By Donald Kirkendall
A three-year survey of injuries in select youth soccer (U12 - U18) was done, and an extensive database of injuries in soccer has been developed. We have learned many things--some obvious, some not so obvious.
For example, two-thirds 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 injuries, strained muscles, contusions, lacerations and concussions.
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?
• Poor flexibility and muscle tightness often are 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 two 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 or 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 risks 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. Start teaching this when they are young.
• 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 one-fourth of all injuries occurred in the last 10 to 15 minutes of a game. Lots of injuries occur during preseason when players are unfit. The message? Arrive in shape, and improve on it as best you can so you don't tire as much late in the game.
• Soccer skill is also a factor in injury. The poorer skilled players suffer more injuries. You may find skill work as dull, but you know that the better-skilled players are injured less frequently.
• Foul play has been implicated in injuries, as up to one-third of traumatic soccer injuries were due to foul play; sometimes to the "foul-er" and sometimes to the "foul-ee." The most skilled and fittest players are better able to avoid these collisions.
• Middle-school-age boys are at a special risk. Height comes faster than muscle growth. The tall, weak 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 spread out the impact across the guard, they are not real helpful at preventing fractures. Shin guards that spread out the impact the most are those air/foam cell pads that happen to be the biggest ones on the market. Most kids want the bare minimum to pass the referee's inspection, but the reality is the bigger the guard, the more protection.
• Head injuries 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 their head, usually backwards. The problem is the defender behind who jumps for the head and gets hit in the chin by the other player popping up for the flick. This can lead to a whiplash type of injury. Solution? For most players, the flick is a desperation move--can't figure out what do, so flick it on. Teach players to take a step back to either control the ball on their chest/thigh/foot or head it back to a teammate they can see. They don't know where that flick is going anyway, so it is usually a wasted pass.
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. – ISN.
Donald Kirkendall has a Ph.D. in Exercise Physiology, and is on the faculty in the Department of Orthopaedics at the University of North Carolina. He is a Fellow in the American College of Sports Medicine. He has coached soccer for ages U10 through college, and is on the USSF Medical Advisory Committee. He's edited seven books in exercise science and sports medicine, and has published numerous articles on soccer and sports sciences.