Injuries among young

soccer

players

SØREN SCHMIDT-OLSEN,* MD, UFFE JØRGENSEN, MD, PhD, SØREN KAALUND, MD, AND JOHN SØRENSEN From the

Department of Rheumatology, Aalborg Hospital, Reberbanegade, Aalborg, Denmark

ABSTRACT

injuries in young soccer players (ages 12 to 18) and to estimate the incidence of injury at different ages within that group. By using the definition in the previous paragraph, comparison with former studies became possible.2-4,8

We

registered all new injuries among 496 male youth players, aged 12 to 18 years, during the course of one year. The incidence of injury was 3.7 injuries per 1000 hours of soccer per player. The incidence increased with age, and at the higher ages within the youth players, approached the incidence rate of senior players (age ≥18 years). Seventy percent of the injuries were located in the lower extremities, particularly the knee (26%) and ankle (23%). Back pain occurred in 14% of players. Fractures, which accounted for 4% of injuries, were most often in the upper extremities. We conclude that youth soccer is a relatively low-risk sport with an injury pattern that differs slightly from that of senior players. soccer

MATERIALS AND METHODS We registered injuries as they occurred during 1 year among 496 boys playing soccer in three large soccer clubs in Denmark and then retrospectively reviewed the data. The definition of injury we used was identical to the definition used in a previous study on male soccer players’ and was close to the new definition used by the Council of Europe. Our definition is as follows: An injury received in connection with the game or in training in the club, which handicaps the player during the game and/or requires special treatment (i.e., special bandaging or medical attention) in order to continue play, or an injury that completely prevents continued playing. Before the study began, a uniform briefing was given to players and coaches about injuries, definitions, and the reporting system. The players, in cooperation with the coaches, registered injuries whenever they occurred. A standardized form was used to record injuries. The form is a modification of a form used for adults,’ developed after pilot testing in the different age groups concerned. The mechanism of injury, location and type of injury, injury duration, and form of treatment, if given, were all recorded. After each half season, the forms were collected from all of the players. A data base was created and data analysis was then performed with SPSS (Statistical Package for the Social Sciences). Each club had elite and recreational teams for youths and adults; th9 youths were between 12 and 18 years of age. They played in age-related series (12 to 13 years, 14 to 15 years, and 16 to 18 years) for approximately 10 months a year, with a mean of 157 to 195 hours of soccer per season, consisting of training and approximately 43 games. Each team consisted of 11 players and 2 substitutes.

Many studies have been done to determine the injury pattern in soccer, but only few have been undertaken prospectively in young players.9 Nilsson and Roaas6 found the incidence of injury in boys to be 14 injuries per 1000 hours of tournament play. Most injuries involved the lower extremities (68%). Only a few of the injuries were severe. Fractures amounted to 3.5%. In seniors (age ~18 years) the incidence of injury was estimated to be 16 per 1000 game hours for the individual player by Ekstrand/ and 4.1 injuries per 1000 hours of play by Jorgensen.’ It is difficult to compare different studies because there has not been any agreement about a general

definition of injury and

a

general method for registering

sporis injuries. However, in 1986 in Papendal, Holland, a group under the European council agreed on the following definition of a sports injury. The injury should be acquired during a game or in practice, causing one or more of the following: reduction of activity, the need for treatment or medical advice, and/or negative social and economic consequences. Our purpose in this

study

was

to describe the

pattern of

*

Address correspondence and repnnt requests to Soren Schmidt-Olsen, MD, Hulda Lutkensvej 14, 9900 Fredenkshavn, Denmark.

