Jospt 2012 4005

[ clinical commentary ]
MARIO BIZZINI, PT, PhD1 • DAVE HANCOCK, MSc, MCSP, BHSc, HPC2 • FRANCO IMPELLIZZERI, PhD3
Suggestions From the Field for Return

to Sports Participation Following Anterior
Cruciate Ligament Reconstruction: Soccer
F
Downloaded from www.jospt.org at on May 14, 2020. For personal use only. No other uses without permission.
ootball (soccer) is the most popular sport worldwide, “when the patient toler-
with an estimated 300 million active players (as ates sport-specific activi-
SUPPLEMENTAL ties.”51 This description,
documented by the Fédération Internationale de VIDEO ONLINE
albeit offering a minimal
Football Association). Anterior cruciate ligament standard for the knee, is
Copyright © 2012 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
(ACL) injury is one of the most serious injuries in soccer and a clearly not detailed enough when dealing
potentially career-ending one.54 The incidence of ACL injuries in with athletes (ie, soccer players) aiming
soccer players accounts for thousands of ACL tears per year.1 Despite for a return to competitive sports after
ACL reconstruction.
the high number of injuries1,3,14 and re- interventions for the early rehabilitation Some authors have described guide-
lated literature, there is still no consen- phases, which included pain/swelling lines for return to play after ACL sur-
sus on the optimal surgical technique control, neuromuscular training, and ear- gery10,28,34; however, few publications
for ACL reconstruction5 and even less ly weight-bearing, range-of-motion, and have specifically discussed the return to
agreement on the ideal rehabilitation strengthening exercises, are supported by competitive soccer.43,44 In a recent review,
Journal of Orthopaedic & Sports Physical Therapy®
protocol following surgery.30,51 Recently, evidence. Criteria for return to sports in- Kvist28 located 39 articles that presented
van Grinsven et al51 proposed an optimal clude “hop tests and strength of the ham- outcomes after ACL reconstruction and
evidence-based rehabilitation program. strings and quadriceps at least of 85% criteria for returning to sports. In most
Their systematic review indicated that compared to the contralateral side” and cases, the decision of when to allow the
patient/athlete to return to sport was
TTSYNOPSIS: Successful return to play remains
empirical and time based, ranging from
sports. The individual coaching of the player by the
a challenge for a soccer player after anterior sports physiotherapist and compliance with the
3 to 12 months postsurgery. Functional
cruciate ligament reconstruction. In addition to a training program by the player are key factors in training and testing have also been ad-
successful surgical intervention, a soccer-specific the rehabilitation process. To minimize reinjury risk vocated, ranging from plyometrics and
functional rehabilitation program is essential to and to maximize the player’s career, concepts of running programs to isokinetic train-
achieve this goal. Soccer-like elements should ing/testing and jump/hop training/test-
soccer-specific injury prevention programs should
be incorporated in the early stages of rehabilita-
be incorporated into the training routine during ing.10,20,37 However, descriptions of the
tion to provide neuromuscular training specific
to the needs of the player. Gym-based and, later, and after the rehabilitation of players post–ACL late phases of the rehabilitation process
field-based drills are gradually intensified and pro- reconstruction. often remain generic. Myer et al34 also
gressed until the player demonstrates the ability to TTLEVEL OF EVIDENCE: Therapy, level 5. J introduced a detailed criteria-based re-
return to team practice. In addition to the recovery Orthop Sports Phys Ther 2012;42(4):304-312. habilitation protocol for the return to
of basic attributes such as mobility, flexibility, sport after ACL reconstruction; however,
doi:10.2519/jospt.2012.4005
strength, and agility, the surgically repaired knee
TTKEY WORDS: ACL, football/soccer, functional
the “reintegration to interval sport par-
must also regain soccer-specific neuromuscular
control and conditioning for an effective return to training, injury prevention ticipation” was not specifically described.
Therefore, it is perhaps understandable
1
Research Associate, FIFA-Medical Assessment and Research Centre (F-MARC), Schulthess Clinic, Zürich, Switzerland. 2Director of Training and Conditioning, New York
Knicks (NBA), New York, NY; Physical Therapist of the England National Football Team (UK); Former Head Physical Therapist, Leeds United Football Club and Chelsea Football
Club (Premier League, England), UK. 3Scientific Director of CeRiSM, Research Center for Sports, Mountain and Health, University of Verona, Rovereto (TN), Italy. Address
correspondence to Dr Mario Bizzini, F-MARC, Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland. E-mail: mario.bizzini@f-marc.com
304 | april 2012 | volume 42 | number 4 | journal of orthopaedic & sports physical therapy
42-04 Bizzini.indd 304 3/21/2012 4:32:29 PM

TABLE 1 Phases of Rehabilitation
Phase 4
Return to Reduced Return to Full
Phase 1 Phase 2 Phase 3 Soccer Practice Soccer Practice
Timing* 4-6 wk 4-6 to 8-12 wk 8-12 to 16-24 wk 16-24 to ? wk
Criteria to enter this • Minimal pain/swelling • No pain/swelling • No pain/swelling • No pain/swelling
phase • Near full ROM • Full ROM • Symmetrical ROM • Symmetrical ROM
• Good patella mobility • Good neuromuscular • Optimal soccer-specific • Optimal soccer-specific
• Sufficient quadriceps control at knee, hip, trunk neuromuscular control neuromuscular control
control • Quadriceps and hamstrings • Quadriceps and hamstrings • Quadriceps and
• Normal gait pattern strength >75% of strength >85% of hamstrings strength >95%
noninvolved limb noninvolved limb of noninvolved limb
• Good hop/jump and land- • Hop index >80% of • Hop index >90% of
ing techniques noninvolved limb noninvolved limb
• Satisfactory Yo-Yo and
RSSA test results
Goals of this phase • Control pain/swelling • Prepare basic soccer- • Optimize soccer-specific • Bring the player back • Final preparation of the
• Improve ROM specific neuromuscular neuromuscular control to unrestricted team player for the needs and
• Quadriceps activation control • Prepare the player for practice, with full demands of competitive
• ADL activities • Prepare the player for the return to team practice possession of his soccer soccer
more intense phase 3 skills and conditioning
Functional training†
Additional training • Strengthen noninvolved • Core stability • Core stability/strength • Core stability/strength • Continue additional train-
limb • Strengthen involved limb • Strength training (body- • Strength training (body- ing, in the form of a soccer-
• Trunk and hip basic core (open/closed chain) machine exercise) machine exercise) focused specific warm-up (11+)
stability exercises • Cardiovascular training • Cardiovascular soccer- on addressing remaining

