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Soccer injuries.

OBJECTIVE: This chapter reviews the existing epidemiological studies on pediatric soccer injuries and discusses possibilities for future research. DATA SOURCES: A comprehensive, web-based search of existing soccer injury literature was performed with an emphasis on the pediatric population. The search encompassed all available studies, including European journals and texts, and initial investigations from the 1970s which serve as a basis of comparison to more recent work. MAIN RESULTS: Youth soccer is a relatively safe sport with an injury incidence ranging from 2.3 per 1,000 practice hours to 14.8 per 1,000 game hours. Similar to adults, youth soccer injuries occur mostly in the lower extremities, specifically the knee and ankle. Contusions are the most common injury, and minor/moderate injuries predominate. Extrinsic risk factors for youth soccer include: dangerous play, play on small fields, and inclusion of youth players on adult teams. The most important intrinsic risk factor is the relation of knee injury and female gender. CONCLUSIONS: Adolescent females suffer a disproportionate number of knee and anterior cruciate ligament injuries compared to adolescent males, but recent injury prevention studies yielded encouraging results. Head injuries in youth soccer are low, and rarely, if ever, occur from head to ball contact. Adherence to the rules of the game, proper coaching, and adequate refereeing are important factors in youth soccer injury prevention.

Adolescent↗

Lower-limb function among former elite male athletes.

To determine the relationship between previous lower-limb loading and current self-reported hip and knee disability, we sent a questionnaire to 1321 former elite male athletes who had represented Finland between 1920 and 1965 in international competitions and to 814 control subjects who had been classified as healthy at the age of 20. After adjustment for age, body mass index, and occupational group, the odds ratios of hip disability in the athletes compared with control subjects were 0.35 in endurance athletes (95% confidence interval, 0.14 to 0.85, P = 0.02), 0.56 in team sport athletes (0.28 to 1.10, P = 0.09), 0.30 in track and field athletes (0.12 to 0.73, P < 0.01), 0.84 in power sport athletes (0.51 to 1.39, P = 0.49), 0.30 in shooters (0.07 to 1.32, P = 0.11), and 0.54 (0.36 to 0.82, P < 0.01) in all athletes combined. Compared with control subjects, only team sport athletes had a higher risk of knee disability (odds ratio, 1.76; 95% confidence interval, 1.03 to 3.02; P = 0.04). Even though athletes have been reported to be at an increased risk for lower-limb osteoarthritis, our data show that former elite male endurance and track and field athletes and all athletes combined reported less hip disability than the control subjects. The effect of vigorous athletic activity on the function of knee joints is more controversial, because sports that involve a high risk of knee injury are likely to lead to pain, disability, and osteoarthritis.

Aged↗

The frequency of muscle tightness and injuries in soccer players.

One hundred-eighty players in a male, senior soccer division were examined for past injuries, persisting symptoms from past injuries, and muscular tightness in the lower extremities. Soccer players were in general less flexible than a group of nonplayers of the same age (n = 86). No correlation was found between past injuries and existing muscle tightness. Sprains of the lower extremity, especially of knees and ankles, predominated among the injuries. Persistent instability symptoms were common sequels to knee and ankle injuries. It is proposed that intensive care of acute injuries will improve the late results.

Adolescent↗

Epidemiology and traumatology of injuries in soccer.

A prospective investigation of soccer injuries among 123 players participating at various competition levels was undertaken in a Danish soccer club. The injury incidence during games was highest at division level (18.5/1000 hours) and lowest at series level (11.9/1000 hours), whereas the distribution of the incidences during practice was reversed. The youth section (16 to 18 years) had incidences that could be compared to the highest senior level. The lower extremity was involved in 84% of the injuries, including 34% of overuse injuries. Ankle sprains were most common (36%) and equally found at all levels, whereas half of all overuse injuries were seen among division players. Contact injuries during tackling occurred most often in lower series and youths (45%). Players participating at high levels had only 30% of the injuries during tackling and 54% during running. More than half of 20 knee injuries were caused by tackling. Thirty-five percent of injured players were absent from soccer for more than 1 month; 28% had complaints 12 months after the end of the season with knee injuries the most serious. The study shows that the injury incidence, the pattern of injury, and the traumatology varied between players participating at different levels of soccer competition.

Adolescent↗

Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes.

One hundred thirty-eight female collegiate athletes, participating in eight weightbearing varsity sports, were administered preseason strength and flexibility tests and followed for injuries during their sports seasons. Strength was measured as the maximal isokinetic torque of the right and left knee flexors and knee extensors at 30 and 180 deg/sec. Flexibility was measured as the active range of motion of several lower body joints. An athletic trainer evaluated and recorded injuries occurring to the athletes in practice or competition. Forty percent of the women suffered one or more injuries. Athletes experienced more lower extremity injuries if they had: 1) a right knee flexor 15% stronger than the left knee flexor at 180 deg/sec; 2) a right hip extensor 15% more flexible than the left hip extensor; 3) a knee flexor/knee extensor ratio of less than 0.75 at 180 deg/sec. There was a trend for higher injury rates to be associated with knee flexor or hip extensor imbalances of 15% or more on either side of the body. These data demonstrate that specific strength and flexibility imbalances are associated with lower extremity injuries in female collegiate athletes.

