Soccer is a great way to build endurance, improve speed, and promote fitness, all while enjoying the camaraderie of a team sport. And, soccer carries an injury rate of one-fifth to one-half of that in American football. But you can still get hurt.  The main soccer-specific injuries are overuse injuries to the knee, leg, ankle and foot, ankle sprain (rupture of an ankle ligament due to “turning” the ankle), contusions (deep bruises to muscle or bone), foot and ankle fracture, ACL tear (on the rise in female athletes), and (infrequently) concussion.  This article focuses on overuse.

One of the most prevalent youth soccer injury patterns that I see in Fort Collins and vicinity, following national trends for youth sports, involves overuse.  Today’s teen pre-teen is expected to perform nearly year-round in many cases.  Specialization occurs much earlier than it did 20 years ago, when many youth then “started” in multiple sports, depending on the time of year.  Training and competition volume has increased as well, leading to overuse of ligaments, muscles, tendons, and even stress fractures of bone in the leg, ankle and foot.  This trend means that parents, coaches and the interdisciplinary Sports Medicine team of athletic trainers, physical therapists, physicians and other health care professionals need to team with the athlete to watch for signs of overuse, identify patterns of practice and play that are contributing to injury, and intervene before those injuries become chronic.  For example, say a 13-year-old soccer player develops pain in both anterior knees, involving the supportive and connective tissue of the knee extensor mechanism.  She first needs to alert her coach that there is a problem, be encouraged to be honest about the problem with parents and coaches, and be evaluated by a Sports Medicine professional or her primary care physician.  Often, physical therapy will be prescribed, and she will be watched closely for improvement versus regression.  Rest, icing, compression with ACE wraps or braces, and elevation of the knees after school are often the mainstay of therapy.  Return to play decisions need to be made in a judicious manner, focusing on the overall health of the athlete, in addition to her short and long-term goals, and often these decisions may need guidance again from the Sports Medicine team. 

Avoiding what Sports Med people call “training error” can avert many overuse injuries.  Factors that increase the risk of overuse injury will be addressed in the following sections:

1. Inadequate base of activity followed by a too-rapid “ramping up” of training volume intensity.  This is the most common injury pattern that I see in this category.   Typically, my clinic volume dramatically increases about two weeks into any given season.  Youth may “take it easy” for a few weeks preceding the season, or simply grow faster than a given tendon can accommodate while maintaining strength.  The body is then subjected to superhuman demands, which accumulate into overuse of the patellar tendon and kneecap stabilizers, hamstrings, and Achilles tendon.  The physiology of soccer involves some aerobic activity, not as much as most people think.  In 90 minutes of elite adult soccer play, an athlete may travel about six miles, only somewhat more than you might walk in the same amount of time.  However, the acceleration-deceleration involved in soccer play causes the need for a great amount of anaerobic power and tendon and muscle strength.  The repetitive lengthening of tendons against resistance, such as occurs to the patellar tendon as the player reaches the ball after a chase and stops, creates great forces.  Training for this takes many weeks of lower-intensity activity interspersed with short bursts of speed and power training to improve the strength of the tendon itself.  Too often, the tendon is relatively soft at the beginning of the season, then repetitively stretched to the point of injury after the first few weeks. 

2. Inadequate flexibility.  For some reason, perhaps due to training patterns or body type, soccer players tend to be less flexible than athletes in most other sports.  A pre-season prophylactic program including flexibility training has been shown in the medical literature to decrease injury incidence.

 3.  Inadequate recovery.  After matches and practices, the growing athlete, and even adult athletes, need time to recover.  The actual connective tissues of the body are trying to repair and fortify themselves within minutes of stopping play.  Those tissues require days of “relative rest,” or easy practicing, to properly repair.  Also, it has been shown that up to eight days of relative immune system impairment is sometimes seen after maximal physical effort.  Tournament play in youth sports including soccer is a common precursor to a medical visit.  Another factor is elite performance, or performance demands from themselves, from coaches and even parents that exceed the athlete’s ability to recover.

In summary, soccer is a wonderful sport, with lower injury rates than football, wrestling, and often cheerleading.  Care to avoid overuse injuries will keep the athlete in the season, healthy and happy.

Dr. Abrahamson grew up in Fort Collins.  He is Board Certified in Family Medicine and Fellowship trained in Sports Medicine, adding to General Surgery Internship and Orthopedic Surgery training.  He treats injuries in people of all ages, reduces fractures, and essentially offers all nonoperative musculoskeletal care.