273

274 TABLE 3 Percent of injuries by location and age

RESULTS

During the season the 496 players sustained 312 injuries (Table 1). Injury incidence (both injuries per player per year, and injuries per 1000 hours of soccer) increased with the age of the boys (Table 2). The theoretical risk for an injury was one injury for every 68 matches (range, 56 to 77) or one every

1% years.

injuries occurred in the lower extremities (70%), especially at the knee and ankle (Table 3). Only 10% Most of the

involved the upper extremities. Surprisingly, many of the players had trouble with their backs (14%). We found relatively few muscle and groin injuries. Only 15 fractures were reported. These were evenly distributed among the age groups and consisted of 10 fractures involving the upper extremity and only 5 involving the lower extremity. In total, 4% of the injuries were fractures. There was no difference in rate of injury between the spring and the fall seasons.

few severe injuries were found, and the injury similar to that for this one whole season of soccer play.’ Perhaps the younger players incur fewer injuries than seniors, because of better flexibility, and less weight and speed during collisions. Youth games are probably also less aggressive, with less stress than exists in senior games. As with older players, most of the injuries in the youths are located in the lower extremities, mainly at the knee and ankle.’ Ankle injuries, however, are more frequent among seniors.1,3 The finding of rather few muscle and groin problems can probably be explained by a greater flexibility among the young players. The problems with the back may be biomechanically (posturally) associated with growth. In working with soccer players, we have found that exercises for the lower back are often not included in the limbering up and cool-down programs. Perhaps this also contributes to the relatively high frequency of back problems. The predominance of upper extremity fractures may be explained by the fact that the younger players are not very coordinated when they try to keep their balance, and thus fall, seeking support from the upper extremity. They also lack a broad view of the playing field when many players are near the ball, increasing the likelihood of contusions and injuries from the ball. However, this study does not reveal the exact mechanism. In a previous clinical study of injuries during a youth soccer tournament (players aged 9 to 19 years), only 7% of the injuries were severe and required hospital treatment, e.g., fractures and ligament injuries.’ Based on this and former studies,I.3,7 youth soccer can be recognized as a relatively low-risk and safe sport, with an injury pattern just slightly different from the seniors and

study, only a pattern

DISCUSSION

Many studies have included

loss of time as a consideration in the definition of sports injury.5By using a definition such as the one we used, a number of injuries that do not cause a break from activity are included. This is an advantage with respect to identification of risk factors for use in prevention. We found an increase in the incidence of injury related to age: Among the oldest boys (ages 16 to 17 years), the risk of injury was 4.0 injuries per 1000 hours of play per player, which is very close to the risk found in a comparable study of senior players (~18 years), in which the incidence was 4.1.’3 When the same definition and system for registering injuries has been used, fewer injuries are seen to occur in youth soccer than in senior ice hockey (4.7 injuries per 1000 hours per player) and senior handball (8.3 injuries per 1000 hours per player).2.4 However, in the noncontact sport of volleyball (senior players), the incidence was only 3.1 injuries per 1000 hours per player.’ This is consistent with the results of a previous study where all injuries during a 5 day international soccer tournament were evaluated. In that TABLE1

Exposure and injury characteristics by age

TABLE 2 Incidence of injury

group

was

only a few severe injuries. by

age

ACKNOWLEDGMENTS This study Council.

was

supported by

the Danish

Sports

Research

275

REFERENCES Ekstrand J Soccer injuries and their prevention Thesis Linkoping University Medical Dissertations, No 130, 1982 2 Jørgensen U Epidemiology of Injuries in typical Scandinavian team sports Br J Sports Med 18 59-63, 1984 3 Jørgensen U Injury pattern in Danish division football (summary in English) Ugeskr L 143: 2185-2188, 1981 4 Jørgensen U, Schmidt-Olsen S The epidemiology of injuries in icehockey Br J Sports Med 20 7-9, 1986 1

Noyes FR, Buncher CR The medical aspects epidemiology Am J Sports Med 15 230-237, 1987

5

Keller CS,

6

Nilsson S, Roaas A Soccer Injuries in adolescents Am J

of

soccer

injury

Sports Med 6.

358-361,1978 Schmidt-Olsen S, Bunemann LK, Lade V, et al Soccer Injuries of youth Br J Sports Med 19 161-164, 1985 8 Schmidt-Olsen S, Jørgensen U The injury pattern in Danish elite volleyball 7

9

(summary in English) Ugeskr L 149 473-474, 1987 Sullivan JA, Gross RH, Grana WA, et al Evaluation of Injuries soccer Am J Sports Med 8 325-327, 1980

in

youth

Injuries among young soccer players.

We registered all new injuries among 496 male youth soccer players, aged 12 to 18 years, during the course of one year. The incidence of injury was 3...
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