports? How are you feeling? Are you healthy? If an athlete comes to us directly from a high school practice, we often relegate them to a session of active recovery and not the full team workout.”

Lastly, don’t forget about education, Dr. Onofrei advises, especially among sport coaches and parents. “The more information they have at their disposal, the more valuable, educated decisions can be made,” he says. “Help them understand the risks and benefits of playing sports and sport specialization. A basic understanding of the physiologic and biomechanical changes in the adolescent athlete will support that conversation.

“In addition, helping parents realize their athlete’s wishes and desires will be beneficial,” Dr. Onofrei continues. “One of the points I emphasize with parents is to ‘look and listen’ when it comes to their child. If a parent can objectively listen to how their athlete talks about the game and engages during sport, they can objectively make decisions to support their child’s health.”

This article appeared in the November 2018 issue of Training & Conditioning.