National Strength and Conditioning Association
Volume 28, Number 1, pages 1013
Keywords: proprioception; balance exercises; balance boards
Preventing Lower Limb
Injuries in Soccer Players
Asimenia F. Gioftsidou, PhD, Paraskevi K. Malliou
Democritus University of Thrace, Komotini, Greece
summary
The frequent use of balance exercis-
es aids in the protection of athletes
from possible injuries. We suggest
that coaches include sport-specific
balance exercises into a daily soccer-
training routine.We recommend the
use of devices such as mini-trampo-
lines and balance boards with the
combination of certain soccer abili-
ties to be more interesting to the
players.
occer is one of the most popular
S sports and attracts many partici-
pants all over the world (8, 11).
This participation, though, leads to a
substantial number of musculoskeletal
injuries (7). To prevent such injuries, re-
habilitation specialists propose specific
exercise programs, like strengthening
exercise programs to restore muscle im-
balances, stretching exercise programs
10
to decrease muscle stiffness,, and balance
exercise programs to improve proprio-
ception (1, 3).
The focus of this article will be on how
to incorporate specific balance exercises
for soccer players in an attempt to pre-
vent lower limb injuries.
It is important to understand the differ-
ence between proprioception and bal-
ance. It has been hypothesized that pro-
prioception is important for providing
smooth, coordinated movement as well
as protection and dynamic stabilization
of joints (4). According to Sherrington,
(10) proprioception is the awareness of
body segment positions and orientations.
Hanney (5) states that proprioception is
the reception of stimuli produced with-
in organism, whereas balance is physi-
cal equilibrium. This means that pro-
prioception is a neurologic process,
whereas balance is the ability to remain
in an upright position (5). Balance exer-
cises are aimed at improving propriocep-
tion; to train the brain to recognize the
bodys segment position every moment.
Therefore, a balance program will train
proprioception pathways more effec-
tively under competitive circumstances.
Specifically, to prevent limb injuries, pe-
February 2006 Strength and Conditioning Journal
ripheral and central nervous system re-
ceptors (5), mechanoreceptors within
muscles; tendons; and ligaments have to
be activated. Balance exercises seem to
help this activation occur faster and
more effectively (9). In other words, the
goal of balance exercises should be to re-
duce the time between neural stimuli
and muscular response (15). Further-
more, it is important that balance exer-
cise programs improve proprioception
not only during the rehabilitation
phase,, but also during the competition
period. This means that balance im-
provement may decrease the risk of fu-
ture injury (6).
Scientists (2, 3, 11, 14) support that bal-
ance exercises are important to athletic
performance and should be incorporat-
ed into an athletes daily training. Re-
search has shown that the frequent use
of these exercises may decrease muscu-
loskeletal injuries and increase balance
ability (3, 14).
More specifically, 1 study (3) mentioned
the positive effect of a specific balance
training program on the decrease of ante-
rior cruciate ligament (ACL) injuries. This
6-week program was of gradual difficulty
and was applied to healthy soccer players
(training group). The results showed that

