The Pulse! No. #71 
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COVER STORY
Development and Training
http://www.usyouthsoccer.org/Blog.asp?post_id=748 by Sam Snow
The best development program for players will involve getting them to tell you a skill they think they need to improve. By having them reflect on the skill they want to improve upon for each individual means they are much more likely to really work at it. Only if they are self-motivated will they put in the time and effort on their own to work on that skill. The intrinsic motivation to improve will give them a better chance to raise their game to play in the premier level of competition.
When the players each tell you the skill they want to improve then give them 10-15 minutes at the beginning of your next training session to work on that skill on their own. You can go from player to player and help them on that skill if they ask for assistance. When you allocate that time at the beginning of one training session per week you also have a chance to evaluate if they are improving on the skill; if an individual is not improving then you can give more direct coaching to that player. It may also show you who is working on their own at home and who needs more guidance and motivation to do so.
To help motivate the players explain to them why you are asking them to work on their skills at home and how it fits into the game for them. Tell them that the objective is to improve technical speed, consistency, touch and timing, eye-foot coordination as well as being able to recognize the way the ball spins and how various body parts react to it. Training activities should be demonstrated to the kids at the training sessions by the coaches.
Regularly encourage the players to practice on their own or with a friend or two and try out new skills. This is the time to experiment and become comfortable with the ball. Practice can also be a good time to improve their personal fitness. Please note that there's a difference between practice and a training session.
Training players do with the team and coach and practice they do on their own or with one or two friends. If players want to become really good at soccer then they need to practice. Training with the team, even a few times a week, may not be enough. So practice at home or in the neighborhood with other kids or maybe even at school if there's a chance to do so.
The things players practice are what they can do on their own. That could be juggling, playing the ball against a wall (someplace without windows), dribbling (make a slalom course) and maybe some physical fitness too. Here are some examples for the kids:
Wall Ball: knocking the ball against a wall gives the chance to practice several skills.
Passing (put an X on the wall and try to hit it with your pass. Vary your distance from the wall and your angle to the X).
Receiving (as the ball comes off the wall control it with different parts of your body: inside of the foot, thigh, top of the foot and so on).
Heading (see how many times you can head the ball against the wall without it touching the ground. How about trying the same things as you did in passing, but now with headers)?
Shooting (hit the X. Try some shots off the ground and some when the ball is in the air).
Throw-in (hit the X).
Goalkeeping (try different types of throws and hit the X).
Goalkeeping (try out different catches as the ball rebounds from the wall. Vary the height of the ball).
Tips on Passing
Point the toes of the foot you are standing on towards your target
Keep the knees of both legs slightly bent
Keep the ankle of your kicking leg locked so that your kicking foot is steady
Lean slightly forward to keep the path of the ball level
Keep your eyes on the ball
Tips on Receiving
Get your body in line with the path of the ball
Keep the knees of both legs slightly bent
Relax the body part receiving the ball upon contact with the ball
Exhale
Keep your eyes on the ball
Tips on Heading
Get yourself in line with the flight of the ball
Keep the knees of both legs slightly bent
Strike the ball with the forehead at the hairline
Keep your mouth shut with your tongue and checks out from between your teeth
Keep your eyes on the ball
Tips on Shooting
Approach the ball at a slight diagonal angle
Point the toes of the foot you are standing on towards your target
Lean over the ball
Point the toes of your kicking foot down and curl them back inside of your shoe to make a firmer striking surface of your foot (kind of like making a fist)
Keep your eyes on the ball
Tips on the Throw In
Stand with your hips facing where you want the ball to go
Firm grip on the ball with the tips of your thumbs just touching behind the ball
Hold the ball with your fingertips
Follow through on your throw for improved accuracy and distance
Tips on Keeper Throws
Hold the ball comfortably in your hand and release it off the fingertips
Stand with your hips facing where you want the ball to go
Keep knees of both legs slightly bent
Keep your head steady and facing your target
Follow through on your throw for improved accuracy and distance
Tips on Keeper Catches
Get your body in line with the path of the ball
Watch the ball all the way to your hands
Keep your knees and elbows slightly bent
Spread your fingers as wide as you can as you catch the ball for a safer grip
Relax and exhale as you catch the ball and absorb it ***********************
"Shout out to da newbies"
We see a few brand new posters since the last Pulse Lets give out a Shout and as always, lets give a warm welcome to all new posters!
