Injury Prevention In Youth Soccer

Injuries in youth soccer come in many forms. If you've been listening to this show for long, you know that I gather a lot of things under the safety umbrella: Physical abuse, mental abuse, sexual predation, physical injury, etc. For this episode, let's narrow the focus to avoiding physical injuries due to overuse, over stress, or subjecting athletes to situations where either their bodies or their support system is not prepared. 

Further, let's break physical injuries into a few sub categories, including:

• Too much, too fast (coming up off the couch after a long summer of inactivity)
• Overload (not maintaining balance between stress and recovery)
• Internal injuries
• Equipment and Environmental situations 
• Overuse injuries brought about by stacking similar body movements from different sports on top of one another

As always, I'm not going to merely describe each of these five physical injury hot spots, but I will attempt to provide some solutions that you can use to prevent injuries for your soccer players. 

Not all kids are created equal. As kids get older, their natural flexibility starts to decrease. I'm pretty sure every listener of this show is painfully aware of decreased flexibility that comes with age, but it might not be common knowledge that this decrease in flexibility can start as early as Junior High School. It's true that most kids are still more flexible than most adults, but bones begin to harden, muscles and sinews stretch with the rapid growth of bones and support structures, and additional stress on the body in the form of additional weight all become contributing factors and good reasons for coaches and parents to start paying attention to fitness, stretching, and whole body conditioning early on. 

I coach high school kids between the ages of 14 and 18. I worry about making sure my players don't get hurt - particularly early in the season before their bodies have a chance to adjust to what amounts to an increased level of activity for most of them. A summer of sitting on the couch seems more and more common these days. It used to be that kids were outside playing street hockey, kick the can, kill-the-guy-with-the-ball (a form of tag), kickball, swimming, frisbee, stick ball, and all manner of creative outdoor games kids use to love. We have a real issue today with kids literally sitting on the couch if they're not being directly instructed to physically play. This makes the Too Much Too Fast problem a real concern. 

Without adequate pre-season conditioning, players are at risk for stretching, tears, pulls, and even metabolic problems (that I'll talk more about in a minute).  Perhaps equally as important, players who's bodies are not prepared for the rigors of a soccer match won't enjoy the match as much. They won't play as well because they're in their head worrying about being gassed. Or, they find themselves facing an early injury they end up wrestling with the rest of the season, or a season-ending injury that takes them out of the game all together.

While Too Much Too Fast injuries can occur at any age, I believe these injuries to be more prevalent in the over 11 age groups. They become progressively more likely as kids mature past Junior High School and into High School (age 14-18). They are super common in adult leagues. 

The way to avoid Too Much Too Fast injuries is to:

If you're working with younger age groups, this level of effort is much less. 9 and 10-year-olds, for example, can only run for maybe an hour of activity and they're topped off. We don't push high levels of fitness on younger players. I prefer lots of general and free-play type activities for younger player in the off season: swimming, neighborhood games - even chasing the dog or chickens around the yard are great activities for younger kids to keep them fit and moving. 

Finally, I would add that getting a preseason physical is a great step towards identifying health risks before they become a problem on the pitch. Most scholastic sport programs require medical physicals before each season. They're screening for common medical problems that experience have shown should discourage some kids from playing sport. 

For every activity, there must be recovery. Recovery gives our bodies time to rebuild and emerge stronger. Sleep, rest between activities, and nutrition are the primary ways we recover and rebuild. 

When activities are spaced too closely together, as in 3-game, single weekend tournaments, or five back-to-back days of riding 100 miles on a bike, the lack of recovery becomes a  noticeable factor for athletes. Injuries tend to be more prevalent where rest between activities is not available or taken seriously. 

Sleep is something that can be hard to come by as kids come up through adolescence. Not because teenagers don't sleep. They sleep! But because the amount of sleep that they need does not fit neatly into a human lifestyle. Homework has gone up. Activities have multiplied. Worries and stress have gone up. Sleep sometimes takes a back seat at the very time when it is needed the most. 

