Introduction to Common Injuries in Youth Soccer
Gerry Delahunt is a sports physiotherapist residing in England. He has worked with professional teams throughout his career and is providing his wide range of knowledge to Football.com in order to help youth soccer players, coaches and parents learn more about soccer injuries.
As football training and coaching has evolved over the years, so too has the management of injury, and injury-related conditions.
With these advances have come a deeper understanding of the mechanics of injury, improvement in diagnostic and treatment methods, together with an overall increase in the knowledge of sports-specific injuries and related conditions.
Additionally, recent times have seen an increased emphasis placed on the prevention of injury, and research has identified that there are particular injuries associated with certain sports; with football carrying one of the highest rates for injuries sustained to the lower limbs.
How do Women's Soccer Injuries Differ From Men's Soccer?
Advances in sports medicine have also seen the profession recognize that adaptations have to be made when dealing with soccer players of youth and college age, and that further adaptations are required when addressing soccer injuries in female players.
Various studies looking at injuries in women’s soccer showed that most of the injuries sustained were similar to those in the men’s game, but that there was an increased prevalence of concussive head injuries (Dvorak 2007 and Dick 2009 research) together with a high incidence of ankle injuries, and injuries to the Anterior Cruciate Ligament (ACL) of the knee as observed by Dick's 2007 study.
Dick's study reviewed 15 years of injury surveillance data collected by the National Collegiate Athletic Association, and in publishing their findings highlighted that concussions, ankle injuries, and internal derangements of the knee were the three most prevalent game-sustained injuries that resulted in an absence from training and playing for longer than 10 days.
However, there is a lack of research in general with regards to injuries in women’s soccer and most authors agree that further study is needed.
Looking at the Injury Numbers
As far as injury studies into youth soccer are concerned, though, many more of these are available and range from the English Football Association’s Audit of injuries in youth academy soccer (Price's 2004 study) to Le Gall’s paper examining the situation in elite French youth football (2006), and Deehan's (2007) later publication focussing on academy injuries at Newcastle United FC in England.
All are extremely relevant and informative in identifying the most common injury presentations in youth soccer, and provide important and academic information relevant to the study of soccer injuries that can be easily accessed and referenced.
These studies are complemented by extensive hospital-based research in the USA and Canada; many of which examine the incidence and nature of youth soccer injuries presenting to Accident and Emergency departments, with Fridman's 2013 research showing that soccer injuries accounted for 11,941 injuries out of the 56,691 injuries recorded from 13 different sports in Canada over a three-year period.
Leininger's earlier 2007 paper audited 1,597,528 soccer injuries sustained over a thirteen-year period in the USA, with sprains and strains accounting for 35.9% of injuries detailed, followed by contusions and abrasions at 24.1% with fractures comprising 23.2% of the total number of injures recorded. They also found that girls were more likely to sustain ankle and knee injuries than boys, but that boys were more likely to sustain head and neck injuries plus facial injuries and lacerations.
However, in real terms not every injury is seen in hospital with the vast majority opting either for local treatment via a physical therapist, or simply by addressing the injuries through self-management strategies supported by the advice of a physician. Many will opt for purely self-management where routine injuries are concerned without advice, particularly if these are self-limiting; but with regards to the overall management of injuries in youth soccer, certain principles have to be adhered to.
Types of Injuries and Their Causes
In particular, when discussing the applications of sports medicine to youth soccer there is a need to acknowledge that the changes in the body which take place during the adolescent years will have an effect not only on how the body reacts to injury, but also to how these adolescent changes can actually predispose the body to injury.
Price (2004) compared the injuries at academy level to those in the adult professional game and found that in 90% of injuries recorded in the academy study were to the lower extremity and that just over half the injuries recorded were sustained during competition (50.4%), and that most injuries were sustained on the dominant side. Additionally, the re-injury rate in the academy study was relatively low at only 3%. There could be a number of reasons for this although one area of the study highlighted that the number of injuries sustained was proportional to the amount of playing and training time.
Potentially, however, the low rate of injury recurrence could perhaps be attributed to the fact that less pressure may be brought to bear on youth team players to return to competition as opposed to their senior counterparts; where an earlier study into injuries sustained in the full professional game recorded an injury recurrence rate of 9% (Hawkins' 2001 research).
How Does Overuse Play Into These Injuries?
With overuse injuries in particular, one of the most common reasons cited for these is often the fact that a sudden unexpected change in training routines or intensity frequently results in overuse injuries. This is never more evident than in the professional game, where teenagers who have previously been used to having no more than a couple of evening training sessions a week in addition to a weekend game suddenly find themselves having to adapt to the twice-daily training routine of a full-time professional players in addition to having an increased amount of game time.
Not surprisingly, it the areas of the body that are most affected by change and growth that will be the first to react to this.
The most common adolescent soccer injuries falling into this category are Osgood Schlatter’s Disease (OSD), Medial Tibial Stress Syndrome (MTSS), and stress fractures – particularly of the metatarsal bones in the feet. Additionally, Sever’s Disease, which affects the area of the insertion of the Achilles tendon on the heel bone (but can also present as pure bilateral heel pain), and Sinden-Larsen-Johanssen’s Syndrome which affects the origin of the patella tendon at the lower aspect of the kneecap, are common in players of youth and adolescent ages. All of these injuries and conditions mentioned are known to be directly proportional to the amount of load-bearing exercise undertaken and respond relatively well to a period of ‘active rest’ and cold applications.
