Nearly a quarter of a million anterior cruciate ligament (ACL) injuries occur each year in North America in athletes who participate in high demand sports such as soccer, football, and basketball.

A major injury prevention position statement released by the Canadian Academy of Sport & Exercise Medicine (CASEM) and published in the Clinical Journal of Sport Medicine (CJSM) concludes that youth soccer players and their coaches can significantly decrease the incidence of ACL injuries by incorporating neuromuscular training (NMT) into their warm-up routines. NMT involves doing specific agility and strength training activities.  NMT should be incorporate into routine practices and warm ups and should begin, at the very latest, in the early teenage years.    “These warm up exercises, carried out correctly, will keep the athletes on the field instead of in our offices”, states Dr. Cathy Campbell, co-author of the new position statement and team doctor for the Canadian women’s soccer team.

CASEM recommends a Canada-wide approach and advocates that all Canadian youth soccer players should have NMT incorporated into their programs. The Canadian Soccer Association (CSA), the governing body for soccer in Canada, endorses CASEM’s position statement and supports this injury prevention program aimed at protecting athlete’s health and allowing them to perform at the highest level.  Dr Robert McCormack, one of four orthopaedic surgeons authoring this position statement, is also the medical representative on the CSA Medical Committee and Chief Medical Officer of the Canadian Olympic Committee and he agrees that “there is an important need to address the epidemic of these serious injuries”.

FIFA, soccer’s international governing body, has adopted the FIFA 11+ program which mandates a complete warm-up programme to reduce injuries among male and female football players aged 14 years and older.  The use of this type of program has resulted in a 52-72% reduction in ACL injury in girls and an 85% reduction in boys.

Dr. James Carson, who is also a co-author of this position statement and a physician for the Seneca College Varsity Athletes program, sums it up by saying, “This is a bad injury which usually requires major surgery.  So it’s important for soccer coaches across Canada to help save kids’ knees.”

The CASEM is an organization of physicians committed to the excellence in the practice of medicine as it applies to all aspects of physical activity.


ACL – Canadian Academy of Sport and Exercise Medicine – Position Statement: Neuromuscular Training Programs Can Decrease Anterior Cruciate Ligament Injuries in Youth Soccer Players

The Foam Rolling You Should Be Doing (But Probably Aren’t)

It’s not just for your legs: These rolling patterns address trouble spots from head to toe.

By now, most educated exercisers have joined the foam rolling revolution. But while your IT bands may be intimately familiar with the tool’s hurts-so-good loosening powers, limiting your experience to the lower body minimizes the total-body benefits. To that end, Master Trainer Josh Stolz has designed this head-to-toe rolling regimen. “Each of these rolling patterns address the most problematic areas where personal trainers and coaches find movement dysfunction and pain,” he explains.

In the following images, Stolz demonstrates the better, smarter way to roll. “You should spend 30 seconds to a minute or more on each individual movement,” he explains. “If it’s a regeneration or recovery day, take even more time, between 2 and 3 minutes for each move.”

And there’s more to the technique than you might think—read on for Stolz’s five most critical rules of foam rolling.

(1) Hydrate Ahead of Time. Even though foam rolling helps hydrate your tissue, you should down between 10 and 20 ounces of water beforehand, which helps prep the muscles for the work you’re about to do. “In general, hydrated tissue is resilient and pliable while dehydrated tissue is glued-down and sticky, which creates adhesions and movement dysfunction,” says Stolz.

(2) Roll Before And After a Workout. Most of us wait until we wrap a session to hit the roller. Instead, Stolz suggests scrapping static stretching and using the tool for your pre-workout warm-up. As much as it’s a recovery tool, the foam roller is also a preparatory tool,” says Stolz. “Think of foam rolling as a way to ‘smooth’ or ‘iron out’ the connective tissue and muscle. Foam rolling actually increases circulation so the connective tissue and muscle are getting more oxygen and water than if you just stretched.”