This week we would like to applaude and give Karma Kisses 
to:
ment2b
Left Foot
Reign
sparkpressure Welcome aboard!
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Brat Jr's YouTube Videos!!
U15 SH Rev vs WPFC
Pt 2
U13 WPFC vs U12 WPFC
U13 WPFC vs U13 WPFC Boys vs Girls!
Pt 2
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DRAGON'S EYE ON.....!!!
Sorry folks, D has gotten a few tidbits and a couple worthy of doin' an article on but D is having "flood" issues 
Will work on a piece for next week this weekend though 
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"...Out on the Pitch"
U15 SH Rev vs WPFCU13 WPFC vs U12 WPFCU13 The girls vs the boys**Please continue to send pix's to the Pulse newsroom! Anything soccer related is welcome!** ***********************
"Help! Is there a Doctor in the house?"
This week I thought I would review hamstring injuries since many a pro player seems to lose time , yet not so much in our DKs.
And I wondered why...
Hamstring Injuries
Muscular strains of the lower limb are among the most common injuries in sport. Hamstring injuries in particular are the most common type of muscular strain to effect the lower limb in the elite athlete They are associated with sports which involve rapid acceleration or deceleration, jumping, cutting, pivoting, turning or kicking, soccer a prime example. They result in significant time off sport, can be the source of considerable painand can result in impaired performance on return to activity.
Mechanism of Injury
The hamstrings function primarily by eccentric contraction to decelerate forward
progression of the tibia during the swing phase of gait.Hamstring tears do not result from direct trauma but rather are stretch induced injuries caused by a sudden forced lengthening occurring during a powerful contraction. ( ie , during a kick the hamstrings contract as the quads are pulling the knee straight leading to an eccentric pull on the hamstrings).
Factors predisposing to injury:
Several factors have been implicated in the etiology .These are poorly supported by scientific evidence.
1. Previous injury to the hamstrings was shown to be the most significant risk factor. A history of a recent hamstring injury predisposed to a subsequent quadriceps or hamstring injury.
2. Muscle fatigue has been shown to predispose to injury. One study has
demonstrated that in the hind leg of the rabbit fatigued muscles absorb less energy in the early stages of stretch when compared with non-fatigued muscle. Fatigued muscle also demonstrates increased stiffness, which has been shown to predispose to subsequent injury. It is thought that this is partly due to altered biomechanics which may be protective to the injured muscle but detrimental to adjacent uninjured muscle.
3. Reduced flexibility has also been shown to have a significant association with hamstring injury. Many authors have emphasised the importance of warm up prior to activity and of maintaining flexibility. Muscle that is cyclically stretched demonstrates an increased ability to increase length prior to failure. A decrease in muscle stiffness is also seen with warming up . One study found a strong correlation between preseason hamstring tightness and subsequent hamstring injury in soccer players. A further study by Jonhagen et al looked at the association between reduced flexibility and hamstring injury in sprinters. They compared the flexibility of the hamstrings and the eccentric and concentric
muscle torque in the posterior and anterior compartments of the thigh in injured and noninjured sprinters. They concluded that sprinters with a history of previous injury had significantly tighter hamstrings.
Laboratory studies have shown the importance of stiffness and the need for stretch and warm up. The hamstrings are viscolelastic and therefore exhibit the property of stress relaxation. That is by increasing the length of the musculotendinous unit, there is a reduction in strain. Garrett showed in the rabbit model that with a simulation of warm up by stretching muscle isometrically and then stimulating, there was increased stretch prior to failure.
