Injuries WILLIAM C.

Soccer

in

soccer

McMASTER, M.D., AND MAARTEN WALTER, Irvine, California

is fast becoming a major factor on the American sports scene. Although long present in this country, it has often been confined to pockets of interest in highly ethnic areas. In the past several years however it has emerged in the general sport consciousness. Foreign superstars like Pele and American personalities like Kyle Rote, Jr. have promoted a positive picture for soccer among the nation’s youth. The popularity of soccer for the spectator was emphasized by a published attendance figure of 65,000 to one NASL match in the 1977 season. Youth participation figures across the nation are astounding. In the 1965 season, 62,000 youths in Southern California and 25,000 in Fairfax County, Virginia played.’ Several organizations have developed age group leagues and soccer camps with emphasis on participation and these numbers will continue to grow. This increased interest in soccer among younger age groups will no doubt reflect itself in the number of future participants at the interscholastic and college level. Participation by girls has also been large and will further heighten universal interest in soccer. The continued high incidence of serious injuries associated with football has resulted in increased liability for schools, coaching staff, and equipment manufacturers.’ This has produced a rising cost for liability coverage for school districts and has brought football under increased scrutiny as an interscholastic sport. The current interest in soccer may reflect some of this concern for injury potential. There is little written in the American sports literature concerning injury potential or a profile I, 3,4 As interest of injuries encountered in soccer. and participation accrues, one can anticipate a greater need for sports medicine practitioners to 354

familiarize themselves with this game, its potential for injury, and the uniqueness of its player’s needs. The prospective compilation of a professional team’s injuries during a season, which is contained in this report, will hopefully assist those involved in soccer to better anticipate problems, devise more responsive training programs, and maximize the safety associated with soccer participation. MATERIAL

The material for this study was collected during the 1976 to 1977 season of play for the California Sunshine of the American Soccer League. The team maintained a roster of 15 players and day to day care was provided by a qualified trainer. In an attempt to assess prospectively the injuries and problems encountered during a season of play, a daily log was kept of all players who complained of or sought care for injuries or problems related to practice or game situation. A physician was in attendance at all games and in ready access to consult for injuries suffered during nongame situations. The season ran 4 months. Excluding approximately 8 weeks, a preseason conditioning and exhibition game, 24 scheduled games were played during the season excluding play-off engagements. RESULTS

During the entire season 60 injuries were encountered. Thirty-five injuries occurred during game situations and 25 in practice circumstances. Of the player positions, goalees received 6 injuries, backs 11injuries, midfielders 18 injuries, and forwards 23 injuries (Table 1). As a consequence of injuries, I day of practice was missed in 9 incidences, 2 days in 7, 3 days in 6, 4 days in 4, 5 days in 5, 133

TABLE 2 missed time

days in 2,

and more than 14 days in 5 injuries. In relation to the number of games missed as a consequence of injuries, 46 injuries resulted in no games missed, I game was missed with 10 injuries, 2 games with 2 injuries, and 5 games with 2 injuries (Table 2). Of the two most seriously injured players requiring the longest term of rehabilitation, only 1 player was able to return to play prior to the end of the season. That player had an injury to the lateral ankle ligament and the interosseous ligament, requiring approximately 5 weeks of rehabilitation. This patient was able to return to first string play prior to the end of the season. The second player injured 4 weeks prior to the end of the season received a low-grade second-degree medial collateral ligament sprain and was unable to return during the season. A compilation of injuries suffered by type showed that foot and ankle sprains were most prevalent (Table 3). Nine ankle sprains and nine foot sprains were noted. Strains were the next most frequent injury, six quadriceps, six adductor, and four hamstring strains were noted. Quadriceps contusions were recorded in five instances. Two lacerations were encountered during the season, both minor, but both requiring suturing. The only fracture was of the nose in a goalee who was accidentally struck by an elbow of a defensive player. Two proximal interphalangeal joint dislocations were noted in goalees and one anterior shoulder dislocation in a midfielder. The dislocation was a chronic recurrent problem having been registered several years earlier on multiple occasions. One transient episode of uncomplicated low back pain occurred. One chronic Achilles tendinitis and three collateral ligament strains of the knee were noted. Two were medial collateral injuries, one a first-degree injury, and one a seconddegree injury. A single minor ligament strain to the lateral collateral ligament was also noted. Two separate recordings of indications of internal derangement of a medial meniscus were diagnosed in the same patient, neither incidence proved to be debilitating. As this was a chronic problem and the player was able to continue to function, he TABLE I

Injunes according to position

Injury related

TABLE 3

Categorization of injuries

wished nothing to be done with the knee. A variety of minor abrasions were seen due to falls on the playing surface, none serious. Minor contusions from impacts with the ball or by an opponent’s foot were common, but were not responsible for loss of playing time. No head or eye injuries were seen.