Young athletes need a sleep routine. Going to bed a little earlier goes against teenaged rules of life, but it's often what's needed to wake up the next day feeling refreshed and strong. Waking up at the same time - even on the weekends - is something that can help teach the body about it's natural circadian rhythm. Not taking iPhones, iPads, or TV's into the bedroom with them can cut down on late night blue light exposure that tricks the mind into thinking it's time to be awake. 

Nutrition means giving your body the proper ingredients it needs to build and rebuild muscle, to enable the nervous system, to strengthen the fuel system, and invigorate the brain. Post workout nutrition and pre-workout nutrition are super important to the athlete. For endurance activities, replenishing easily digestible snacks and electrolytes is essential to keeping our body-machines running. See the resources section for some specific advice for pre and post workout nutrition. 

The athlete must spend some time understanding what balance means and how to achieve it for themselves. Coaches and parents can help out a lot in this regard by educating athletes during practices and games (coaches), ensuring balanced and nutrient rich foods at home, and encouraging attention to sleep and rest. 

I admit that I was really thinking about proper hydration when I conceived this section. Hydration is so much more important than most of us give it credit for. Our bodies being made up of such a high percentage of water - water is life. Water provides cooling, lubrication, cushion, warmth, strength, energy transport, blood transport, and brain function. Water, combined with electrolytes is so important that without it, athlete bodies can cease or their thermostats can break. In either case, we're talking about life threatening stuff. 

In December of 2017, I did an in-depth episode on Dehydration and it's effects on performance. It's worth a listen. Lots of good science and studies are behind that episode. 

Internal injuries can also come from neglecting concussions. Micro-concussive events can add up over time. The brain is a fragile organ, it's tucked away in a hardened case we never want to open. And the effects of concussions is something we must keep an eye out for. Parents can help big time in the discovery of concussions because they know their child's baseline better than anyone. Shifts in personality, memory loss, more frequent complaints of headaches, etc. All of these things can be indicative of concussive injury and should be discussed with a doctor during medical visits. 

Head bands like the Halo 3 from Unequal Technologies are devices that slip on over the head and get worn like a regular headband. They're soft and pliable when they are warm against the body, but they stiffen instantly when an object like a soccer ball, a goal post, another player's body, or the ground come in contact with it at speed. These device manufacturers claim that the devices dissipate the energy of the impact around the head instead of allowing it to penetrate the head to the brain. I've personally seen these devices at work against a goal post, a ball, and the ground. In all cases, the players walked away with no injury. I could not recommend them enough - and I unfortunately do not make any money by recommending them - although if you purchase one through the Amazon link I provide in my show notes, Amazon will kick me a few pennies. I personally own three in my family and my kids wear them to every event. 

Jewelry and unprotected casts from other injuries are at risk for getting caught in player's clothes or hurting another player during the run of play. Safety checks of the players happens at every game where licensed officials are looking out for our safety. Coaches are encouraged to check players during practices the same way. And parents are encouraged to reenforce the fact that we don't wear jewelry on the field and we always wear safety gear like properly fitting shin guards and proper soccer boots. 

​Weather ​is another factor that can cause injuries. Soccer in my region is played in the Spring and Fall. Generally, these seasons provide the most comfortable temperatures to be running around on a soccer pitch. They are each flanked with the cold of Winter and the heat of Summer, however, and both can be susceptible to rain and thunderstorms. ​​

For the temperature extremes, I invite you to have a listen to Episode #44 that I recorded back in September of 2018 titled Effective Weather Policy for Youth Soccer. Read the show notes too. That episode lays out exactly what to do to relax uniform and game time restrictions based on the perceived temperature (not just the actual temperature). We can't have our athletes suffering from Heat Stroke or HypoThermia by exposing them to weather extremes for long periods. 

Lightning carries obvious risks - which I also cover in that episode - but I'll summarize to say: keep people off of soccer fields and out of bleachers for 30 minutes from the last strike of lightning or boom of thunder. That stuff is hazardous to human life. It demands respect. 

Most of us overlook the risks that rain presents. It's just rain, right? Generally, I agree that playing in the rain is not much of a problem, but there are conditions that can make rain a real hazard.