• Cardiovascular (upper-body (basic, bike) specific training (interval, deficits
ergometer) • Flexibility bike) • Flexibility
• Flexibility
Pool activities • Gait training • Progression toward water • Water running: endurance
• Simple exercises (ROM, running (wet vest) training
balance) • Flexibility/ROM
• Simulated basic soccer
drills (heading the ball)
Abbreviations: ADL, activities of daily living; ROM, range of motion; RSSA, repeated-shuttle-sprint-ability test; Yo-Yo, Yo-Yo intermittent recovery test.
*The timing of each phase is dependent on additional surgical procedures and individual progress in rehabilitation/training.
†
Details provided in the text.
that Walden et al53 found a significantly or basketball player.49 One of the key or near maximal actions (eg, striding,
higher risk of new knee injury (either elements to a soccer-specific rehabili- turning, cutting, sprinting, jumping) of
reinjury or contralateral injury) in elite tation program is an understanding of short duration with brief recovery peri-
soccer players who had a previous ACL the physical demands of the sport and ods.33,48,49 These activities, which require
injury/reconstruction. the level of play to which the player coordination and power, place consid-
The major challenge is to integrate needs to return. Consideration of the erable demands on the neuromuscular
sports-specific elements within the re- frequency and intensity of training ses- system. A carefully planned rehabilita-
habilitation and training of the soccer sions and games is very important. Soc- tion program that addresses all aspects
athlete, considering that a soccer player cer is a physically demanding sport, with of the game is vital to return the player
has different neuromuscular and physi- match analysis studies showing that soc- to maximum function, while minimiz-
ological demands than an ice hockey cer players repeatedly produce maximal ing risk of reinjury. The following is our
journal of orthopaedic & sports physical therapy | volume 42 | number 4 | april 2012 | 305
42-04 Bizzini.indd 305 3/21/2012 4:32:30 PM

FIGURE 3. Male professional soccer player sitting on

a soccer ball (and juggling another ball).
Phase 1
This phase, focusing on recovery of mo-
tion and ambulation and control of swell-
ing immediately postsurgery, will not be
discussed. The criteria that the patient
has to fulfill to enter phase 2 are de-

scribed in TABLE 1.
Phase 2
FIGURE 1. Male professional soccer player on
swinging platform (simulation of kicking ball with This phase includes soccer-specific neu-
nonoperated leg). romuscular training. Initially, the focus is
on knee (and lower extremity) stabiliza-
perspective on a return-to-play model to tion in weight-bearing positions, starting
prepare soccer players to compete after with static, then dynamic, and eventually
ACL reconstruction. reactive exercises.41 Particular attention is

given to the varus/valgus and rotational
PHASES OF THE PROGRAM FIGURE 2. Female amateur soccer player on foam control of the surgically repaired knee
pad (passing back the soccer ball with nonoperated and lower extremity, emphasizing prop-
A
key aspect for successful reha- leg). er lower extremity alignment (avoiding
bilitation of a professional soccer collapse of the knee medially) and pelvis
player is a one-to-one (sports phys- cific, criteria based, and intensive but not and trunk stabilization.6,40 Training on
iotherapist-to-athlete) approach. This al- aggressive (TABLE 1).7,17,21,43 unstable surfaces is particularly useful to
lows daily monitoring of the knee status Myer et al34 presented a criteria-driv- enhance neuromuscular activation and
and progress, and also permits optimal en progression through the return-to- control (FIGURE 1). Rotational stabiliza-
adaptation of the intensity and content sport phase of rehabilitation following tion can be trained on a simple rotatory
of the rehabilitation program. A close ACL reconstruction. The authors pro- unstable surface.7
cooperation between the athlete, phys- posed objective assessments of strength, According to motor-learning prin-
iotherapist, surgeon, athletic trainer, and stability, balance, limb symmetry, power, ciples (blocked/random practice),46 it is
coach is another key factor. agility, technique, and endurance to important to exercise in different envi-
The rehabilitation may arbitrarily be guide the athlete back to sports. Recently, ronmental conditions (eg, in the gym-
divided into 4 phases: (1) protection and Impellizzeri and Marcora23 critically dis- nasium, indoor hall, and on the pitch)
controlled ambulation, (2) controlled cussed the validity of physiological and and with different footwear (eg, with no
training, (3) intensive training, and (4) performance tests in sports. As the focus shoes, athletic shoes, and soccer shoes).
return to play.7,8 The time frame for each of this paper is on functional rehabilita- The soccer ball should be used, as much
phase varies depending on the surgical tion, we will not cover the assessments for as possible, as a tool to enhance reactive
procedure and individual response to all phases in detail but, rather, provide stabilization strategies (FIGURE 2). With
treatment. The overall guiding principle updated evidence-based and clinical- a field player, the basic passes (feet) are
is that the program should be soccer spe- expertise guidelines. simulated, while basic ball receptions
42-04 Bizzini.indd 306 3/21/2012 4:32:32 PM

TABLE 2 Progression of Running and Soccer Drills
Part 1 Part 2 Part 3

Level 1 Running: straight line Passing Dribbling
a. Endurance (time/distance) Side footing: start with standing ball and move through the a. Straight-line ball control
b. Player-specific runs, midfield/center forwards distances progressions, then progress to a moving ball both on the floor b. Forward/backward turns
c. Shorter distances and on the volley. c. Instep ball control
d. Gradually increasing speed a. Short distances d. Outstep ball control
e. Forward/backward runs: 1:4 min run-rest ratio building up b. Longer distances
to 1:1 min (×4) and 2:1 (×3) to train the anaerobic lactate c. Greater velocity on the pass
threshold. A long recovery time is needed between each set
of exercises (4 min)
Level 2 Running: figure-of-eight runs Passing: forefoot (on the laces) Lateral dribbling movements
With the same progressions as straight line a. Short distances a. Long distances
b. Longer distances b. Short distances
c. Greater velocity on the pass: same as with the side-foot c. At speed
pass once, moved through the progressions, progress to d. Side movement with the ball, changing
moving the ball on the floor first to eventually on the volley direction on command, at speed
a. Volleys side foot/laces/outside of foot
b. Volleys with quick-feet: incorporate quick-feet and volley to
ladders/hurdles/left-right foot on command, quick reaction
volley drills
Level 3 Running: open lateral zigzag runs Corners
a. Endurance base with long turns Goal kicks from the hands to on the floor
b. Gradually reducing distance between cones Follow the above kicking progressions
c. Increase number of turns and increase speed of turn
Level 4 Running: rotations Free kicks Rotation dribbling movements