DISCUSSION

As is seen from this analysis of injuries, muscle strains and foot and ankle sprains were the most common encountered. Injury of the foot may occur either when striking a ball that has been trapped by an opposing player or because of perils associated with a faulty playing surface. This is interesting in view of the fact that protective strapping and taping of the foot and ankle is only rarely used. Muscle strains, also very common, would be anticipated from the running nature of the sport. A requirement for fast starts and cuts with rapid deceleration, a tendency for very strenuous use of the leg often in abducted position, and extreme fatigue situations may lend to the muscle strain problem. These strains during this season occurred

spite of a diligent stretching program. Soccer and football are basically contact sports. The contact in the two sports differ primarily in the intent thus the type of contact encountered. In football, particularly in offensive play, one’s objective is to neutralize his opponent, taking him out of the play thus contributing to the over-all development of the tactic. This results in a relatively high-risk situation for injury and even greater risks are present during special events such in

355

kickoffs and punts. Soccer, on the other hand, allows contact only in specific circumstances associated with the prime object of the game, that is, to control the ball. Intentional efforts to neutralize the opposing player are forbidden and carry a as

The referee in soccer has ultithe enforcement of these rules with absolute authority. Infractions will result in loss of possession of the ball. Serious or repeated infractions can lead to ejection from the game and field with that team to play the remainder of the game with a man disadvantage. This most dreaded &dquo;red card&dquo; penalty is a strong deterrent to unwarranted aggression and is a strong factor in controlling injury potential of the game. Nevertheless, unavoidable injuries do occur during the heat of play in soccer as a result of legal contact between players who wear no protection outside of a thin shin guard in some instances. Injuries can result from kicks, direct contact from a kicked ball, and contact with the playing surface during falls. Because of the agility requiicd of a soccer player in cutting and faking with his body and in using facile movements of the foot to manipulate the ball, players prefer a minimum of strapping, tap-

penalty provision. mate control

ing,

or

over

protective equipment. Taping techniques

used in football to minimize subtalar motion will be unduly restrictive to a soccer player. At best he will only tolerate a light taping. The players are particularly vulnerable to hazards within the playing surface itself. Chuck holes, sprinkler heads, and hidden objects on the playing surface all post a serious threat to the player and can be a cause for foot, ankle, and knee injuries. The vast experience for most physicians involved in sports medicine in this country centers around football. That experience is deep from years of involvement as well as previous personal experience. On the other hand, in soccer one finds few physicians with an in depth knowledge of the sport as well as experience involved in its medical care. Under only rare circumstances has the physician any personal experience of participation. Many aspects are nontransferable between the two sports, requiring one to acquire a new bank of experience and approach when dealing with these players. Soccer with its origins and great interest in Europe is played worldwide. In many of these nations, the more modern conditioning and training concepts have yet to permeate. As a physician one will sometimes be faced with foreign coaching staffs who are not totally familiar with the sophis356

tication of training techniques and approaches to sports medicine that we look upon with such familiarity in other sports. At high school and age group levels, the necessity for a large number of coaches requires them to be drawn from the ranks of the uninitiated m soccer. Thus, coaching and conditioning techniques to be adapted for use in soccer may be nonexistent or inappropriately applied. Trainers also have to modify their techniques and treatments in many instances. The physician involved in soccer during its infancy in this country has a unique opportunity to help formulate safe and productive conditioning techniques adapted specifically to the needs of soccer

players. Injury prevention in soccer requires an adequate and competent coaching staff that will embrace sound conditioning and training techniques, the teaching of correct execution in the various facets of the game, and a competent training and medical staff. The trainers must be expected to render appropriate directed care for injuries, both acute and chronic, and function in injury rehabilitation and prevention. The physician care for players must provide accurate and rapid diagnosis of problems. This must be followed by appropriate therapeutic regimens to minimize time loss from practice and/or game situations. The clubs must ensure that playing surfaces are in good condition and do not pose undue hazards to the player from unseen objects, uneven playing surfaces, and inadequate safety margins around fields. The league must be responsible for providing competent and responsible officiating, because this by far is one of the major factors in controlling practices which may contribute to injury. SUMMARY

The injury profile of a professional soccer team from the 1976 to 1977 season is compiled in this report. Injuries are spread across all of the playing positions, with midfielders and forwards being most prone to injury. During the entire season of this report, 60 injuries were encountered, 35 during game situations and 25 in practice. The most common injuries noted were foot and ankle sprains, but muscle strains were also frequent. Most injuries were of a minor variety. Seventeen injuries resulted in missed games while 46 injuries resulted in no games being missed. Only one player had an injury which did not allow him to return to play during the season. Although little is

written in the American literature concerning soccer injuries, it does appear that the injury potential is much less when compared with that of football. The rapid increase in interest in this sport will require physicians and trainers to become familiar with its specific needs in order to render adequate care and participate in injury prevention pro-

grams.

REFERENCES 1.

2. 3 4.

Special Report: Soccer blends skill, stamina, simplicity. Physician Sports Med 4: 115-116, 1976 U. S. Product Safety Commission: Football related injuries and deaths. Orthop Rev 5: 43, 1976 Kauzlarich JW: Medical care of a championship soccer club. Physician Sports Med 5: 99-100, 1977 Gunther SF: An avoidable soccer injury. J Sports Med 2: 167-169, 1974

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Injuries in soccer.

Injuries WILLIAM C. Soccer in soccer McMASTER, M.D., AND MAARTEN WALTER, Irvine, California is fast becoming a major factor on the American sport...
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