• When a leather clad ball is used, leather soaks up water and gets heavy. Trying to do headers with a heavy, wet leather ball can lead to concussions or neck injuries. 
• When rain pools on the field, it makes the depth of the pool difficult or impossible to judge for running soccer players. A step into a hole filled with water can lead to leg and joint injuries. 
• Mud can make field conditions slippery and once again, subject players to leg and joint injuries. 

The last bit I want to say about equipment situations is that coaches and officials need to walk the field and make sure that there are no leftover equipment in the ground from other sports like lacrosse, that all relevant gear is properly assembled and secured. A large metal goal topped over in the wind and killed a 2-year-old toddler in Tennessee in 2017.  This sad story is a reminder to us all that a safety walk down of the field is a good idea before every game. 

Soccer has a lot of running - in a full size game, a player should run 3-7 miles. A lot of this running is done in short sprints with lateral movement. Athletes who run track at the same time as play soccer can "stack" two running sports on top of one another. It's not uncommon for my players to come walking up the hill towards our practice field and report that they just ran 7 miles in track practice. 

As a coach, this is a red flag moment. If I have yet another 5-7 miles of running planned for my soccer practice, that would mean 12-14 miles of running for my track runner in one day. A bit much? How about if we do that two days in a row? 

In cases like this, we're inviting overuse injuries. Tendonitis, plantar fasciitis, etc are dangerously close & things I must protect them from. I typically ask my athletes who is participating in other sports besides my soccer team. When I find runners like this, I typically exempt them from the running portion of practice and have them work on stretching instead. The stretches I introduce them to are specifically designed to ward off overuse injuries - any one of which could take my player off the field, off the track - or both. 

At home, I encourage a routine for all 12-and-older players of stretching twice per day. This is especially important for high school aged players. 

Youth soccer is an incredible game, but like all sports, it's not without its risks. Injury prevention in youth soccer is something we can all help with. Simply being aware of the risks and taking a few steps to prevent injury, our kids will have more fun, stay in sport longer, and be free to perform at their highest level. 

• Fundação Real Madrid. “Fifa 11 : Warm-Up to Prevent Injuries.” LinkedIn SlideShare, 4 Jan. 2014, https://www.slideshare.net/PedMenCoach/fifa-11-warmup-to-prevent-injuries.
• Rose, Brent. “How Far Do You Run Playing Different Sports?” Gizmodo, Gizmodo, 17 June 2013, https://gizmodo.com/how-far-do-you-run-playing-different-sports-5992583.
• Miller, Tracy. “Which Sports Run the Most? Stats from Football, Basketball, Soccer and Tennis Show Who Burns the Most Shoe Leather.” Nydailynews.com, New York Daily News, 10 Jan. 2019, https://www.nydailynews.com/life-style/health/sports-run-stats-show-burns-shoe-leather-article-1.1307763.
• Fischer-Colbrie, Megan. “The Impact of Post-Workout Nutrition on Recovery.” BridgeAthletic Blog, https://blog.bridgeathletic.com/post-workout-nutrition-recovery.
• BridgeAthletic. “Customize Recovery: Club and High School Athletes.” BridgeAthletic Blog, https://blog.bridgeathletic.com/customize-recovery-club-and-high-school-athletes.
• Emery, Ca, and H Tyreman. “Sport Participation, Sport Injury, Risk Factors and Sport Safety Practices in Calgary and Area Junior High Schools.” Paediatrics & Child Health, Pulsus Group Inc, Sept. 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2786948/.
• “Welcome to the FIFA 11 Website.” FIFA 11 RSS2, http://f-marc.com/11plus/home/.
• Halo 3 Protective Headgear from Unequal Technologies
• Alund, Natalie Neysa. “Two-Year-Old Girl Killed as High Winds Topple Soccer Goal in Antioch.” The Tennessean, The Tennessean, 1 May 2017, https://www.tennessean.com/story/news/2017/04/30/two-year-old-girl-killed-high-winds-topple-soccer-goal-antioch/101136554/.
• Advanced Solutions International, Inc. “Preventing Soccer Injuries.” Soccer Injuries | Soccer Injury Prevention & Treatment, https://www.stopsportsinjuries.org/stop/prevent_injuries/soccer_injury_prevention.aspx.