Jesse Saenz, D.C., CCSP, is Head of Sports Science and First Team Chiropractor at Sacramento Republic FC and has worked in the English Premier League and Championship. He is an expert in soccer periodization and has mentored with Raymond Verheijen in the Netherlands. He was previously appointed Team Physician of Team USA Skydiving and was selected to the USA Track & Field Sports Medicine Team for the National Championships. Dr. Saenz is currently consultant to Hull City AFC of the English Premier League after serving as their First Team Chiropractor during the 2015/16 season.
Freelap USA: Jesse, your team does nearly all of its conditioning on the field. With soccer creating adaptations to the body around the hips, how do you restore the body from pattern overload? With your manual therapy knowledge, could you get into how specific training can be done without creating overuse syndromes besides managing volume?
Dr. Saenz: It’s important to not only monitor physiological loads, but also biomechanical stresses and internal loads. As medical staff, we spend a fair amount of energy addressing players’ individual needs. In our treatment room, you’ll see a lot of soft tissue therapies like ART (active release technique), Graston, and chiropractic care. We want the players to be moving well when they step on the field, so we continually use manual therapies to restore hip and foot/ankle mobility and clear impingements.Take care of your body—that’s our message to older and younger players alike. Click To Tweet
We’ve also created a culture of proactive care as opposed to reactive care. You won’t see senior players chastising younger players for getting treatment in Sacramento. Take care of your body—that’s our message to older and younger players alike. Every player’s body is different, so we try to address them individually. We help the players prepare for training with daily, custom preact/prehab exercises based on a variety of information, including injury history and pre-season testing data. We consider our prehab/preact program not only performance enhancement, but also injury prevention. Our individualized program was inspired by the work of Cristian Fernández, who I was lucky enough to work with at Hull City. He’s a top guy who’s now at Newcastle doing great things.
Freelap USA: Practice design is paramount between games. Can you share what you do with PLAYERTEK to prepare for the game needs as well as keeping fit and fresh? Can you talk more about your team coaches and their views of what you are doing?
Dr. Saenz: The planning of training sessions is critical. We have to achieve the manager’s vision, tactically, while advancing fitness levels and preventing injury—a massive task. We are big on soccer periodization in Sacramento. Periodization provides us with an objective reference from which to plan: when to condition; when to recover; when to do sprint training; when to have shooting exercises; when to do extensive vs. intensive warmups, passing drills, and possession games: and the appropriate work-to-rest ratios for those exercises. We have tactical goals to achieve in specific training sessions and each session has physical performance targets to hit.Periodization provides us with an objective reference from which to plan. Click To Tweet
We use PLAYERTEK GPS to record and monitor that data. I think that more data isn’t necessarily better, so it’s my job to present the data in a way that is useful for the coaching staff without giving them a blizzard of numbers and graphs. The coaches like the PLAYERTEK data and will periodically ask for reports on certain players. The data can be helpful when talking to players about their performances and in alerting us to a player that may be underperforming for a variety of reasons.
It is also very helpful when rehabilitating players. We regularly compare pre-injury data to rehab data to see how close a player is to their normal, healthy self. That way, we can return a player to the first team session with minimal risk of re-injury and without bringing down the session quality. For example, we have a player returning from a season-ending lower limb injury who is now on the rehab pitch and hitting top speeds higher than he hit last year while healthy. We are gradually building up his workload. The numbers back up what we are seeing with our eyes, but give us that extra bit of confidence and some objective data from which to advance his loading. We’ve been very successful preventing re-injury using this methodology.
Freelap USA: Eccentric strength is trending again in sports science. Do you use any technique or approach to leverage the adaptations? Is this possible in the middle of the season with athletes that have short off-season periods and hard practices?
Dr. Saenz: Eccentrics have been hot in soccer for a few years now and we absolutely do them. Hamstring eccentrics are part of our hamstring group preact/prehab menu and part of our strength training. Hamstrings are the No. 1 injury in soccer, so for injury prevention, we will plan team eccentrics two weeks prior to a week with congested fixtures and then basically de-load the week prior. Eccentrics are very demanding, so I feel more comfortable doing them post-training as we don’t want to induce fatigue before a training session.
There are two types of hamstring injuries: the slow stretch injury associated with longer RTP, and the one we typically see—the high-speed running injury. Everyone is doing Nordics, which are great, but this injury is most commonly to the long head of the biceps femoris, so we also do exercises that seem to better target the lateral hamstrings. We make sure to mix up exercises that we classify as one of three types: those that favor the hip, those that favor the knee, and those that challenge the tendons. As with any type of strength training, we just need to ensure that everything is done on the appropriate day of the training week. So, we don’t do strength sessions on the day of soccer conditioning or the day after conditioning.
Freelap USA: The day after games tends to range from a day off to some lifting of weights. What do you do after games and does this change much if you are on the road?
Dr. Saenz: In soccer, it would be unusual to see teams lifting the day after a match. There’s so much tissue breakdown during a soccer match that match day +1 is all about recovery. It should be an active recovery day, not a true rest day. For that reason, our players have an “active recovery menu” from which to choose activities. These include pool exercises, light jog or bike, NormaTec recovery session, etc.
Match day +2 is almost always a rest day. In last Saturday’s match, I had players covering 12km total distance and sprinting 1500-1600m. It takes the average player 48-72 hours to fully recover from that load. So, we wouldn’t typically train or lift until the Tuesday after a Saturday match.
Travel in the U.S. is much different than in Europe. Last season, we played away in St. Louis, which is further than going from London to Moscow. We have long flights and hours of travel, so we make sure to do some light exercise and hip mobility workouts upon arrival. On the road, we’ll take advantage of the hotel pool to get a jump start on our recovery. It’s often straight into the pool for a recovery session after the match. At home, the routine is simpler.
Freelap USA: What are emerging problems that you are seeing now more than you did years ago? Are athletes more durable or less durable now than the past? Are the injuries just different or are they basically the same?
Dr. Saenz: Longitudinal studies show injury rates in elite soccer are fairly stable, but the physical performance data has been increasing over time. The game is quicker now than ever before. Players are running faster and running more. So, I have to think players are becoming more durable.
However, we are seeing increasing rates of hamstring injuries in training. We need to look carefully into training loads, but there isn’t much transparency in professional soccer training, so it’s up to the individual clubs to manage those loads. The most common injuries are still strains to the hamstring, followed by adductor, and then ankle sprain. Ankle sprains seem to have decreased over the last few decades, slightly. There is a belief this is due to referees protecting players better in recent years, but that’s up for debate.
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