(3) Slow Your Roll. Foam rolling can hurt, and you’re only human. But speeding through each movement is a wasted opportunity. “The biggest misuse I see is club members rolling extremely fast, most likely to avoid the discomfort of the roller,” says Stolz. Instead, you want slow, purposeful motions. “If we go back to the ironing example, a quick-moving iron will not apply enough heat and/or steam and the article of clothing will still remain wrinkled. The key is to focus on these painful areas because they need the most attention and desperately need oxygen, water, and nutrients.” (Note: Stolz may appear to be rolling quickly in the gifs, but that is an effect of the animation; his real-life movements are slow and concentrated.)

(4) Move In Multiple Directions. It’s not just up-and-down, up-and-down. “If you look at the angle of how the muscle and fascia attach, it’s not straight up and down—some fascial attachments run from front to back or in spirals,” says Stolz. “The key is to not only slow down the foam rolling, but also add side-to-side movements, cross-friction (rubbing the spot being rolled side to side on the roller) and flexing and extending the joint being rolled.”

(5) Make It A Daily Ritual. Even on days that you’re not in the gym, foam rolling should be part of your repertoire. “I try to use the foam roller daily as maintenance for my fascia,” says Stolz. “It’s kind of like flossing—you need to do it every day to make a difference even if it’s only for 5 minutes.” But deep cleaning is necessary, too. “I think an important fact to remember is that foam rolling doesn’t take the place of a great massage or body working session.”

Note the following movements for your pre/post workout foam rolling routine:

Target:  LATS

Position yourself on your right side, with your right leg flat, knee bent 90 degrees, your left foot flat on the floor. Place the center of a foam roller beneath your right arm pit, perpendicular to your body, and extend your right arm straight, resting your left hand on the foam roller. (Reach that right arm as far as possible to create more of a stretch.) From this position, roll from your armpit about four inches down towards your waist, and back again, for 30 seconds to a minute. Switch sides; repeat. 



Lie face down, resting your left forearm on the floor, legs slightly wider than shoulder width. Place one end of a foam roller under your right shoulder, extending arm straight out at shoulder height, forming a T with the roller. (Again, reach that straight arm as far as possible to create more tension.) In short movements, roll from your shoulder to right pec and back again, for 30 seconds to a minute. Switch sides and repeat.


Target:  THORACIC SPINE (mid-upper back)

Lie faceup with feet shoulder-width apart and flat on the floor. Center a foam roller beneath your mid-back or shoulder blades so that it is perpendicular to your body. (Note: You can move the foam roller up and down to target different areas of the thoracic spine while still doing the extension motion.) Extend arms out from shoulders at a 45-degree angle. Reach arms back behind you towards floor and back again for 30 seconds to a minute. Make sure that the lower back doesn’t extend—think about pushing the lumbar spine into the ground as you are reaching back.


Target:  CALVES

Sit with legs extended in front of you, and rest your lower right calf on the center of a foam roller that’s perpendicular to your body. With hands on the floor, press your triceps to lift your butt off the floor, and then place your left foot on top of your right calf. Roll up from your lower right calf to the meat of your calf and back for 30 seconds to a minute. Switch legs; repeat. (Note: Also target the inside and the outside of the calf simply by turning the foot in or turning the foot out.)



With your feet flat on the floor, slightly wider than shoulder-width, center a foam roller beneath your glutes. Lift your right leg and rest your right ankle on your left knee. Roll back and forth from the center of your right glute to the bottom of your spine for 30 seconds to a minute; switch legs and repeat.



Lower yourself onto the floor, extending your right leg out in front of you, and bend your left knee so that your lower leg is behind you. Place the end of a foam roller beneath your upper right hamstring, just below the glute, and place your hands on the foam roller on either side of your leg. Roll your upper hamstring just enough so that your foot flexes down, and roll it back again, for 30 seconds to a minute; switch sides and repeat.


Target:  QUADS

Get on the floor, resting on your forearms, and center a foam roller beneath your right quad, your right leg extended directly behind you. Roll from the bottom of your quad to the top, rotating from the outside of your quad to the inside, in one fluid circular motion. Roll for 30 seconds to a minute; switch legs and repeat.


Thanks to and Shelia Monaghan, November 4, 2013