a. Without the ball Follow the above progressions on kicking the ball (distance/ a. Long rotations with the ball at the feet
b. With the ball force/speed) b. Short rotations with the ball
c. Including pass increase as with the above Shooting c. Quick, sharp turns with the ball to both
Progressions: endurance/distance/repetitions/speed As above with regard to progression left and right sides
d. Sharp turns on receiving a pass or volley
(hands) are used with a goalkeeper. The focusing on knee stabilization. Working ample, the athlete stands still, then, at the
athlete is allowed to bounce/juggle the against elastic resistance is considered start signal, performs soft sprinting over
ball, and also to execute simple passes a powerful tool to train neuromuscular a few meters before stopping and stabiliz-
(using the internal and external sides of control, as the knee, lower extremity, pel- ing on the operated knee, then kicks the
the foot) with the operated leg. Some- vis, and upper body need to be controlled ball with the nonoperated leg. This may
times the athlete may combine specific based on the direction of the resistance. be performed first in the gym and then
training with less-focused activities First, the focus is on proper stabiliza- on the pitch to best stimulate the motor-
(FIGURE 3). Incorporating the soccer ball tion at slower speeds (side to side, with- learning process.
and soccer-specific equipment (shoes) out jumping), then speeds and dynamic The basic plyometric techniques
in phase 2 is not only important to en- movements are gradually increased. Ba- (proper landing and stabilization) are
hance soccer-specific neuromuscular sic exercises, such as lunges (front, lat- progressed from double-leg to single-leg
stabilization strategies but also to pro- eral, or diagonal), performed with and activities (horizontal and vertical jump),
mote a positive psychological attitude in without trunk rotations, are useful in emphasizing quality versus quantity of
rehabilitation. promoting multiplanar stabilization of movement. Heading the ball is also prac-
Later in phase 2, the goal is to con- the surgically repaired knee. ticed, with proper take-off and landing
trol forward, backward, lateral, diagonal, Some simple forms of quickness drills technique(s).
and rotational body displacements, while are also included in this phase. For ex- Pool activities are a popular form of
42-04 Bizzini.indd 307 3/21/2012 4:32:33 PM

FIGURE 4. Star run drill. Basic setup and different drills: (A) star run outline, (B) star run with zigzag cutting drill, (C) star run with forward/backward ladder drills, (D) star run
with running curves through poles.
additional training for soccer players in progression for a level at the same fre- square and the intensity with which the
this controlled phase.43 Using the prop- quency for 3 days is recommended before player is working. Research from match
erties of water, the athlete may exercise moving to the next level, whether it be analyses49 has shown that the sprints
balance and coordination, in addition to distance, time, repetitions, or intensity. are between 10 and 25 m in length and
performing running exercises (eventually This allows for a gradual progression of 3 and 5 seconds in duration. The energy
with a wet vest), with minimal loading on each part and thus ensures correct func- systems being used are also an important
the operated knee. tion and that no adverse knee reaction consideration during these phases of re-
The athlete is ready to move to phase is noted before moving on to the next habilitation. Soccer players need to train
3 when he/she has reached the criteria level. Rehabilitation programs have been both the anaerobic and aerobic systems,
described in TABLE 1. shown to fail due to a rapid increase in as distances up to 10 km (central defend-
exercise load, whether of speed or dura- ers) or 12 km (midfielders) are covered
Phase 3 tion, or the addition of different exercises by top-level professional players in a
More complex and challenging soccer- that place a higher demand on the knee match.49
specific drills characterize phase 3 (TABLE and graft.34 Combined Drills Different activities such
1). Star Run Drill This drill can be adapted as quick-feet, short sprints, cutting and
Soccer-Specific Drills TABLE 2 shows an to running and soccer-specific training. accelerating, and body rotations can be
outline of a “classical” progression (3 It can incorporate all aspects of soccer, trained in a rapid sequence over a pre-
parts with 4 levels each) for running and including forward, backward, or multidi- defined distance (eg, 20 m). Incorporat-
soccer drills. Specific parts/levels can rectional drills, and explosive and reac- ing various skills into a rapid sequence
be added or removed as the player pro- tive drills with cutting. The outline of the has proven to be an effective specific
gresses. There are no set time frames to drill is simple (FIGURE 4). The distances quickness and dynamic body control
complete each part at a given level, but may be increased or decreased, but player training method for soccer players after
performing each point (a, b, c, etc) of the position tends to dictate the size of the knee surgery (ONLINE VIDEO 1).
42-04 Bizzini.indd 308 3/21/2012 4:32:35 PM

patient to slide in and kick the ball away
from the therapist’s feet. Sets and repeti-
tions can be added gradually, with speed
only being added as the patient is starting
to join group training. It is vital, however,
that before adding these late-stage drills,
all aspects of single-leg hopping and rota-
tion training have been completed. The
grass surface must also be inspected prior
to performing these types of drills, as ex-
ternal conditions, such as a slippery wet
surface, could place the athlete at great-
FIGURE 5. Block tackles at different angles and er risk. The criteria to allow the athlete
intensities, on different types of surfaces, from a soft to progress to phase 4 are described in
FIGURE 7. In-air body contact, trying to simulate
deflated soccer ball to a harder leather medicine ball. TABLE 1.

heading and body contact in the gym environment.
Specific instructions are given on landing correctly on
the forefoot/toes and absorbing the landing forces. Phase 4, Return to Play:
Progressions can be added by different directional What Does It Mean?
forces and intensity of body weight contact.
Respecting a gradual and progressive re-
turn to competitive soccer is crucial for

they gradually rejoin training. Although the player following ACL reconstruction.
there is always risk with contact, we sug- Therefore, it is necessary to differentiate
gest that it may be better to include this between various types of return:
aspect of the game in a controlled envi- • Return to reduced team training prac-
ronment of rehabilitation rather than tice (no contact)
leave it to the unpredictable environment • Return to full (normal) team training
of a training session. If the player’s knee practice (with contact)
FIGURE 6. Kicking action into pads while balancing is able to gradually withstand forces of • Return to “friendly” games (initially
on an unstable surface, incorporating standing

