Team Physicians for · female soccer players aged 12-15 on prospective basis • 33 select and elite clubs in Washington state studied from 2008-2012 • Risk factors studied- joint

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emoryhealthcare.org/sports

Soccer Injury Prevention

Michael Biller PT, OCS Emory Physical Therapy Emory Soccer Medicine Program


“SUCCESS IS WHERE PREPARATION AND OPPORTUNITY MEET”

BOBBY UNSER


INJURY PREVENTION CHECKLIST

•  Injury Prevention Rationale •  Warm up and Cool Down •  Stretching •  Strength Training •  Fatigue and Rest •  Monitor Loads •  Screening •  Nutrition and Hydration •  Equipment •  Proper Technique


PRIMARY AND SECONDARY PREVENTION

•  Primary- prevention of injury before it occurs – ACL , ankle sprains, concussion, hamstring

•  Secondary- prevention of re-injury – Hamstring strain recurrence rate 13-18% in

first 2 months of return to play – ACL second injury 17% in males and 25%

in females under age 20


RATIONALE FOR INJURY PREVENTION PROGRAMS

•  Rate of injuries is increasing in many sports and injury types despite better understanding of how injuries occur

•  Several research studies have shown significant reduction in injuries when prevention programs employed – PEP and FIFA 11+ specific to soccer


RE-INJURIES AND RECURRENCE

•  When do they occur? –  50% in first 25 days after return to sport –  25% in first week –  Suggest slow return to sport- limit minutes –  Avoid playing athlete when fatigued

•  Recurrence rates –  Severe injuries (>28 days missed) with lowest recurrence

rates –  Mild injuries with highest recurrence rate- tendinopathies ,

sprains and strains –  Hamstring strain recurrence rate 13-18% in first 2 months of

return to play


RISK FACTORS FOR OVERUSE INJURIES IN FEMALES

•  O’Kane et al study , AJSM 2017 looked at 351 female soccer players aged 12-15 on prospective basis

•  33 select and elite clubs in Washington state studied from 2008-2012

•  Risk factors studied- joint hypermobility, muscle strength, drop-jump test

•  83 lower extremity overuse injuries; 38/83 in knee. •  Rate of first time injuries 1.7/ 1000 athlete

exposure hour; rate of repeat injuries 3.4/ 1000 AEH


RISK FACTORS FOR OVERUSE INJURIES IN FEMALES

•  Risk of injury unchanged: –  Joint hypermobility

•  Risk of injury increased: –  Bottom 10th % of normalized knee separation – 2.24 to 3.2

fold increased risk –  Playing on another soccer team- 2.5 fold increased risk

•  Risk of injury decreased: –  One standard deviation increase in hamstring, quad, hip

flexor and abductor strength –  Players who played participated in other physical activities


RISK FACTORS IN MALE PLAYERS

INJURY

Trainingload

NeuromuscularControl

Fatigue

PriorInjury


WARM UP


“COOL” DOWN

•  Utilize simple and effective methods including ice and proper nutrition


STRETCHING

•  Current evidence is unclear if stretching prevents injury

•  Utilize a dynamic warmup


STRENGTH TRAINING •  Copenhagen adduction exercise –  Improved eccentric adductor strength

•  Eccentric Strength training for hamstrings – 71% decrease in male soccer players – 86% reduction in risk if prior hamstring

injury


BALANCE BOARD TRAINING

•  Balance board training has been proven to reduce and prevent ACL and ankle injuries


FATIGUE AND REST

•  Fatigue influenced by position and time in match


LOAD AND TRAINING VOLUMES

•  Increased rates of loading and sudden changes associated with increased risk of injury

•  Loads increase: –  Pre-season –  Increase to next level of competition –  Return from injury

•  High tech and low tech monitoring –  GPS –  Heart Rate monitors –  Acute vs. chronic loads


MONITORING LOADS

•  Common sense prevention •  Periodization •  Monitor exterior loads-

–  record reps / mileage –  games / practice per week –  Hours in structured play per week

•  Monitor internal loads- –  rate of perceived exertion (RPE) –  Monitor hydration –  Monitor heart rate

•  Fatigue= injury


MONITORING LOADS


SCREENING FOR POTENTIAL INJURY

•  Many types of screening tests available •  Research has not shown tests to be reliable •  Tests identify some at risk but not others •  Landing error scoring system (LESS test) •  Drop vertical jump •  Star excursion balance test / Modified Y Test •  FMS •  Flexibility / range of motion / strength testing


SCREENING FOR POTENTIAL INJURY


NUTRITION AND HYDRATION

•  US Soccer – Recognize to Recover Program

•  Extremely important for tournaments with multiple games/days

•  3 “R’s” of recovery – Rehydrate – Refuel – Rebuild


EQUIPMENT

•  Ankle bracing and taping can reduce risk of future sprain by 50%

•  Proper fit for shoes and shin guards •  Dressing for weather •  Mouth guards •  Soccer ball correct size for age group


PROPER TECHNIQUE

•  Correct technique jumping and landing can reduce injuries

•  Correct heading technique can prevent concussion- avoiding head to head contact – Eliminate heading age 10 and under – Limit heading frequency in practice 11-13

year olds


JUMPING AND LANDING

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Team Physicians for · female soccer players aged 12-15 on prospective basis • 33 select and elite clubs in Washington state studied from 2008-2012 • Risk factors studied- joint

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