Contents of the Balance Training Program
Drills performed on
(a) trampoline,
(b) hemicylindrical board, and
(c) hemispherical board
First drill: heading
Second drill: leg passing
Third drill: heading and leg passing alternate
Fourth drill: control and leg passing
(Each drill performed 2 times)
the training group only had 13% of the in-
juries of the control group. Similarly, an-
other study (14) stated that the perfor-
mance of a 10-month balance training
program on balance boards resulted in the
decrease in the frequency of lower limb in-
juries for healthy female handball players.
The content of a balance training pro-
gram should be adjusted to the peculiari-
ties of each sport (12). Balance exercises
must be done in a controlled environ-
ment in which the joints are moving in a
functional relationship to each other and
to the same degree as in normal function-
al activities, including sports activities
(15). In terms of relative difficulty, exer-
cises may be progressed by changing from
bilateral to unilateral standing, from eyes
open to eyes closed, or by adding lower
extremity motion or upper extremity
skills to the exercise routine (15). All the
activities are designed to be a natural part
of playing movements (14). The balance
training exercises performed on balance
boards require the combination of bal-
ance ability and certain soccer abilities,
like kicking and heading (coming into
contact with the ball using the forehead).
Balance Exercise Program
Progression
1. Start from a 2-leg stance position, and
advance to a 1-leg stance position.
2. Select basic drills related to the spe-
February 2006 Strength and Conditioning Journal
Table 1
Training period
1st and 2nd wk: 20 s/drill (total 8 min)
3rd and 4th wk: 25 s/drill (total 10 min)
5th and 6th wk: 30 s/drill (total 12 min)
7th and 8th wk: 35 s/drill (total 14 min)
9th and 10th wk: 40 s/drill (total 16 min)
11th and 12th wk: 45 s/drill (total 18 min)
cific sport, progressing from the easi-
er to the more difficult.
3. Start performing the drills from the
more stable surface to a less stable
surface. For example, perform drills
from a single-plane balance board to
a multi-plane balance board, or
change the surface on which the
board is placed (from soft carpet to
hard tile).
4. Start performing the drills with open
eyes and then with closed eyes (if
that is possible).
5. Try to increase the duration of each
drill.
Balance Exercise Program
Because physical therapists recommend
that athletes perform balance exercises,
we suggest that coaches include balance
exercises into a daily soccer training rou-
tine and combine them with soccer drills
to be more sport-specific and interesting.
Because our balance exercise program is
for healthy soccer players, we suggest that
they begin performing these specific drills
in a closed-chain lower limb position (5,
13). The proposed pieces of equipment
are a mini-trampoline and 2 wooden bal-
ance boards. The use of a mini-trampo-
line can change the weight bearing surface
from hard to soft and provide an element
of instability, thus requiring more control
in the weight-bearing lower extremity for
stability (15). The first board is a flat
Rest period between each drill
1st and 2nd wk: 30 s (total 4, 5 min)
3rd and 4th wk: 25 s (total 3, 7 min)
5th and 6th wk: 20 s (total 3 min)
7th and 8th wk: 20 s (total 3 min)
9th and 10th wk: 15 s (total 2, 3 min)
11th and 12th wk: 15 s (total 2, 3min)
wooden disk, 51 cm in diameter, and 1
cm high with a round hardwood block
(9.5 cm diameter, 3.7 cm high) in the
middle of its under surface (hemispherical
board). The second board is a flat wooden
box, 35 cm by 33 cm, and 1 cm high with
a hemicylindrical hardwood block (35
length, 6 cm high) in the middle of its
under surface (hemicylindrical board).
The board with the hemispherical bottom
moves in all directions. The board with
the hemicylindrical bottom moves anteri-
orposterior or mediallateral, according
to athletes leg position on the board sur-
face. With the use of these pieces of equip-
ment, the balance training program in-
cludes 4 different soccer drills (Table 1).
During the first 2 weeks of the balance
program, exercises should be performed
for 20 seconds and then increased 5 sec-
onds every 2 weeks (e.g., duration in-
creased at 3rd, 5th, 7th, 9th, and 11th
weeks). Respectively, after the first 2
weeks, the rest period between each drill
should be reduced 5 seconds (from 30
seconds to 15 seconds, gradually) (Table
1). The progression of the balance train-
ing program should be from less to more
challenging surfaces. Athletes start by
performing the drills on a more stable
surface, such as placing a board on a soft
surface (e.g., carpet), and progress to a
less stable or hard surface (e.g., tile).
This can also be achieved by increasing
11
 Figure 3. Athlete stands on the mini-trampoline and tries to return the soccer ball by
passing it back to the coach.

Figure 1. Athlete stands on the mini-

trampoline and tries to re-
turn the soccer ball by head-
ing it back to the coach.

Figure 4. Athlete stands on the board with the hemicylindrical bottom surface and
tries to return the soccer ball by passing it back to the coach.

Figure 2. Athlete stands on the board
with the hemicylindrical
bottom surface and tries to
return the soccer ball by
heading it back to the coach.
the distance the coach stands from the
player. The changes to the balance train-
ing progression should be made every
second week (e.g., 2nd, 4th, 6th, 8th,
10th, and 12th weeks).. The balance ex-
ercise programs duration and progres-
sion can be found in Table 1.
The soccer specific drills that were cho-
sen for this specific balance program are
as follows.
Headers
In this drill, the soccer player stands
with both feet on the mini-trampoline
and tries to return the soccer ball by
heading it to the coach. Then, the ath-
lete does the same drill on the board
with the hemi-cylindrical bottom sur-
face and then on the board with the
hemispheric bottom surface. Continu-
ally, while a player is first in a 1-legged
stance on the mini-trampoline or on 1
of the 2 different wooden boards, he or
she will attempt to return the soccer
ball by heading it back to the coach
(Figures 1 and 2).
Leg Passing
In this drill, the soccer player is in a 1-
legged stance position on the mini-
trampoline and tries to return the soccer
ball by passing it back to the coach. As
the program progresses, the athlete does

12 February 2006 Strength and Conditioning Journal

the same drill on the board with the
hemicylindrical bottom surface, and
then on the board with the hemispheric
bottom surface (Figure 3 and 4).
Headers and Leg Passing
In this drill, the soccer player is in a 1-
legged stance position on the mini-
trampoline and tries to return the soccer
ball alternately with a header and with
leg-passing. As the program progresses,
the athlete does the same drill on the
board with the hemicylindrical bottom
surface and then on the board with the
hemispheric bottom surface.
Control and Leg Passing
In this drill, the soccer player is in a 1-
legged stance position on the mini-
trampoline. While keeping his or her
body under control, the athlete attempts
to return the soccer ball to the coach by
leg passing. As the program progresses,
the athlete does the same drill on the
board with the hemicylindrical bottom
surface and then on the board with the
hemispheric bottom surface.
In conclusion, because soccer is a contact
sport associated with a large number of
injuries (4, 8, 11), we suggest that coach-
es include balance exercises into a daily
soccer training routine. The frequent use
of balance exercises increases balance
ability (3, 14) and aids in the protection
of athletes from possible injuries (3, 6).
Balance exercises should mimic the type
of activities that soccer players will en-
counter during a practice or game to be
more sport-specific and interesting to
the players. We suggest the use of devices
such as mini-trampolines and balance
boards with the combination of certain
soccer abilities, like kicking and heading.
The duration of our recommended
training program should be 12 weeks
with a daily training duration that in-
creases from 8 to 18 minutes.
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13