SOCCER INJURY PREVENTION AND TREATMENT

by Troy Smurawa, M.D. 
Director of Pediatric Sports Medicine, Children’s Health Andrews Institute for Orthopaedics & Sports Medicine

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Soccer is the most popular sport worldwide and is catching on in America. Male and female athletes of all ages develop speed, agility, coordination, endurance, strength and teamwork—all in one sport. The following recommendations can help prepare young athletes and keep them healthy throughout the soccer season.

 

PRE-PARTICIPATION PHYSICAL

Getting a sports physical six to eight weeks before the start of the season is the best way to detect medical problems that may lead to injury. 

 

GENERAL FITNESS AND STRENGTH TRAINING

Soccer requires endurance, rapid explosive movements and neuromuscular coordination. Achieving and maintaining a good fitness level during the off-season requires a combination of distance running, interval running, strength and agility training, three to five times a week for 30-60 minutes.

 

COMMON INJURIES AND RECOMMENDATIONS

 

1. Concussions: 
Concussion prevention includes using an appropriately sized ball for the age group playing and training, and monitoring children in correct head-ball technique. Make sure the neck is braced with muscles tensed, ball impacts forehead, and thrust is with body in a forward direction. 

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The most recent studies show heading the ball does not cause brain injury. It may, however, worsen existing or recent head injuries from head-to-head, ground, goal, or elbow contact. In general, children under the age of 12 should avoid heading while neck muscles are developing; however, there are variations in maturity levels at this age.

 

Coaches should not allow play if the athlete is confused and/or has memory loss, headache, nausea, weakness or neck pain. Seek medical attention before allowing return to play if any of these symptoms occur.

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2. Turf Toe:
Turf toe occurs when pushing off to sprint and hyper-extending the big toe. Wear stiff soled shoes and/or tape the toe to prevent bending back too far. Cushioned neutral arch supports may also be helpful.

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3. Ankle Sprains: 
Ligaments of the ankle (bone-to-bone attachments) are often torn when “turning the ankle.” The ankle may become unstable if sprained severely or multiple times. Rehabilitation is the key to returning these sprains to 100% strength and balance, and to prevent recurring sprains. Prevent sprains with exercise band strengthening, balance and agility drills. Bracing or taping may be helpful while the ankle is injured or weak until strength has improved.

 

4. Muscle Strains: 
Muscle strains around the hips, groin, quadriceps and hamstrings are common in soccer. Rest, ice, gentle and progressive stretching, compression sleeves or wrap bandages are immediate treatments. If the strain persists, physical therapy can help prevent scarring and loss of motion and strength. Prevention includes adequate conditioning, proper warmup and stretch, drinking plenty of water and avoiding fatigue.

 

5. Knee Injuries:
Cartilage Tears – Symptoms include pain and limited motion inside the knee joint, difficulty with squatting, and twisting movements in a mature player. Evaluation by a sports medicine specialist to determine the need for physical therapy or surgery is suggested. Icing after activity, anti-inflammatory medication, and a cartilage brace may reduce symptoms.

 

Osgood-Schlatter Disease – Painful area below the kneecap on the tibia in a young player. Stretch quadriceps (thigh) and hamstring muscles two times per day and ice sore areas 3-4 times per day for 15-20 minutes. If necessary, try an open-hole knee brace with padding for the bony bump below the kneecap for protection. If weakness occurs, rest, ice, apply an elastic bandage and seek medical advice.

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Patellar Tendonitis – Pain in the tendon below the kneecap. Icing and a tendonitis strap that fits across the tendon, below the kneecap, may relieve symptoms. If symptoms persist, physical therapy may be necessary to prevent scarring and loss of motion and strength.

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6. Heat Illness:
The signs of heat illness include chills, cramping, dizziness, weakness, nausea and vomiting. More serious symptoms are rapid pulse, confusion, lack of sweat production, hot skin, passing out and heat stroke. Treatment includes removing the player from the heat and applying ice bags or ice towels to arm pits, chest and groin. Encourage water intake and call 911 if the player is unable to drink, not responding appropriately or having trouble breathing. To prevent heat illness, athletes should drink 4-6 ounces of chilled fluids every 15-20 minutes and limit activity in high heat/humidity. Coaches should plan early morning or evening events.

 

7. Heat Cramps:
In the last several years, the number of athletes that have been cramping and the severity of cramping continue to increase. There is some suspicion that this may have to do with more rigorous workout programs or the increased lean body mass or muscle mass of young athletes.

 

There are currently many theories as to the development of cramps:

 

Fitness Level – The first theory, and probably the oldest one from many years ago, was that athletes were out of shape and had lack of flexibility or conditioning. This does not seem to be the case today because some of our most well-conditioned athletes are those who are cramping most often.