valgus/varus with and without rotation, not over the full duration of a match)
balance while making contact. The use of unstable
surfaces helps to promote different reactive they must be able to cope with the grad- • Return to competitive match (initially
stabilization strategies. ual load/forces of contact. Controlling not over the full duration of a match)
the decelerating forces from a contact is This first return is often the most
Contact Situations One aspect of the lat- vital, as it has been shown to reduce the crucial. The player must be physically
er sport-specific drills is contact, which is incidence of ACL rupture.9,16 Repetitive and psychologically ready to shift from
a major element of the game of soccer. Al- training of proper landing techniques individual training, where most situa-
though ACL ruptures tend to occur more has enabled athletes to develop learned tions are intense but controlled, to team
often without contact,42 those occurring responses that may help minimize or pre- training, where the player is also exposed
from contacts cannot be ignored. Roi et vent injury when they are placed in game to uncontrolled situations. In this phase,
al,44 analyzing data from the Italian Serie or practice situations.34,52 the player also continues to perform
A League, determined that ACL contact Contact can be controlled with block specific training, focusing on improving
injuries occurred more frequently during tackles (FIGURE 5) and single-leg kicking identified deficits (strength, coordina-
competitive games, while noncontact in- of objects that move (FIGURE 6), eventually tion, and endurance) under supervision.
juries occurred more often during train- progressing to actual body load, whether Recent research has clearly shown that
ing and nonofficial games. Mihata et al32 on the ground or in the air (FIGURE 7). strength/power and functional deficits
compared a number of different sports Tackle Situations The sliding tackle is in the involved lower extremity may
(basketball, soccer, and lacrosse) and another type of contact that must be ad- persist up to 6 or more months after pri-
suggested that the level of allowed con- dressed, as it is an important function mary ACL reconstruction,20,35,36 and that
tact in pivoting sports may be a factor in of the knee in the defensive side of the persistent strength imbalances may be
determining sport-specific ACL risk. game. Graded progressions of landing linked with an increased risk of reinjury
Often, the level of contact of the sport on the floor and kicking a ball away can in soccer.12,29
is overlooked in the rehabilitation pro- be included first without another person, Thomeé et al50 critically discussed the
gram and left to players to manage as and eventually with a therapist asking the common muscle strength and hop per-
42-04 Bizzini.indd 309 3/21/2012 4:32:36 PM

formance criteria used prior to return to Yo and RSSA tests may also be used to SUMMARY
sport, which may not be demanding and monitor improvement of the athlete over
A
sensitive enough to detect side differenc- time. Additional specific tests, such as soccer player faces many chal-
es, and proposed new recommendations speed dribbling, short-long passing, and lenges following ACL reconstruc-
for muscle function tests in individuals shooting, have been proposed in the lit- tion. The player has to deal with the
after ACL reconstruction. erature45 but have never been fully scien- pressure of his entourage (club, coach,
Because soccer is a high-intensity tifically validated. These and other skills other) and the risk of jeopardizing his
intermittent activity, training should are practiced daily, and, similar to playing career, while pursuing the goal of a suc-
include physical exercises aimed to en- against an opponent, physical and mental cessful return to play. The sports phys-
hance aerobic fitness, anaerobic power preparation must be gradually optimized iotherapist plays an important role in
and capacity, repeated sprint ability, and (TABLE 2). monitoring a closely supervised criteria-
muscle power and strength. Other than Therefore, to return to full partici- based program and in guiding the athlete
coping with the physiological demands pation after ACL surgery, the soccer during the rehabilitation and training
of the match, physical training can coun- player must make a successful progres- process. Functional training is a key el-
teract the decline in technical proficien- sion through the described rehabilitation ement in regaining the soccer-specific
cy caused by fatigue.26 Several studies phases and show satisfactory (as judged neuromuscular control necessary to per-
have shown different effective training by the sports physiotherapist) Yo-Yo and form skills ranging from basic to soccer-
strategies for improving these fitness RSSA test results. specific drills. Particular attention should
components.13,15,19,22,24 be given to the quality of the movement
Functional Tests to Clear Return to Play PREVENTION OF REINJURY patterns and stabilization strategies. Re-
Myer et al35 recently presented a battery AFTER ACL RECONSTRUCTION sidual impairments in strength, power,
of performance tests (modified NFL agility, and sensorimotor capacity should
I
Combine testing) to show how unilateral n the last few years, ACL injury be specifically addressed while the athlete
deficits are present and may be hidden prevention programs for female and undergoes soccer-specific conditioning
in double-leg activities in athletes 1 year male soccer players have been devel- and fitness training.
after ACL reconstruction. Therefore, the oped and their effectiveness scientifi- The goal is to reintegrate the player
sports physiotherapist needs to regu- cally confirmed.2 A reduction of 30% to gradually in the game, taking into ac-
larly check single-leg hop tasks of the 50%, and even higher for females,18 has count his/her individual characteristics.
involved limb, while ensuring that the been shown in the incidence of noncon- Several evidence-based and empirical cri-
player continues to demonstrate good tact ACL injuries.47 Programs such as the teria are needed to plan and monitor the
overall quality of movement (knee, hip, Perform and Enhance Performance31 and efficient return to competitive soccer. In-
and trunk). the 11+ (ONLINE VIDEO 2),47 which combine jury prevention education should be part
Unrestricted participation in team cardiovascular and specific injury pre- of this process to maximize the chance of
practice (without any adverse knee joint vention exercises, should be performed a durable career. Further research is nec-
reactions) is, of course, an important cri- as a warm-up prior to technical and essary to better understand and assess
terion to be able to return to compete in tactical training. Considering the risk different aspects of muscle function and
a soccer match. There are no validated of reinjury39,53 and that some aspects of motor control after ACL reconstruction
sports-specific tests to determine readi- biomechanical and neuromuscular func- in soccer players. t
ness to return to full participation in tion may be deficient up to several years
team practice and competitive matches after the ACL reconstruction,11,34,36 play-
for soccer players after ACL surgery. ers should ideally continue post–ACL REFERENCES
However, the 2 performance tests con- reconstruction neuromuscular training
1. A lentorn-Geli E, Myer GD, Silvers HJ, et al. Pre-
sidered the best, in terms of validity and on a regular basis for the remainder of vention of non-contact anterior cruciate ligament
reliability in healthy soccer players, are their career. injuries in soccer players. Part 1: mechanisms
the Yo-Yo intermittent recovery (Yo-Yo) In this respect, the use of screening of injury and underlying risk factors. Knee Surg
test4 and the repeated shuttle-sprint tests to identify players at risk for ACL Sports Traumatol Arthrosc. 2009;17:705-729.
http://dx.doi.org/10.1007/s00167-009-0813-1
ability (RSSA) test.25 Data are available injury may be recommended. The Land-
2. Alentorn-Geli E, Myer GD, Silvers HJ, et al. Pre-
for different players’ roles (defender, full- ing Error Scoring System, developed by vention of non-contact anterior cruciate ligament
back, midfielder, and forward) that, even Padua et al,38 is a valid and reliable clini- injuries in soccer players. Part 2: a review of
if cut-off values do not exist, may help cal assessment tool for jump-landing bio- prevention programs aimed to modify risk fac-
in judging the performance and return- mechanics, and may have the potential to tors and to reduce injury rates. Knee Surg Sports
Traumatol Arthrosc. 2009;17:859-879. http://
to-play readiness of the player.27 The Yo- predict ACL injury or reinjury.
42-04 Bizzini.indd 310 3/21/2012 4:32:37 PM

