Ask The PT: Your Burning Soccer Questions Answered
Our resident expert, Yukiko Matsuzaki from the Hospital for Special Surgery, offers her guidance around headers, overtraining, and why more female soccer players are suffering ACL tears.
Hello from Cooperstown, NY where I’m on the second leg of vacation watching 600+ joyous 12-year-olds have the time of their lives bonding and playing baseball. My son is among them, of course, because it would be super weird and creepy if I were here without him. I’ll write more on this experience in the coming weeks but as a preview, this might be the first youth sports experience with insane upcharges on everything that I think is entirely worth it. We’ll see if I still feel that way when I work up the courage to check our bank account!
Good Game is now officially back on our regular Wednesday/Friday schedule. I couldn’t be more thrilled to present to you our next Ask the PT piece, and this one is specifically for the soccer parents and players out there. Our resident expert Yukiko Matsuzaki is back to answer an array of questions about soccer including overuse injuries, the toll of headers, and why female players suffer more ACL tears than males.
Yukiko is a Board-Certified Clinical Specialist both in Orthopedic and Sports Physical Therapy in the Pediatric Physical Therapy department of HSS (Hospital for Special Surgery) in New York. Simply put, she treats a slew of injured young athletes, and has an abundance of wisdom to offer us sports parents. We very much appreciate her insight!
Yukiko, take it away!
What are the most common injuries in soccer?
Most soccer injuries are acute (meaning they happen suddenly), as a result of athlete-to-athlete contact. Sprains, strains, contusions, fractures, and concussions are the most common. These type of injuries are not preventable.
*Sprains are common in soccer players, but in kids, it is more common to see a fracture rather than a sprain, because bone is softer than ligaments. So, when an athlete twists their ankle and is not able to walk or is having significant pain, it’s recommended that they see a pediatric orthopedist to rule out a fracture.
Overuse injuries, like knee pain, tendonitis, shin pain, and stress fractures are also very common. In youth, especially in those who are actively growing, we see a lot of “growing pains”, like Osgood Schlatter (knee), Sinding Larson Johannsen (knee), and Sever’s disease (heel). Growing pains are not serious but can be painful and bothersome.
What do you consider overuse? Is it different by position?
As mentioned previously, overuse injuries can be “growing pains” like Osgood Schlatter, Sinding Larson Johannsen, and Sever’s disease. These can also happen at the hip/ pelvis (they don’t have a special names). Overuse injuries also include: tendonitis, strains, stress fractures (especially at the lower leg/ foot), or pain around the knee. Goalkeepers have slightly different injury patterns- they may have less overuse injuries and suffer more acute upper body injuries (like fractures of the collarbone, hand/ wrist) compared to other positions.
What are some questions we as parents can ask our kids in pain to help determine whether further evaluation is needed?
Great question! It’s always important to take complaints from kids seriously, especially after an actual mechanism has taken place (like twisting the ankle, or being hit by another player). Generally, if they are not able to walk right after the incident, or are significantly limping for days after the injury, it’s recommended to see a doctor. If there was a concussion, they MUST NOT return to play until cleared by a doctor.
I read that ACL tears are much more frequent in women players than men. Is that true and if so, why?
This is true- female youth athletes are at increased risk for ACL injuries compared to male athletes. There are several different factors like the female anatomy (wider hip/ pelvis, and knee anatomy relating to the ACL); hormonal influences, and improper movement patterns (e.g. a tendency for females to be more knock-kneed when they land jumps/ hops, and tendency to land jumps with stiff knee). While the first two really cannot be changed, proper training can modify landing mechanics and decrease the risk for injury.
What is your advice around headers? (Age, frequency, cautions)
Youth soccer players younger than 10 are banned from heading a ball, and 11 to 13-year-old athletes have limitations on heading practice (specifics can be found here: https://usclubsoccer.org/headinjuries/). Concussion risk from heading a ball depends on athlete’s size, strength, and technical ability- all of which are not fully developed in kids. It’s imperative for athletes to learn the correct heading technique and have adequate neck strength to reduce the risk of injury. Balls that are overinflated or too big for the athlete can also increase the risk of head injuries, so playing with an appropriate size ball is super important.
My daughter trains 2x/week. Is it better to have her train one more day in soccer or two more days in basketball which is her other sport?
It depends on how old the athlete is, but if they are on the younger side (let’s say younger than 15), then there is more benefit from playing different sports. While there are special circumstances, the general recommendation from the American Academy of Pediatrics is for athletes’ training/ playing time in a single sport (in hours per week) to be less than their age (so if your kid is 13 years old, they should be playing soccer- including games- no more than 13 hours per week).
If they are an older adolescent, then “specializing” is ok, if they cross train, strength train, work on mobility (like stretching/ foam rolling) and get adequate rest/recovery
What kind of preventative measures can players take to mitigate the risk of injury?
1) proper warm up and cool down
2) regular stretching routine (especially in growing athletes!!)
3) strength training (core, legs, upper body)
4) balance training
5) plyometrics- “Neuromuscular training”- Sounds complicated, but essentially learn the proper way to move. Humans are born with the ability to move properly, but we lose it during growth spurts. It’s super important for athletes to know how to squat, jump, cut/ pivot correctly. A good example is the FIFA 11+; or working with a good trainer.
How does the playing surface (grass vs. turf) impact the injury risk?
When the very first turf came out, there were suspicions of increased shoe-surface friction that increased torque at the knee and ankle resulting in a spike of ACL injuries and ankle sprains. The newer third generation turf mimics natural grass, and most recent studies reveal no difference in injury rates between turf and grass. In fact, a 2016 study found that youth soccer players who had a leg injury were more likely to have played on grass! (Grass is also hard to maintain…)
Ask The PT is a recurring series offering parents advice on training, preventative care, and injury trends.