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Dehydration – Another theory is that these athletes still are not keeping up with fluid intake and that it is directly related to heat. We know that heat cramps and hydration go hand-in-hand. Nevertheless, many athletes these days are paying good attention to hydration but are still cramping. Also, many of these cramps are going on even past our worst heat season.

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Lack of Calcium – There has long been a known relationship between calcium and muscle function. Lack of calcium may contribute to cramping.

 

Supplements – With the craze and increased use of supplements in the ’90s and 2000s, we have seen a strong relationship between supplements and cramping. Athletes who use creatine, other protein supplements and ephedra all are at risk for dehydrating and, ultimately, significant exercise-related cramping.

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Lack of Sodium – The latest theory is that the lack of sodium for young athletes is a major cause of significant cramps. Sodium has been decreased, and often eliminated, in healthy diets in an attempt to decrease blood pressure. There is an increase of sodium in sweat, and certain people have particularly salty sweat that may predispose them to significant cramping. Those who rehydrate only with water may be adding to this problem of sodium depletion.

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TREATMENT OF CRAMPS 

When it comes to cramping, as in many sports problems, the best treatment is prevention. We need to avoid the problem during practice—not just during the game, race, or competition. Coaches should pay attention to the following areas to help athletes avoid interruption of play and competition:

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1. Make sure athletes pay good attention to flexibility of muscles during training. After muscle cramping begins, stretching or massaging the muscles may feel good, but it is somewhat questionable as to whether or not it really helps get rid of the cramp.

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2. Pay good attention to fluid intake before competition, during competition and after competition. It may be useful to replace both salt and water with rehydrating solutions/sports drinks.

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3. Cool athletes who are exercising in heat early with ice, fans, and rest.

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4. Attempt to increase dietary calcium with milk, cheese, yogurt and even a consideration of calcium supplementation.

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5. Avoid performance supplements, especially creatine, but also protein supplements and ephedra in athletes prone to cramping.

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6. Increase dietary sodium during the week with snacks such as pretzels, peanuts, pickles and other salty foods. Rehydration drinks with salt and water may also be beneficial.

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7. Finally, in those situations where people have severe general cramping, very rarely athletes may need intravenous rehydration.

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STRETCHING

Who should Stretch?
EVERYBODY! Athletes and people who engage in regular exercise should stretch to minimize injuries, improve sports performance and reduce tightness associated with repeated use of the same muscles. People with sedentary lifestyles should stretch to improve posture and exercise the muscles and joints. Older people should stretch to prevent and relieve muscle-joint stiffness. Kids should stretch to form good habits that will have long-term beneficial effects.

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It’s important to stretch at least a few times a week to maintain and promote good muscle length and health, even if you’re not playing a sport or engaging in any other kind of physical activity.

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When and How to Stretch
Muscles should be stretched before activities, such as running, practice, competitions and lifting weights. Be specific to the activity or event you will be doing. For example, if you’re running, stretch the hamstrings, calf and quad; if you’re throwing, stretch the chest, shoulder and triceps. 

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Stretching should take place with the muscles warm – for example, after about five minutes of a low-intensity warm-up such as jogging, jumping jacks, jump rope or even walking. Stretch until you feel a slight pulling sensation and hold there for 20 seconds. Repeat three or four times, increasing the stretch slightly each time. Hold the stretch. Do not bounce; bouncing during a stretch can cause more harm than not stretching.

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While warming up is important, a good cool-down also plays a vital role in helping prevent sports injury by preventing blood from pooling in your limbs. After activity, stretch for the same amount of time as before the activity in order to replenish blood into the muscles and return muscles to normal resting length. It will also help your muscles and tendons to relax and loosen, stopping them from becoming stiff and tight.

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OTHER RECOMMENDATIONS

•    Be prepared for emergency situations and have a plan to reach medical personnel by having a cell phone or other nearby phone. Know CPR and first aid.
•    Ban foul play like rear challenges, pushing, holding, tripping, striking or intentional kicking.
•    Require protective equipment, mouth guards, shin guards, and shoes with molded cleats or ribbed soles. Shoes with screw-in cleats often are associated with a higher risk of injury.
•    Prohibit climbing on the goal or hanging from the net. Injuries and deaths have occurred when goals have fallen onto players. Soccer goals should be well padded and properly secured. Padding the goal decreases the incidence of head injuries when the goalie and other team members collide with the posts. Inspect the playing surface; holes should be filled, bare spots reseeded and debris removed.

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KEY POINTS TO SUCCESS IN SOCCER

•    Always keep well hydrated.
•    Work hard to maintain a good general fitness level.
•    Rest injuries if necessary, and rehabilitate quickly if not healing completely.
•    Always wear good quality shoes that fit properly and are comfortable.
•    Cushioned insoles or cushioned arch supports are a very good idea.