dx.doi.org/10.1007/s00167-009-0823-z grams for physical active individuals. Phys Ther. junior elite soccer players. Scand J Med
3. A rnason A, Sigurdsson SB, Gudmundsson 2000;80:128-140. Sci Sports. 2009;19:243-251. http://dx.doi.
A, Holme I, Engebretsen L, Bahr R. Risk fac- 17. Fuller CW, Walker J. Quantifying the functional org/10.1111/j.1600-0838.2008.00780.x
tors for injuries in football. Am J Sports Med. rehabilitation of injured football players. Br J 30. Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe
2004;32:5S-16S. Sports Med. 2006;40:151-157. http://dx.doi. MJ, Godges JJ. Knee stability and movement
4. Bangsbo J, Iaia FM, Krustrup P. The Yo-Yo inter- org/10.1136/bjsm.2005.021048 coordination impairments: knee ligament sprain.
mittent recovery test: a useful tool for evaluation 18. Gilchrist J, Mandelbaum BR, Melancon H, et J Orthop Sports Phys Ther. 2010;40:A1-A37.
of physical performance in intermittent sports. al. A randomized controlled trial to prevent http://dx.doi.org/10.2519/jospt.2010.0303
Sports Med. 2008;38:37-51. noncontact anterior cruciate ligament injury in 31. Mandelbaum BR, Silvers HJ, Watanabe DS,
5. Beynnon BD, Johnson RJ, Abate JA, Flem- female collegiate soccer players. Am J Sports et al. Effectiveness of a neuromuscular and
ing BC, Nichols CE. Treatment of anterior Med. 2008;36:1476-1483. http://dx.doi. proprioceptive training program in prevent-
cruciate ligament injuries, part I. Am J Sports org/10.1177/0363546508318188 ing anterior cruciate ligament injuries in
Med. 2005;33:1579-1602. http://dx.doi. 19. Gorostiaga EM, Izquierdo M, Ruesta M, Iribar- female athletes: 2-year follow-up. Am J Sports
org/10.1177/0363546505279913 ren J, Gonzalez-Badillo JJ, Ibanez J. Strength Med. 2005;33:1003-1010. http://dx.doi.
6. Bizzini M. Sensomotorische Rehabilitation nach training effects on physical performance and org/10.1177/0363546504272261
Beinverletzungen. Mit Fallbeispielen in allen Hei- serum hormones in young soccer players. Eur 32. Mihata LC, Beutler AI, Boden BP. Comparing the
lungsstadien. Stuttgart, Germany: Thieme; 2000. J Appl Physiol. 2004;91:698-707. http://dx.doi. incidence of anterior cruciate ligament injury
7. Bizzini M, Gorelick M, Drobny T. Lateral meniscus org/10.1007/s00421-003-1032-y in collegiate lacrosse, soccer, and basketball
repair in a professional ice hockey goaltender: 20. Gustavsson A, Neeter C, Thomeé P, et al. A players: implications for anterior cruciate
a case report with a 5-year follow-up. J Orthop test battery for evaluating hop performance in ligament mechanism and prevention. Am J
Sports Phys Ther. 2006;36:89-100. http://dx.doi. patients with an ACL injury and patients who Sports Med. 2006;34:899-904. http://dx.doi.
org/10.2519/jospt.2006.2015 have undergone ACL reconstruction. Knee Surg org/10.1177/0363546505285582
8. Bizzini M, Notzli HP, Maffiuletti NA. Femoro- Sports Traumatol Arthrosc. 2006;14:778-788. 33. Mohr M, Krustrup P, Bangsbo J. Match perfor-
acetabular impingement in professional ice http://dx.doi.org/10.1007/s00167-006-0045-6 mance of high-standard soccer players with
hockey players: a case series of 5 athletes after 21. Hagglund M, Walden M, Ekstrand J. Lower special reference to development of fatigue.
open surgical decompression of the hip. Am J reinjury rate with a coach-controlled reha- J Sports Sci. 2003;21:519-528. http://dx.doi.
Sports Med. 2007;35:1955-1959. http://dx.doi. bilitation program in amateur male soccer: org/10.1080/0264041031000071182
org/10.1177/0363546507304141 a randomized controlled trial. Am J Sports 34. Myer GD, Paterno MV, Ford KR, Quatman CE,
9. Caraffa A, Cerulli G, Projetti M, Aisa G, Rizzo A. Med. 2007;35:1433-1442. http://dx.doi. Hewett TE. Rehabilitation after anterior cruciate
Prevention of anterior cruciate ligament injuries org/10.1177/0363546507300063 ligament reconstruction: criteria-based progres-
in soccer. A prospective controlled study of pro- 22. Hill-Haas SV, Coutts AJ, Rowsell GJ, Dawson BT. sion through the return-to-sport phase. J Orthop
prioceptive training. Knee Surg Sports Traumatol Generic versus small-sided game training in soc- Sports Phys Ther. 2006;36:385-402. http://
Arthrosc. 1996;4:19-21. cer. Int J Sports Med. 2009;30:636-642. http:// dx.doi.org/10.2519/jospt.2006.2222
10. Cascio BM, Culp L, Cosgarea AJ. Return to play dx.doi.org/10.1055/s-0029-1220730 35. Myer GD, Schmitt LC, Brent JL, et al. Utilization
after anterior cruciate ligament reconstruction. 23. Impellizzeri FM, Marcora SM. Test validation of modified NFL combine testing to identify
Clin Sports Med. 2004;23:395-408. http:// in sport physiology: lessons learned from functional deficits in athletes following ACL
dx.doi.org/10.1016/j.csm.2004.03.004 clinimetrics. Int J Sports Physiol Perform. reconstruction. J Orthop Sports Phys Ther.
11. Chmielewski TL. Asymmetrical lower extremity 2009;4:269-277. 2011;41:377-387. http://dx.doi.org/10.2519/
loading after ACL reconstruction: more than 24. Impellizzeri FM, Marcora SM, Castagna C, et al. jospt.2011.3547
meets the eye. J Orthop Sports Phys Ther. Physiological and performance effects of generic 36. Myklebust G, Bahr R. Return to play guidelines
2011;41:374-376. http://dx.doi.org/10.2519/ versus specific aerobic training in soccer play- after anterior cruciate ligament surgery. Br J
jospt.2011.0104 ers. Int J Sports Med. 2006;27:483-492. http:// Sports Med. 2005;39:127-131. http://dx.doi.
12. Croisier JL, Ganteaume S, Binet J, Genty M, dx.doi.org/10.1055/s-2005-865839 org/10.1136/bjsm.2004.010900
Ferret JM. Strength imbalances and preven- 25. Impellizzeri FM, Rampinini E, Castagna C, et al. 37. Neeter C, Gustavsson A, Thomeé P, Augusts-
tion of hamstring injury in professional soccer Validity of a repeated-sprint test for football. Int son J, Thomeé R, Karlsson J. Development of a
players: a prospective study. Am J Sports J Sports Med. 2008;29:899-905. http://dx.doi. strength test battery for evaluating leg muscle
Med. 2008;36:1469-1475. http://dx.doi. org/10.1055/s-2008-1038491 power after anterior cruciate ligament injury
org/10.1177/0363546508316764 26. Impellizzeri FM, Rampinini E, Maffiuletti NA, and reconstruction. Knee Surg Sports Trauma-
13. Dupont G, Akakpo K, Berthoin S. The ef- Castagna C, Bizzini M, Wisloff U. Effects of tol Arthrosc. 2006;14:571-580. http://dx.doi.
fect of in-season, high-intensity interval aerobic training on the exercise-induced decline org/10.1007/s00167-006-0040-y
training in soccer players. J Strength in short-passing ability in junior soccer players. 38. Padua DA, Marshall SW, Boling MC, Thigpen
Cond Res. 2004;18:584-589. http://dx.doi. Appl Physiol Nutr Metab. 2008;33:1192-1198. CA, Garrett WE, Jr., Beutler AI. The Landing
org/10.1519/1533-4287(2004)18<584:TEOIHI>2. http://dx.doi.org/10.1139/H08-111 Error Scoring System (LESS) is a valid and reli-
0.CO;2 27. Krustrup P, Mohr M, Amstrup T, et al. The able clinical assessment tool of jump-landing
14. Dvorak J, Junge A. Football injuries and physi- Yo-Yo intermittent recovery test: physiologi- biomechanics: the JUMP-ACL study. Am J
cal symptoms. A review of the literature. Am J cal response, reliability, and validity. Med Sci Sports Med. 2009;37:1996-2002. http://dx.doi.
Sports Med. 2000;28:S3-S9. Sports Exerc. 2003;35:697-705. http://dx.doi. org/10.1177/0363546509343200
15. Ferrari Bravo D, Impellizzeri FM, Rampi- org/10.1249/01.MSS.0000058441.94520.32 39. Paterno MV, Schmitt LC, Ford KR, et al. Biome-
nini E, Castagna C, Bishop D, Wisloff U. 28. Kvist J. Rehabilitation following anterior cruci- chanical measures during landing and postural
Sprint vs. interval training in football. Int J ate ligament injury: current recommenda- stability predict second anterior cruciate liga-
Sports Med. 2008;29:668-674. http://dx.doi. tions for sports participation. Sports Med. ment injury after anterior cruciate ligament
org/10.1055/s-2007-989371 2004;34:269-280. reconstruction and return to sport. Am J
16. Fitzgerald GK, Axe MJ, Snyder-Mackler L. The 29. Lehance C, Binet J, Bury T, Croisier JL. Sports Med. 2010;38:1968-1978. http://dx.doi.
efficacy of perturbation training in nonoperative Muscular strength, functional perfor- org/10.1177/0363546510376053
anterior cruciate ligament rehabilitation pro- mances and injury risk in professional and 40. Powers CM. The influence of abnormal hip
42-04 Bizzini.indd 311 3/21/2012 4:32:38 PM

