As part of our continuing effort to service and educate our membership, each Thursday U.S. Soccer will provide an informative article from one of its departments. Each Thursday will bring a new article, from the Referee Department (first Thursday of each month), Sports Medicine Department (second Thursday of each month), Coaching Department (third Thursday of each month) or Membership Services (fourth Thursday).
This week, an article by Dr. Donald T. Kirkendall examines injuries on the soccer field. Dr. Kirkendall shares his findings from a recent sudy about players' injuries and whether or not players are taking the necessary precautions to keep themselves healthy and on the playing field. The article also discusses some of the most efficient ways to prevent certain injuries.
Are You Protecting Yourself From Injury?
By Dr. Donald T. Kirkendall
Clinical Professor, University of North Carolina, Dept. of Orthopedics
We have just concluded a 3-year survey of injuries in select youth soccer (Under-12 through Under-18) and have developed a pretty extensive database on injuries in soccer. We have learned many things, some obvious, some not so obvious. For example, 2/3 of all injuries occurred to the ankle, knee, head, lower leg, and foot. One obvious conclusion is first aid for games; be prepared to administer first aid for ankle and knee sprains, strained (pulled) muscles, contusions and lacerations.
Another interesting finding was the number of players who had a similar prior injury. About half the players with ankle sprains had a prior sprain, many within the same season. Competitive sport is inherently risky, but are you taking appropriate precautions against injury or re-injury? For example:
- Poor flexibility and muscle tightness are often cited as risk factors in muscle strains, tendon injuries, and especially re-injuries of strained muscles. The groin, hip flexors and ankle dorsiflexors (pointing your toe up) are tight in soccer players. Don’t neglect stretching.
- Ankle sprains often occur during tackling. Sounds like technique may be an issue. Plus, over half of those with an ankle sprain will re-injure it and half of those do so within 2 months of the first injury. Follow the doctors and therapists orders about rehab. You may view a sprained ankle as a nuisance, but if you return too soon, you are putting yourself at risk for another, possibly more serious, injury - ankle or otherwise. Protection of a sprained ankle (e.g. taping, lace-up ankle supports) for a year or more has been suggested. So practice the technique. If injured, don’t try to come back too early. Follow rehab orders to the letter and protect prior sprains. Your team needs you on the field, not on the sidelines.
- The risk of non-contact knee injuries include:
- laxity - loose ligaments due to either prior injury or genetics
- muscle imbalance - one leg being stronger than the other
- flexibility - people with knee injuries have pretty flexible hamstrings
- general motor skills - knee ligaments seem to tear during landing, stopping or cutting in an erect stance (straight knee and straight hip). This is especially true in females. Players (girls especially) should play with a lower center of gravity (the old “ready position”) and absorb these shocks by flexing the hips and knees.
- Low endurance has been cited as an injury risk. Injuries and goals are a lot alike – they occur late in the game. In our survey, about ¼ of all injuries occurred in the last 10-15 minutes of a game. Lots of injuries occur during preseason when players are unfit. The message? Stay in shape and improve on your fitness during preseason so you don’t tire as much late in the game.
- One-third of traumatic soccer injuries occured when a foul was committed; sometimes to the ‘foul-er’ and sometimes to the ‘foul-ee’.
- Middle-school age boys are at a special risk. Height comes faster than muscle growth. The taller boy gets injured more often than the shorter, less mature or the older more mature. That in-between period is the problem.
- Shin guards are required in soccer. While all shinguards spread out the impact across the guard, they are not very helpful at preventing fractures. Shin guards that spread out the impact the most are the air/foam cell pads that are the largest ones on the market. Most kids want the bare minimum to pass the referee’s inspection. The bigger they are, the more protection they offer.
- Head injuries are most likely to occur during head-head contact or head-ground contact, mostly in the penalty area and near the midline (when competing for goal kicks, punts, clears, etc). Especially dangerous are head flicks where a player flicks the ball off the head, usually backwards. The problem is the defender who jumps for the header and gets hit in the chin by the other player popping up for the flick. This can lead to a whiplash type of injury.
Many injuries, especially re-injuries, in soccer are preventable. Preparation prior to play is important as well as decisions made during play. Remember, you are needed on the field, not on the bench. Not all injuries can be avoided, but by taking the proper precautions you can lessen the chances against injury and re-injury.
Questions can be directed to Hughie O'Malley, U.S. Soccer's Manager of Sports Medicine Administration. Hughie can be reached at email@example.com or at 312-528-1225.