Adolescent↗

Injuries in indoor soccer. The Lake Placid Dawn to Dark Soccer Tournament.

We conducted a prospective study of soccer injuries during the Soccer America Dawn to Dark Indoor Soccer Tournament, which was organized by the Lake Placid Soccer Center, Lake Placid, New York, 1993. Eight hundred twenty-four players competed in open men's, open women's, over-30 men's, and mixed divisions. The overall rate of injury per 100 player hours was 4.44, with a rate of 5.79 in the open men's, 4.74 in the open women's, 2.73 in the over-30 men's, and 1.54 for the mixed divisions. The differences in injury rates for men versus women and men versus older men were not statistically significant. Twenty-five of the 38 injuries (65.8%) were mild, with 27 injuries (71.4%) occurring in the lower extremities. Ankle sprains were the most common injuries and combined ligamentous injuries to the knee were the most common severe injuries. As the injuries increased in severity, they were more likely to be noncontact injuries. The data demonstrate the low incidence of injury in male and female indoor soccer participants. The data also show the similarity in the types of injuries sustained by indoor and outdoor soccer players.

Adult↗

Sports injuries in team handball. A one-year prospective study of sixteen men's senior teams of a superior nonprofessional level.

One hundred eighty-six players of 16 teams in 2 male team handball senior divisions were observed prospectively for 1 season to study the injury incidence in relation to exposure in games and practices. Ninety-one injuries were recorded. Injury incidence was evaluated at 2.5 injuries per 1000 player-hours, with a significantly higher incidence in game injuries (14.3 injuries per 1000 game-hours) compared with practice injuries (0.6 injuries per 1000 practice-hours). Practice injury incidence was higher in the lower performance level group, and game injury incidence was higher in the high-level group. The upper extremity was involved in 37% of the injuries, and the lower extremity in 54%. The knee was the most commonly injured joint, followed by the finger, ankle, and shoulder. Knee injuries were the most severe injuries, and they were more frequent in high-level players. There was an increase in the severity of injury with respect to performance level. The injury mechanism revealed a high number of offensive injuries, one-third of them occurring during a counterattack. The injury pattern showed certain variations with respect to player position and performance level. Prophylactic equipment was used by a majority of players at the higher performance level.

Adult↗

The effect of foot structure and range of motion on musculoskeletal overuse injuries.

The purpose of this prospective study was to determine whether an association exists between foot structure and the development of musculoskeletal overuse injuries. The study group was a well-defined cohort of 449 trainees at the Naval Special Warfare Training Center in Coronado, California. Before beginning training, measurements were made of ankle motion, subtalar motion, and the static (standing) and dynamic (walking) characteristics of the foot arch. The subjects were tracked prospectively for injuries throughout training. We identified risk factors that predispose people to lower extremity overuse injuries. These risk factors include dynamic pes planus, pes cavus, restricted ankle dorsiflexion, and increased hindfoot inversion, all of which are subject to intervention and possible correction.

Achilles Tendon↗

The role of nutrition in the management of lower extremity wounds.

From 3000 BC, healers have understood the importance of nutrition in wound care and used nutritional supplements to aid healing. Many of the teachings from Hippocrates, the father of modern-day medicine, clearly state his firm belief that good health can be achieved through nutrition. In the early 1900s when advances in biochemistry were frequent, many of the essential constituents of nutrition were characterized, which formed the basis for many animal and human wound-healing experiments. This led to the discovery of vitamin C, zinc, and many other components essential for the orderly progression of healing. Modern-day research has concentrated on finding nutritional components that can enhance healing through supra-physiological doses, such as in the use of the amino acids arginine and carnitine. However, clinicians need to be aware that approximately 50% of patients admitted to the hospital are malnourished, requiring dietary supplementation; appropriate nutritional assessment and advice therefore should be an integral part of all wound management. This review provides an up-to-date commentary on the role of nutrition in wound care, with specific emphasis on lower limb wounds, from a historical perspective, and within it both the biomedical approach and current herbalist practices are considered.

Animals↗

Electrical stimulation for wound healing: a review of evidence from in vitro studies, animal experiments, and clinical trials.

This article reviews theories linked to endogenous bioelectric currents and the role they may play in wound repair with further appraisal of in vitro and in vivo research related to the effects of clinically applicable electrical currents on protein synthesis, cell migration, and antibacterial outcomes. In addition, studies on the effects of electrical stimulation (ES) on skin grafts, donor sites, and musculocutaneous flaps in animals are evaluated, as well as assessments of numerous clinical reports that examined the effects of ES on angiogenesis, perfusion, PtcO2, and epithelialization. Finally, a plethora of clinical trials related to the responses of chronic lower extremity wounds to ES therapy are reviewed, with emphasis on wounds caused by venous insufficiency, diabetic neuropathy, and ischemia in patients with and without diabetes mellitus. A glossary that addresses ES terminology is also included.

Animals↗