4. Many studies have shown that poor strength is associated with hamstring injury.
Jonhagen showed that uninjured sprinters had significantly higher eccentric hamstring torques at all angular velocities. They also had weaker concentric contractions at low velocities.One study found a strong correlation with subsequent hamstring injury and have since introduced protocols looking at hamstring to quadriceps and hamstring to contralalateral hamstring, muscle strength ratios. If a player is found to have preseason weakness they
undertake a strengthening programm and are retested.
Recurrence
This common injury has a high incidence of recurrence which makes it one of the most frustrating for players, coaches, treating doctors and physiotherapists.Studies have shown a recurrence rate of 30.6% for the remainder of the season !!. Animal studies have shown that an incomplete disruption to the myotendinous junction causes the muscle to be more susceptible to injury.
A further possible cause for recurrence includes alteration to normal biomechanics. The resulting scar tissue has a reduced tensile strength and is therefore more susceptible to strain injury. The scar is also stiffer than normal tissue and therefore causes reduced range of motion. Furthermore, with a prior injury there is also a loss of strength in other muscle groups due to disuse.
As mentioned above the healing process has been shown to be more prolonged than initially thought . Although the vast majority of re-ruptures occur in the first week on return to activity, there is a significant risk of recurrence for many weeks after return to play .
Anatomical Site
The hamstring muscles make up the posterior compartment of the thigh. They are biarticular in that they cross both the hip and knee joints. They comprise biceps femoris, semimembranosus and semitedinosus. The long head of biceps takes its origin from the Ischial tuberosity in conjunction with semitendinosus and semimembranosus. The short head of biceps takes its origin from the linea aspera. Distally the biceps inserts into the lateral aspect of the fibular head and the medial hamstrings insert into the medial aspect of the proximal tibia via the pes anserinus. Their primary function is to act as flexors of the knee and hip extensors. They also facilitate in rotation of the knee.
Several studies have shown that the most common site for hamstring injury is in the biceps femoris at the myotendinous junction. At the microscopic level the injury disrupts the myotendinous junction at the Z line between adjacent thin filaments.
An elegant study by Garrett with Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) has shown that the lesion is most commonly found in the long head of biceps, proximally and laterally. He went on to state that the muscles most susceptible to a strain injury are those which cross 2 joints (biceps femoris, gastrocnemius, rectus femoris) or those with a more complex architecture such as the adductor longus.
The injury can be seen on MRI / CT to occur at the myotendinous junction, supporting the laboratory models . The lesion is not localised to one focal area as there is extensive altered signal within muscle which is remote from the site of injury. High signal can also be seen tracking around the epimysium and surrounding neurovascular structures on T2 weighted MR images .
A study by Verrall et al also showed biceps femoris to be the most common site of injury.
They further found that injuries occurring in the lower third were less common and less painful than those occurring in the proximal or middle thirds. However they went on to show there is no difference in site of injury and number of missed days from sport.
Pathophysiology
Essentially muscle tissue heals with scar after injury, especially if multiple. Scar is less elastic and therefore it takes less trauma for the next tear to occur!!!
Clinical Presentation
Clinically hamstring injuries are usually characterised by a history of a sudden onset of posterior thigh pain associated with localised tenderness and loss of function. On examination there may be localised swelling, tenderness and possibly a palpable defect.
Ecchymosis is highly indicative of a significant injury. Athletes with chronic
injuries often describe a feeling of tightness or an impending “pull”. There is pain on resisted knee flexion when prone with decreased strength. There is also a reduced straight leg raise when compared with the uninjured side.
Classification
The most widely used grading system of injury is that devised by O’Donoghue . This is related to the violence of the injury and the subsequent amount of tissue damage that follows.
• Grade 1 or 1st Degree. There is no appreciable tissue disruption, no loss of function or strength and there is only a low-grade inflammatory response.
• Grade 2 or 2nd degree.