Osgood Schlatter’s Disease is perhaps the most well-known of the inflammatory pathologies affecting youth and adolescent soccer players and presents as a very tender area near the top of the shin where the patella tendon inserts. This area is known anatomically as the tibial tubercule, and can be felt as a natural bony prominence. OSD arises from repeated exertion which leads to an inflammation where the patella tendon inserts on the shin, and a swelling can be felt over the tubercule which often looks different in size to the unaffected leg. This happens as a direct result of physical structures in the adolescent body growing and developing at different stages; but generally settles as growth-speed changes begin to level out towards the end of the teenage years. The effects of OSD can also carry-over into adulthood in some cases leading to generalized knee pain due to biomechanical alterations.
MTSS or Medial Tibial Stress Syndrome is the modern name for what used to be commonly referred to as ‘shin splints’; a collective term used to encompass any painful condition affecting the shins on exercise (usually impact-running) and is almost always the result of biomechanical imbalances and / or a leg-length discrepancy. In youth soccer players, the different rates of growth between ligamentous and bony structures can influence a young player’s biomechanics and present as shin pain due to increased loading of the lower leg muscles at their origins on the tibial bone which subsequently eases when running or impact-related activity is stopped.
Rest from known aggravating factors, an assessment of running gait and appropriate podiatry input in terms of issuing customized orthotic insoles to address any imbalances are usually effective in terms of injury management once the presence of stress fractures of the tibia have been excluded. For this reason, a visit to a physician as early in the treatment process as possible, is always recommended.
Another effect of biomechanically-related shin pain is that of compartment syndrome, which usually affects distance runners more than soccer players but still has to be excluded, particularly if pain quickly ceases on stopping the activity and is immediately aggravated by the commencement of running, for example. Although, more frequent in older adolescents, the contributing factors are essentially an overuse pattern, sudden and increased training loads, together with an identified biomechanical imbalance. Often the presence of over-pronation – aka ‘flat feet’ together with tight calf and hamstring muscles can manifest themselves as overuse conditions, particularly in shin or knee pain of a generalized nature occurring by gradual development without a single, specific injury or incident reported leading to the symptoms.
Stress fractures are the third injury I would attribute to overuse factors which commonly affect the youth soccer player As mentioned earlier, sudden increases in training loads and frequencies can result in abnormal and repeated forces acting on the immature skeleton which result in trauma. In the case of stress fractures of the metatarsal bones, often the wearing of extremely light football boots or running shoes that offer little protection against the effects of ground reaction forces can lead to impact-related fractures of the feet, and the onset of potential stress fractures of the tibia.
It is important to remember, though, that a plain x-ray will not reveal an immediate stress fracture and that deeper investigation via a bone scan may be required to accurately diagnose these. Routine radiology if performed a few weeks after the onset of injury may raise the suspicion that a resolving fracture is present in the bony area affected but will not pick up a new injury if performed at the time the initial symptoms are present. Again, an early examination by a physician is important at this stage, though, in order to exclude any more serious pathologies that may be disguised as routine musculoskeletal injuries.
It is important to recognize that the treatment and management of youth soccer injuries needs to allow for age-related variations in physical development and skeletal maturity, together with an acknowledgement that gender differences can affect the injury management and presentation.
This is particularly important when making a diagnosis or formulating a physical therapy treatment plan.
We will discuss these differences in greater depth as the series progresses.
In addition to taking a look at the various injuries and conditions that commonly present in a youth soccer environment, we will also address injury prevention strategies, basic nutrition and hydration, together with an analysis of the basic components of fitness required for soccer.
Deehan DJ, Bell K, McCaskie AW (2007). Adolescent musculoskeletal injuries in a football academy. The Journal of Bone and Joint Surgery, British Volume. Vol. 89 (1); 5 – 8.
Dick RW (2009). Is there a gender difference in concussion incidence and outcomes? British Journal of Sports Medicine. Vol. 43; i46 – i50.
Dick R, Putukian M, Agel J, Evans TA, Marshall SW (2007). Descriptive epidemiology of Collegiate women’s soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988 – 1989 through 2002 – 2003. Journal of Athletic Training. Vol. 42 (2); 278 – 285.
Dvorak J, McCrory P, Kirkendall DT (2007). Head injuries in the female football player: incidence, mechanisms, risk factors and management. British Journal of Sports Medicine. Vol. 43; i44 – i46.
Fridman LR, Fraser-Thomas JL, McFaull SR, McPherson AK (2013). Epidemiology of sports-related injuries in children and youth presenting to Canadian emergency departments from 2007 – 2010. BMC, Sports Science, Medicine and Rehabilitation. Vol. 5 (30). Available at: http://www.biomedcentral.com/2052-1847/5/30 accessed 2nd July, 2015.
Hawkins RD, Hulse MA, Wilkinson C, Hodson A, Gibson M (2001). The association football medical research programme: an audit of injuries in professional football. British Journal of Sports Medicine. Vol. 35; 43 – 47.
Le Gall F, Carling C, Reilly T, Vandewalle H, Church J, Rochcongar P (2006). Incidence of injuries in elite French youth soccer players: a 10-season study. American Journal of Sports Medicine. Vol. 34 (6); 928 – 938.
Leininger RE, Knox KL, Comstock RD (2007). Epidemiology of 1.6 million paediatric soccer-related injuries presenting to US emergency departments from 1990 – 2003. American Journal of Sports Medicine. Vol. 35 (2); 288 – 293.
Price RJ, Hawkins RD, Hulse MA, Hodson A (2004). An audit of injuries in Academy youth football. British Journal of Sports Medicine. Vol. 38; 466 – 471.