mechanics on knee injury: a biomechani- http://dx.doi.org/10.1007/s11332-006-0025-8 51. v an Grinsven S, van Cingel RE, Holla CJ, van
cal perspective. J Orthop Sports Phys Ther. 45. R osch D, Hodgson R, Peterson TL, et al. Assess- Loon CJ. Evidence-based rehabilitation fol-
2010;40:42-51. http://dx.doi.org/10.2519/ ment and evaluation of football performance. lowing anterior cruciate ligament reconstruc-
jospt.2010.3337 Am J Sports Med. 2000;28:S29-S39. tion. Knee Surg Sports Traumatol Arthrosc.
41. Risberg MA, Holm I, Myklebust G, Engebretsen 46. Schmidt RA, Lee TD. Motor Control and Learn- 2010;18:1128-1144. http://dx.doi.org/10.1007/
L. Neuromuscular training versus strength training: A Behavioral Emphasis. 3rd ed. Champaign, s00167-009-1027-2
ing during first 6 months after anterior cruciate IL: Human Kinetics; 1999. 52. Voight M, Cook G. Clinical application of
ligament reconstruction: a randomized clinical 47. Soligard T, Myklebust G, Steffen K, et al. Compre- closed kinetic chain exercise. J Sport Rehabil.
trial. Phys Ther. 2007;87:737-750. http://dx.doi. hensive warm-up programme to prevent injuries 1996;5:25-44.
org/10.2522/ptj.20060041 in young female footballers: cluster randomised 53. Walden M, Hagglund M, Ekstrand J. High risk
42. Rochcongar P, Laboute E, Jan J, Carling C. Rup- controlled trial. BMJ. 2008;337:a2469. of new knee injury in elite footballers with
tures of the anterior cruciate ligament in soccer. 48. Spencer M, Bishop D, Dawson B, Goodman previous anterior cruciate ligament injury. Br
Int J Sports Med. 2009;30:372-378. http:// C. Physiological and metabolic responses of J Sports Med. 2006;40:158-162. http://dx.doi.
dx.doi.org/10.1055/s-0028-1105947 repeated-sprint activities specific to field-based org/10.1136/bjsm.2005.021055
43. Roi GS, Creta D, Nanni G, Marcacci M, Zaffagnini team sports. Sports Med. 2005;35:1025-1044. 54. Walden M, Hagglund M, Magnusson H, Ekstrand
S, Snyder-Mackler L. Return to official Italian 49. Stolen T, Chamari K, Castagna C, Wisloff U. J. Anterior cruciate ligament injury in elite foot-
First Division soccer games within 90 days after Physiology of soccer: an update. Sports Med. ball: a prospective three-cohort study. Knee Surg
anterior cruciate ligament reconstruction: a case 2005;35:501-536. Sports Traumatol Arthrosc. 2011;19:11-19. http://
report. J Orthop Sports Phys Ther. 2005;35:52- 50. Thomeé R, Kaplan Y, Kvist J, et al. Muscle dx.doi.org/10.1007/s00167-010-1170-9
61; discussion 61-66. http://dx.doi.org/10.2519/ strength and hop performance criteria prior
jospt.2005.1583 to return to sports after ACL reconstruction.
@ MORE INFORMATION
44. Roi GS, Nanni G, Tencone F. Time to return to Knee Surg Sports Traumatol Arthrosc.
professional soccer matches after ACL recon- 2011;19:1798-1805. http://dx.doi.org/10.1007/
WWW.JOSPT.ORG
struction. Sport Sci Health. 2006;1:142-145. s00167-011-1669-8