Actual tissue damage occurs that reduces the strength of the musculotendinous unit. There is some residual function.
• Grade 3 or 3rd degree
This is characterised by complete disruption of the musculotendinous unit with
complete loss of function.
Imaging
Ultrasound and CT are useful modalities but the gold standard for assessing these injuries is MRI. This is particularly useful in minor hamstring injuries or where the diagnosis is equivocal. Once the correct diagnosis has been made the patient can then be started on an appropriate tailored rehabilitation programme.
MRI has further corroborated laboratory studies which have localised the injury to being at or near the musculotendinous junction.
A study by Gibbs et al looked at the ability of MRI to predict recovery and recurrence from grade 1 hamstring injuries in AFL players. This prospective study showed a strong correlation between the length of the lesion and recovery time. However it did not show a close correlation with risk of recurrent injury.
Treatment
The management of these common injuries is essentially activity modification together with a tailored rehabilitation program. Other non-operative measures include the use of non-steroidal anti-inflammatory medication, intramuscular injection of corticosteroid, electrical stimulation and ultrasound. Surgery is occasionally indicated where there is complete avulsion.
1. Non-steroidal Anti-inflammatory medication
Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used following muscle strain injury. Their role has been questioned15 in that they may slow the healing response and recovery of normal tensile strength of the injured musculo-tendinous unit.
2. Corticosteroid injection
The use of steroids is also controversial for fear of poor healing, rupture or infection. The vast majority of sports medicine practitioners do not advocate the use of corticosteroid injection in the management of these injuries.
Levine at al 16 carried out a retrospective study reviewing NFL players between 1995-98 who had sustained hamstring injuries. 431 players were included. The indication for steroid injection was a severe discrete injury with or without a palpable defect. 58 (13 %) players were treated with injection. They reported no complications and only 9 players (16%) missed any games as a result of their injury. They recommended the use of steroid injection in selected patients as a means of returning to normal activity quicker with less missed time off sport.
3. UltrasoundAlthough frequently used, the role of ultrasound in these injuries is poorly supported by scientific evidence. Studies have shown that low frequency ultrasound increases the
tensile strength of healing bone following fracture, healing tendon and soft tissue in general .
Ultrasound is thought to act by causing a localised increase in temperature. This results in an increase in protein synthesis and membrane permeability and also increases fibroblast activity. One study looked specifically at the role of ultrasound and at myoregeneration in simulated muscle strain injury in vivo and found no evidence of enhanced muscle regeneration.
4. Surgery
Surgical intervention although rarely indicated in the management of these injuries does have a role where there has been complete avulsion of the proximal hamstrings. This is a soft tissue injury with avulsion from the lateral aspect of the ischium. Occasionally a bony avulsion of the ischium occurs and this may require internal fixation.
The diagnosis is difficult and as a result often made late. The patient presents with posterior thigh pain, massive swelling and ecchymosis. Clinical examination may demonstrate localised tenderness, swelling and asymmetry due to distal retraction of the avulsed muscle belly. Weakness and a visible defect are demonstrated by active resisted contraction of the hamstrings whilst the patient lies prone. The investigation of choice is MRI.
The literature shows that these injuries are associated with significant morbidity and do not do well with non-operative treatment . In a retrospective review of 11 patients by Kliengele et al , good results were reported with reconstruction in both acute and chronic injuries. The indication for surgery was complete avulsion or in the chronic situation where the patient had persisting weakness or pain.
Rehabilitation
Initial management consists of RICE (rest, ice, compression and elevation) to minimise further tissue damage, reduce further bleeding, settle the acute inflammatory response and control pain. This is followed by a period of gentle range of motion exercises including seated active knee extensions. Simple analgesics and NSAIDs can be used. Early motion promotes healing, and minimises scar formation.
The next phase involves stretching which initially is done passively and through a limited range. Early strength work can be started as tolerated with specific exercises including hamstring curls, bridges, flicks and dead lifts.
