Soccer is considered the world’s most popular sport and excitement is growing for the 2014 FIFA World Cup in Brazil this summer. Overall, the highest proportion of participants in soccer are under 18 years of age. In 2008-2009, more than 700,000 girls and boys played soccer in US high schools. According to the US Youth Soccer website, more than 3 million youth players between the ages of 5 and 19 are currently registered.
Playing soccer is an excellent way for children and adolescents to increase their level of activity and fitness. However, soccer is a high intensity sport with frequent, often unpredictable changes in direction and potential for contact and collisions between players and playing surfaces. Injuries in soccer are common. Some studies show an injury rate even higher than in football. Many of these injuries occur in younger participants. In one study, 80 percent of soccer-related injuries occurred in participants younger than 24 years of age with 44 percent occurring in participants younger than 15 years of age. Players, parents, and coaches should be aware of the types of injuries common to soccer as well as risk factors for injury and prevention strategies.
Two articles reviewing soccer injuries in children and adolescents (19 and younger) were published recently (see references at the end of this blog post). Here are some of the most interesting findings:
- Overall incidence between 2 and 7 injuries per 1000 hours of play (ages 13-19).
- Very little information is available on injuries in players under 13.
- Skill level does not seem to have an effect on injury rate.
- Position on the field does not seem to be associated with injury rate.
- No conclusive data on whether injury rate is higher on turf versus grass.
- No conclusive evidence on the influence of maturity status on injury rates.
- 40 to 60 percent of all injuries were due to contact with another player or object.
- Contact injuries are more common during matches, whereas noncontact injuries are more common during training.
- Contact injuries commonly occur during tackling and heading challenges.
- 60 to 90 percent of all injuries were caused by a single, traumatic event and 10 to 40 percent were overuse injuries. Common overuse injuries include pain in the front of the knee and leg pain (shin splints, stress fractures).
- Players with a history of injury have an increased risk of a new injury.
- 60 to 90 percent are lower extremity injuries (ankle, knee, thigh). Breakdown is as follows: 10 percent lower leg/foot/toe; 10 percent trunk/back; 10 percent upper extremity; and 5 percent head/face.
- Upper body injuries are more common during matches and in children under 15.
- Strains, sprains, contusions are the most common injury types.
- Fractures are more common in younger players.
- Growth related conditions, specifically Osgood-Schlatter’s disease (knee pain) and Sever’s Disease (heel pain) are common.
- The most severe and life threatening injuries occur almost always with contact to the goalpost.
Overall, there were no major differences in injury rates between boys and girls, but there exist important differences in relation to specific injuries. Girls have a much higher risk of ACL tears and also concussions. Ankle injuries are more common in male players. The reasons for these differences are still not clear, despite considerable research.
In general, many overuse injuries can be treated effectively with a period of rest. The treatment of traumatic injuries varies widely, depending on the injury. For example, some fractures can be treated in a cast, while some require surgery. Some knee ligament injuries, such as isolated MCL tears are almost treated without surgery, whereas ACL tears are almost always treated with surgery in young athletes.
Much emphasis has been placed on injury prevention programs, specifically with respect to knee injuries. There is some evidence that these programs may help reduce the risk of injury, but additional research is needed. Many are available on the internet. FIFA has promoted a warm-up program called “FIFA 11+” which is available online.
Other general strategies for reducing injury include:
- Ensure proper playing surfaces.
- Wear proper footwear and shin guards.
- Know that prophylactic knee braces do not prevent ACL injury.
- Avoid over-training (Consider taking a season off of sports or participating in a different sport. This is especially important in younger players who are still growing).
- Promote fair play and sportsmanship.
- Check that goalposts are secured and adequately padded.
- Teach proper heading techniques at the appropriate age.
- Remember that soccer balls should not be hyperinflated or water-logged.
- Develop familiarity with signs/symptoms of concussion (Remember “when in doubt, sit them out”). There is lack of consensus on the use of soft helmets to prevent concussion. Mouthguards may prevent dental injury, but not concussions.
- Maintain proper hydration and nutrition.
- Avoid playing in excessively hot or humid conditions.
- Maintain proper fitness level.
- If there is concern for an injury, get evaluated by someone with expertise in sports medicine.
Nathan Endres, MD, is an orthopaedic surgeon at the University of Vermont Medical Center and assistant professor at UVM. He is fellowship trained in sports medicine, shoulder surgery and orthopaedic trauma. He is a former ski racer and member of the United States Ski and Snowboard Assocation (USSA) physician pool.
Koutures CG, Gregory AJM, and The Council On Sports Medicine and Fitness. Injuries in Youth Soccer. Pediatrics. 2010; 125; 410.
Faude O, Robler R, Junge A. Football Injuries in Children and Adolescent Players: Are There Clues for Prevention? Sports Medicine (2013) 43:819-837.