I have been prompted to write this article after many years of treating the ‘over 35’s’ soccer player in my clinic. Unfortunately (or fortunately, depending on how you look at it!) this demographic is one of my best generators of referrals.

You may be the one – at 36 your son or daughter has just signed up to play with the U6’s. Whilst having a soccer background in your teens and early 20’s, marriage and family have kept you off the pitch for a good 10 years. You keep reasonably fit going to the gym a 2-3 times per week, but are a good 5-10kg heavier than when in your prime. You probably haven’t performed 90 minutes of aerobic activity with repeat sprint efforts for some time. Someone at the club suggests at that the U 35’s are looking for some players and you think ‘why not, I used to love playing soccer!’ After all, like most of us your brain still thinks its 21, but the frame carrying it around may not be travelling quite so well.

This is the history that I commonly obtain from the person sitting across my consultation room who has limped in with either an acute knee injury (often an anterior cruciate ligament tear), or either a hamstring or calf tear. Other patients describe felling great in the first game, only to succumb to a severe case of delayed onset muscle soreness (DOMS) 2-3 days after, subsequently tearing a hamstring at the next training session.  Injury is far less common in players who have continued to play year in and out, than in those who have had a break, even for a year or two.

So how do we go about preventing this clinical problem? The most important first step is general conditioning. The mistake most of us make, in our time poor state, is to train once or twice and get straight in and play a game. Realistically the decision to play should be made early, at least 3 months before the season starts. A running based conditioning program should be undertaken for at least 6 weeks prior to even starting football related activity. This initially needs to include slower conditioning work, but needs to be upgraded to include both high intensity running (sprinting) and also needs a direction change component. As a football code in particular soccer involves a combination of both continuous low intensity running (as you track the ball or another player on the field) and repeat sprint efforts (getting to a contest or chasing a loose ball). Most of us haven’t trained with that degree of endurance or intensity since we were a lot younger, and then try to reproduce it on aging hamstrings for 90 minutes (with a short break for oranges). It really is a recipe for injury.

Once the 6 week conditioning program is complete, then a period of 6 weeks of soccer specific practice, involving a continuation of speed and endurance conditioning, should be performed before playing games. This will hopefully provide a more ‘soccer hardened’ body, able to withstand traumatic injuries to the knee and ankle, as well as one more able to recover faster after games.

The last components of a successful training program would ideally include addressing some ‘prehabilitation’ exercises and recovery techniques. I think the majority who are able to complete a conditioning program as described above would be ahead of the pack, but these last components are the ‘extras’ that may prevent injury. This would include a flexibility program (not just a 2 minute stretch before training!), particularly for the glutes (buttock), hamstrings, quadriceps, hip flexors and calves. These should be performed on most days, and especially days after training and games. Exercise should involve strengthening for the thighs and buttocks (squats, lunges, etc), core strength and proprioception or balance exercises. ‘Core strength’ is a fashionable term for the deep muscles supporting the spine and pelvis. It is excellent for treating patients with back problems, but is definitely helpful in preventing hamstring tears and injuries around the groin. Proprioceptive exercises involve using devices like a ‘wobble board’ or (even standing on a pillow with your eyes closed) to improve balance sense. This has been shown to reduce the incidence of acute injury to the knee and ankle.

Recovery techniques would after a game should also be considered. A post game warm down and stretch is recommended. Low intensity exercise the day after a game such as going for a walk, a swim or a light bike ride will aid muscle recovery and reduce delayed onset muscle soreness (DOMS). A massage 1-2 days post game will also facilitate muscle recovery.  Be careful not to neglect post game hydration, and ideally not just with alcohol!

In summary then, if you are serious about a return to the soccer field after a an absence then preparation is the key ingredient. It may seem like preparing for a marathon, but the duration of a soccer game is similar to a half-marathon at least, and includes sprinting.  Make the decision to play early as this will allow enough time to develop adequate running fitness and also soccer specific conditioning before the games start. Consider all the extras that you can do to prepare, including flexibility, core strength, proprioception and recovery. If you follow these suggestions then hopefully your return to the field will be incident free.