PUBLISH Your Manuscript in a Journal With International Reach

JOSPT offers authors of accepted papers an international audience. The
Journal is currently distributed to the members of APTA’s Orthopaedic
and Sports Physical Therapy Sections and 22 orthopaedics, manual therapy,
and sports groups in 20 countries who provide online access as a member
benefit. As a result, the Journal is now distributed monthly to more than
30 000 individuals around the world who specialize in musculoskeletal and
sports-related rehabilitation, health, and wellness. In addition, JOSPT
reaches students and faculty, physical therapists and physicians at more
than 1,400 institutions in 55 countries. Please review our Information for and
Instructions to Authors at www.jospt.org and submit your manuscript for
peer review at http://mc.manuscriptcentral.com/jospt.
42-04 Bizzini.indd 312 3/21/2012 4:32:39 PM

This article has been cited by:
1. Wouter Welling, Anne Benjaminse, Koen Lemmink, Alli Gokeler. 2020. Passing return to sports tests after ACL
reconstruction is associated with greater likelihood for return to sport but fail to identify second injury risk. The Knee
. [Crossref]
2. Theresa Diermeier, Rob Tisherman, Jonathan Hughes, Michael Tulman, Erica Baum Coffey, Christian Fink, Andrew
Lynch, Freddie H. Fu, Volker Musahl. 2020. Quadriceps tendon anterior cruciate ligament reconstruction. Knee Surgery,
Sports Traumatology, Arthroscopy 26. . [Crossref]
3. Takeshi Oshima, Sven Putnis, Samuel Grasso, Antonio Klasan, David Anthony Parker. 2020. Graft Size and Orientation
Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction. The American
Journal of Sports Medicine 48:1, 99-108. [Crossref]
4. Claudio Legnani, Giuseppe M. Peretti, Matteo Del Re, Enrico Borgo, Alberto Ventura. 2019. Return to sports and re-
rupture rate following anterior cruciate ligament reconstruction in amateur sportsman: long-term outcomes. The Journal
of Sports Medicine and Physical Fitness 59:11. . [Crossref]
5. Eoghan T. Hurley, Yoshiharu Shimozono, Niall P. McGoldrick, Charles L. Myerson, Youichi Yasui, John G. Kennedy.
2019. High reported rate of return to play following bone marrow stimulation for osteochondral lesions of the talus. Knee
Surgery, Sports Traumatology, Arthroscopy 27:9, 2721-2730. [Crossref]