Finally, straight-line running is encouraged gradually working up to more rapid
acceleration and deceleration drills. Sports specific training follows and when ready the athlete can return to sport.
It is widely accepted that the average muscle strain will resolve over a 2-3 week period.
Heiser et al carried out a retrospective review of 46 primary hamstring injuries in
collegiate American football players. They noted an average convalescence period of 2 weeks before return to full activity.
Many protocols have been established but most consist of the following 5 phases with regular clinical assessment to determine whether treatment can be accelerated or needs to be slowed down.
Phase 1
RICE with assessment of severity of injury. Progression to the next phase is guided by
initial response to treatment.
Phase 2
Early motion with protective exercise and passive stretching. Initially isometric type exercise is encouraged at whatever range is comfortable and continued with 20 degree increments. Isotonics are then commenced with the introduction of resistance work.
Swimming and upper body workouts are encouraged for general conditioning and tailored according to severity of injury and symptoms.
Phase 3
Isokinetic exercises are then introduced. For ongoing conditioning, the use of an exercise bike and treadmill are encouraged. Flexibility is assessed at regular intervals with the hip flexed to 90 degrees and the knee maximally extended.
Phase 4
Once the athlete can perform slow isokinetic exercises comfortably, a running programme is introduced. This allows eccentric work of the hamstrings. The intensity of training is gradually increased and the athlete begins agility work and sprinting.
Phase 5
The final phase of the rehabilitation is return to sport. There is no consensus as to when an athlete can return to sport after sustaining a hamstring injury. Every effort is made to mimic the specific sporting activity and if this can be done pain free, with normal strength, full agility and no focal tenderness, then return to full activity is allowed. In spite of this, the risk of recurrence remains high for a significant period of time.
Conclusion
The management of hamstring injuries remains difficult and frustrating. Prevention is the ultimate goal however there is no consensus or gold standard as to how this is best achieved. Several studies have shown that pre-participation warm up, repetitive stretching, adequate conditioning to reduce fatigue and proper technique can reduce the risk of injury.
The risk of re-rupture is high at 30% and the risk remains for many weeks
following the index injury. New methods of assessment have been introduced to look specifically at preseason weakness and this has been useful to identify those at risk of a further injury.
As a rule return to activity is guided by the functionality of the athlete. However the clinician needs to convey caution following hamstring injury, as the risk of a further injury remains high even in the absence of any residual symptoms.
So why are hamstring injuries not as prevalent in our DKs?? Not really sure. It may be a function of the total muscle mass, intensity of play and general stiffness that occurs with aging. But there is NO great answer. So stretch baby stretch!***********************
WPS FAMILY CIRCLE FOUNDATION!!! 
Continued Good thoughts and Prayers for Luke, Ashley and Michelle***********************
OTHER NEWS AND GOSSIP AND TIDBITS:
Coach K of Synergy***********************
THINGS THAT MAKE YOU GO HMMMMMDear Dragon,
Thank you for letting me take an active part in the Pulse.
It has been fun coming up with new topics to share with WPS and with the Commish Cup starting their eliminations and the 2nd half of the PDL season starting, I'm sure there will be some blah blah blah starting again for some great topics!
WPS has been my 'home' for almost 5 years, but I need to step away from WPS as my kids and hubby are complaining that I spend too much time on here 
Gee, they are at school and work, what else am I supposed to do? Oh I know..... GET A JOB!
So thats what I am going to do.
With that being said, I need to resign from doing the Pulse and being an active board spammer lol
Take Care
Tracie aka Brat Jrand once again the end of another great effort by all on the Pulse staff! Thank you for all your help in getting the Pulse out!
If you would like to donate to WPS click below to go to the front page and click on the Donate button:
http://washingtonpremiersoccer.com/Thats it for this weeks Issue of the Pulse, hope you enjoy it...and as always never forget to... Play with Heart & Fire, Heart & Fire Always!
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Topic: THE PULSE - #71 (Read 635 times)