Soccer Injury and Prevention

People have been playing soccer in North America for years. In fact, in the early 1600s, Native Americans played a game called "pasuckuakohowog," meaning "they gather to play ball with the foot." Despite the game's long history, it has been long overshadowed by our nation's love of baseball, basketball and soccer's Americanized cousin, football.

The 1990s, however, seems to be the soccer decade. Youth soccer is the fastest-growing sport in the U.S., and clubs have popped up across the country. The phrase "soccer mom," coined to describe the Middle America parent, has become for the '90s what the term "Yuppie" was for the '80s. When the U.S. Women's National Team won the 1999 Women's World Cup in July, it seemed to be the crowning feat, legitimizing soccer in America.

Unfortunately, the increase in soccer's popularity has also led to an increase in soccer injuries. Earlier studies showed that soccer injuries, although frequent, have tended to be minor. Recent studies, however, have indicated that soccer isn't always a gentle sport.

One such study evaluated 68 serious soccer injuries in California during the fall 1997 soccer season. For the purpose of this study, a serious injury was defined as one that resulted in a player missing at least one week of play. On average, the time lost from serious injuries was six weeks.

A downfall of the study was that it focused on the severity of injury for these particular individuals rather than the rate of injury for soccer players overall. The study did reveal some interesting statistics, however:

• Of these more serious injuries, most -- 80 percent -- were fractures.
• The most dangerous positions on the field were forward and goalkeeper. Forwards accounted for 28 percent of the injuries, and goalkeepers accounted for 18 percent.
• Slippery field conditions weren't a factor in most of the injuries; the field was dry when 87 percent of the injuries occurred.
• Only 18 percent of the injury incidences were related to a foul.

This study, along with numerous other studies, also found that types and severity of injury vary by age. For younger players -- in this study, ages 6 to 10 -- 64 percent of the injuries came from players putting out their arms to break their fall. For older players -- those ages 10 to 17 in this study -- the majority of the injuries were in the lower extremities and resulted from being kicked.

Other studies have confirmed that younger soccer players experience less injury than do older players, and their injuries tend to be more minor. A study from New York published in the American Journal of Sports Medicine found that "as injuries increased in severity, they were more likely to be noncontact injuries."

As with any sport, it's important that participants take special precautions to avoid injury. Here are some points to consider:

• Make sure you wear the proper protective equipment.
  Shin guards are the most important piece of equipment you can wear in soccer and are usually required. "In soccer, your shins are the most vulnerable area on your body and are likely to get hit by cleats or kicks," said John Pritchard, M.D., orthopaedic surgeon with SportONE.
  
  Although less common, contact injuries can occur on the face. Mouth guards are not required, but many players elect to use them. Some players who've had prior facial injuries, such as a broken nose, wear protective shields.
  
  Dr. Pritchard recommends you talk with your coach and physician about your need for protective equipment, especially if you're prone to a particular type of injury.
  
  
• Maintain playing equipment.
  If the playing surface is in rough condition -- with holes or depressions in the field -- players will be at increased risk for injury. Goalposts should be padded. The ball should not be hard (brittle or old), wet, heavy or over-inflated. The ball should also be appropriately matched to the players' size. Youth leagues should be using the smaller, lighter soccer balls designed for use by kids.
  
  
• Use proper technique when heading.
  A soccer player heads the ball an average of six times per match and many more times in training. A soccer ball can be driven at more than 60 miles per hour, creating significant force upon impact with a player's head.
  
  Proper technique means keeping the neck and head rigid while using the body's forward momentum to propel the ball up and away. By keeping your neck and torso rigid and moving together, you minimize the potential for neck injury. The stronger the neck, the more force the head and brain can sustain without injury.
  
  
• Start slow.
  "If you haven't played soccer since last season -- even if you've been participating in other types of athletic activity -- you're not going to be in the same shape you were at the end of last season," said Michael Lee, M.D., orthopaedic surgeon with SportONE. "Start slow and make sure you warm up properly before a match."
  
  Researchers at Duke University's Michael W. Krzyzewski Human Performance Laboratory say that most soccer injuries are associated with fatigue, with 90 percent of injuries happening during a match. "Take frequent rest breaks," said Stephen Wright, M.D., orthopaedic surgeon with SportONE. "That doesn't mean all activity needs to halt -- although it may be advisable sometimes -- but try to rest the body parts that are working hard and prone to injury."
  
  
• Pay attention to your body.
  "Don't ignore aches and pains," said Dr. Wright. "Your body could be signaling you about a problem that needs special attention."