6. Matthew Buckthorpe, Francesco Della Villa, Stefano Della Villa, Giulio Sergio Roi. 2019. On-field Rehabilitation Part 2:
A 5-Stage Program for the Soccer Player Focused on Linear Movements, Multidirectional Movements, Soccer-Specific
Skills, Soccer-Specific Movements, and Modified Practice. Journal of Orthopaedic & Sports Physical Therapy 49:8, 570-575.
[Abstract] [Full Text] [PDF] [PDF Plus] [Supplementary Material]
7. MING-SHENG CHAN, SUSAN M. SIGWARD. 2019. Loading Behaviors Do Not Match Loading Abilities Postanterior
Cruciate Ligament Reconstruction. Medicine & Science in Sports & Exercise 51:8, 1626-1634. [Crossref]
8. Dai Sugimoto, Benton E. Heyworth, Jeff J. Brodeur, Dennis E. Kramer, Mininder S. Kocher, Lyle J. Micheli. 2019. Effect
of Graft Type on Balance and Hop Tests in Adolescent Males Following Anterior Cruciate Ligament Reconstruction.
Journal of Sport Rehabilitation 28:5, 468-475. [Crossref]
9. Matthew Buckthorpe. 2019. Optimising the Late-Stage Rehabilitation and Return-to-Sport Training and Testing Process
After ACL Reconstruction. Sports Medicine 49:7, 1043-1058. [Crossref]
10. Frank R. Noyes, Sue Barber-Westin. Return to Sport for Soccer and Basketball 383-419. [Crossref]
11. Wouter Welling, Anne Benjaminse, Romain Seil, Koen Lemmink, Stefano Zaffagnini, Alli Gokeler. 2018. Low rates of
patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal
study. Knee Surgery, Sports Traumatology, Arthroscopy 26:12, 3636-3644. [Crossref]
12. Shannon N. Heidorn, Sherman O. Canapp, Christine M. Zink, Christopher S. Leasure, Brittany J. Carr. 2018. Rate of
return to agility competition for dogs with cranial cruciate ligament tears treated with tibial plateau leveling osteotomy.
Journal of the American Veterinary Medical Association 253:11, 1439-1444. [Crossref]
13. Amelia J.H. Arundale, Jacob J. Capin, Ryan Zarzycki, Angela Smith, Lynn Snyder-Mackler. 2018. Functional and Patient-
Reported Outcomes Improve Over the Course of Rehabilitation: A Secondary Analysis of the ACL-SPORTS Trial. Sports
Health: A Multidisciplinary Approach 10:5, 441-452. [Crossref]
14. Chan Gao, Aaron Yang. 2018. Patellar Dislocations: Review of Current Literature and Return to Play Potential. Current
Physical Medicine and Rehabilitation Reports 6:2, 161-170. [Crossref]
15. Andreas Ivarsson, Urban Johnson, Jón Karlsson, Mats Börjesson, Martin Hägglund, Mark B. Andersen, Markus Waldén.
2018. Elite female footballers’ stories of sociocultural factors, emotions, and behaviours prior to anterior cruciate ligament
injury. International Journal of Sport and Exercise Psychology 23, 1-17. [Crossref]
16. Pelin Pişirici, Atakan Çağlayan, Mustafa Karahan, Michael Hantes. On Field Testing After Anterior Cruciate Ligament
Reconstruction 559-567. [Crossref]
17. Hong Li, Jiwu Chen, Hongyun Li, Ziying Wu, Shiyi Chen. 2017. MRI-based ACL graft maturity does not predict clinical
and functional outcomes during the first year after ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy
25:10, 3171-3178. [Crossref]
18. Amelia J. H. Arundale, Kathleen Cummer, Jacob J. Capin, Ryan Zarzycki, Lynn Snyder-Mackler. 2017. Report of the
Clinical and Functional Primary Outcomes in Men of the ACL-SPORTS Trial: Similar Outcomes in Men Receiving
Secondary Prevention With and Without Perturbation Training 1 and 2 Years After ACL Reconstruction. Clinical
Orthopaedics and Related Research 475:10, 2523-2534. [Crossref]
19. Toni Caparrós, Montserrat Pujol, Carlos Salas. 2017. General guidelines in the rehabilitation process for return to training
after a sports injury. Apunts. Medicina de l'Esport 52:196, 167-172. [Crossref]
20. A. Gokeler, W. Welling, A. Benjaminse, K. Lemmink, R. Seil, S. Zaffagnini. 2017. A critical analysis of limb symmetry
indices of hop tests in athletes after anterior cruciate ligament reconstruction: A case control study. Orthopaedics &
Traumatology: Surgery & Research 103:6, 947-951. [Crossref]
21. Bart Dingenen, Alli Gokeler. 2017. Optimization of the Return-to-Sport Paradigm After Anterior Cruciate Ligament
Reconstruction: A Critical Step Back to Move Forward. Sports Medicine 47:8, 1487-1500. [Crossref]
22. John R. Harry, Leland A. Barker, John A. Mercer, Janet S. Dufek. 2017. Vertical and Horizontal Impact Force Comparison
During Jump Landings With and Without Rotation in NCAA Division I Male Soccer Players. Journal of Strength and
Conditioning Research 31:7, 1780-1786. [Crossref]
23. Scott W. Talpey, Emma J. Siesmaa. 2017. Sports Injury Prevention. Strength and Conditioning Journal 39:3, 14-19.
[Crossref]
24. Johnathan D. Dzurka, MacKensie F. Mezzano, Drew L. Miller, Michael J. Van Alstyne, Omar M. ElShelkany. ACL
recovery tracking insole 1-1. [Crossref]
25. H. Bloch, C. Klein, P. Luig, H. Riepenhof. 2017. Return-to-Competition. Trauma und Berufskrankheit 19:1, 26-34.
[Crossref]
26. Alli Gokeler, Wouter Welling, Stefano Zaffagnini, Romain Seil, Darin Padua. 2017. Development of a test battery to
enhance safe return to sports after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy
25:1, 192-199. [Crossref]
27. Tabata Cristina do Carmo Almeida, Luiz Vinicius de Alcantara Sousa, Diego Monteiro de Melo Lucena, Francisco Winter
dos Santos Figueiredo, Vitor Engrácia Valenti, Laércio da Silva Paiva, Luiz Carlos de Abreu, Fernando Adami. 2016.
Evaluation of functional rehabilitation physiotherapy protocol in the postoperative patients with anterior cruciate ligament
reconstruction through clinical prognosis: an observational prospective study. BMC Research Notes 9:1. . [Crossref]
28. Fucai Han, Anirban Banerjee, Liang Shen, Lingaraj Krishna. 2015. Increased Compliance With Supervised Rehabilitation
Improves Functional Outcome and Return to Sport After Anterior Cruciate Ligament Reconstruction in Recreational
Athletes. Orthopaedic Journal of Sports Medicine 3:12, 232596711562077. [Crossref]
29. Alli Gokeler, Anne Benjaminse, Wouter Welling, Malou Alferink, Peter Eppinga, Bert Otten. 2015. The effects of
attentional focus on jump performance and knee joint kinematics in patients after ACL reconstruction. Physical Therapy
in Sport 16:2, 114-120. [Crossref]
30. Jacques Ménétrey, Sophie Putman, Suzanne Gard. 2014. Return to sport after patellar dislocation or following surgery
for patellofemoral instability. Knee Surgery, Sports Traumatology, Arthroscopy 22:10, 2320-2326. [Crossref]
31. Benjamin G. Domb, Christine E. Stake, Nathan A. Finch, T. Luke Cramer. 2014. Return to Sport After Hip Arthroscopy:
Aggregate Recommendations From High-volume Hip Arthroscopy Centers. Orthopedics 37:10, e902-e905. [Crossref]
32. Mario Bizzini, Holly Jacinda Silvers. 2014. Return to competitive football after major knee surgery: more questions than
answers?. Journal of Sports Sciences 32:13, 1209-1216. [Crossref]
33. Stephanie Di Stasi, Gregory D. Myer, Timothy E. Hewett. 2013. Neuromuscular Training to Target Deficits Associated
With Second Anterior Cruciate Ligament Injury. Journal of Orthopaedic & Sports Physical Therapy 43:11, 777-A11.
[Abstract] [Full Text] [PDF] [PDF Plus]
34. Lee Herrington, Gregory Myer, Ian Horsley. 2013. Task based rehabilitation protocol for elite athletes following Anterior
Cruciate ligament reconstruction: a clinical commentary. Physical Therapy in Sport 14:4, 188-198. [Crossref]
35. Guy G. Simoneau, Kevin E. Wilk. 2012. The Challenge of Return to Sports for Patients Post-ACL Reconstruction.
Journal of Orthopaedic & Sports Physical Therapy 42:4, 300-301. [Citation] [Full Text] [PDF] [PDF Plus]

Jospt 2012 4005

Uploaded by

Copyright:

Available Formats

You might also like

Jospt 2012 4005

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Jospt 2012 4005

Uploaded by

Copyright:

Available Formats

[ clinical commentary ]

Suggestions From the Field for Return

42-04 Bizzini.indd 304 3/21/2012 4:32:29 PM

stability exercises • Cardiovascular training • Cardiovascular soccer- on addressing remaining

42-04 Bizzini.indd 305 3/21/2012 4:32:30 PM

FIGURE 3. Male professional soccer player sitting on

has to fulfill to enter phase 2 are de-

ACL reconstruction. reactive exercises.41 Particular attention is

42-04 Bizzini.indd 306 3/21/2012 4:32:32 PM

Part 1 Part 2 Part 3

Level 4 Running: rotations Free kicks Rotation dribbling movements

42-04 Bizzini.indd 307 3/21/2012 4:32:33 PM

42-04 Bizzini.indd 308 3/21/2012 4:32:35 PM

deflated soccer ball to a harder leather medicine ball. TABLE 1.

turn to competitive soccer is crucial for

on an unstable surface, incorporating standing

42-04 Bizzini.indd 309 3/21/2012 4:32:36 PM

42-04 Bizzini.indd 310 3/21/2012 4:32:37 PM

42-04 Bizzini.indd 311 3/21/2012 4:32:38 PM

struction. Sport Sci Health. 2006;1:142-145. s00167-011-1669-8

PUBLISH Your Manuscript in a Journal With International Reach

42-04 Bizzini.indd 312 3/21/2012 4:32:39 PM

Surgery, Sports Traumatology, Arthroscopy 27:9, 2721-2730. [Crossref]

You might also like

stability exercises • Cardiovascular training • Cardiovascular soccer- on addressing remaining