The weather is warm, and with only weeks left in the school year, kids will be heading into intense summer athletics. For many, that means soccer. In the United States alone, as many as 12 million players over six have registered to play outdoor soccer.  While this means plenty of sunshine after the years-long pause of team sports and group activity, it also means injury.

Injuries are, unfortunately, synonymous with sporting activities. Soccer participation is on the rise, as is the emphasis on starting small children in youth soccer. As a result, anticipating and preventing injuries has become essential to families and organizations invested in the well-being of our future generations.

In soccer, lower extremity injuries are common, as the game is a running, cutting, sliding, and kicking activity. Hamstrings, shins, ankles, and feet are all areas of concern, but the most common soccer injuries occur in the knee. The femur (the bottom end of the thigh bone), the tibia plateau (the front of the shin bone at its top end), the patella (the kneecap), their tendons and ligaments, and the meniscus and cartilage of the knee are all vulnerable to fractures and bruising, as well as general overuse stress. After the injury, there are also longer-term consequences of monitoring and treatment that must be addressed.

What Injuries Do Kids Experience Most Often?

Trauma and simple overuse or repetitive movements are primary causes of injury during training and high-intensity play. Repetitive and overuse injuries occur with prolonged movement of any joint. They often involve tendons and the ignoring or playing through ligament sprains or strains. These are the most common but not the only repetitive motion injuries we see in soccer.

Bone and cartilage within joints can wear on each other, creating inflammation and degradation. Patellofemoral disease can occur from the mistracking of the kneecap and the end of the thigh bone. This often relates to the shape of leg bones and flat or pronounced foot arches but could also develop over time due to imbalance or unusual stress, often following injury. The cartilage can degrade or “bruise” depending on the force of an impact or injury, especially when the ligaments are strained. This type of cartilage does not recover well after injury and may scar at best, leading to inflammation and swelling, joint degradation, arthritis, and pain.

As the femur and tibia impact under stress, a scissor-type pressure on the meniscus can cause tears, often leaving frayed pieces of cartilage, which can be painful and easy to re-injure. This can contribute to inflammation leading to fluid swelling of the joint, which can be painful and cause a range of motion issues when trying to perform athletically.

A ruptured ligament may often (but not always) require surgical reconstruction. A common and well-known type of this injury is the Anterior Cruciate Ligament (ACL) tear. Surgical repair involves grafting or replacing the native ACL with one’s tissue. In all reconstruction cases, a time of deliberate rest followed by comprehensive physical rehabilitation is required for success and return to sports.

Preventing Acute Injuries

Acute or Acute-on-Chronic injuries may be preventable to a degree.  Primary preventative measures include:

• Nutrition and hydration goals with balanced electrolyte replacement, during and even days before or following games.
• Resistance and cross-training between and after competition can strengthen supportive muscles. This can be achieved with light resistance bands, weighted bracelets, anklets, vests, weight lifting (with proper form), and swimming. This serves to strengthen supporting muscles, especially within the abdomen and pelvis.
• Repetitive motion injuries such as tendonitis, patella-femoral inflammation, or shin splints are best prevented and treated with rest.  This is not always possible during times of elevated competition, so speak to your orthopedic surgeon or sports medicine specialist for strategies.

On-the-field measures should always include:

• Deliberate and patient stretching exercises. Avoid bouncing or full weight-bearing stretching when possible. Use slow and incremental increases in motion, especially with assistance from a trainer or partner.
• Active range of motion exercises (as opposed to stationary) may be beneficial to ‘warming up’ cold muscles and lubricating joints by circulating blood supply to muscles and synovial fluid (natural internal joint lubrication fluid). This can help decrease the wear and tear of repetitive motion stresses and injuries.
• Full-length warm-up garments and compression wear, even in warm weather, can help maintain circulation while awaiting competitive play, either during pre-game warmup or while subbed out.
• Specialized equipment for youth soccer, such as dedicated footwear with smaller multi-knobbed and textured cleats, may be more stabilizing than even expensive screw-on cleats and help prevent stress on the knees.
• Artificial turf may be less forgiving of stresses and strains, leading to greater incidences of injuries as opposed to natural turf, especially on well-maintained fields, which is not always a given in less-regulated youth sports.
• Wearing shin guards is non-negotiable at the youth level. Sleeves and braces may be recommended by your sports medicine professional.

Tips for Getting the Best Care

As with all medical concerns, information is paramount in preventing injuries. When they (almost inevitably) occur, ascertaining their degree and severity, determining how to address them in a conservative versus aggressive manner, how to recover, and potential long-term consequences must be considered and discussed with your specialist physician.  Relying on the care guidelines from competitive youth organizations alone, even those with certified trainers and specialists, is not enough.

A good rule of thumb is: “when in doubt, get checked out.” This is especially true for issues related to stability and circulation.

1. When injuries such as pain, redness, and/or swelling, especially instability of the knee, occur, seeking professional evaluation would be a significant first step. Injuries can appear well after the competition, so keep an eye on the development or worsening of symptoms.
2. Be mindful of excessive travel and competition, especially with active or recent injuries.  When trainers and specialists are engaged, continued open communication on return to play is essential.
3. Explanations of all treatment regimens and potential side effects are essential. Attendance by a parent or child advocate during exams and treatments helps ensure safety and allows a child to feel comfortable communicating pain or anxiety.
4. A stepwise plan with potential contingencies for exams or further diagnostics due to variations in healing would enable thoughtful decision-making and when to contact physicians in times of concern.
5. Do not rely on paperwork or hearsay alone.  Be an advocate for your youth athlete, and never be afraid to communicate when you are not comfortable with their safety or care. Ask questions and solicit the opinions of the medical experts around you.

Ensuring a lifetime of safety and activity in sports is always more important than a single game or even season of youth soccer participation. For more information about preventing and treating injuries sustained during youth soccer, we encourage you to contact our office and speak to an experienced sports injury specialist.

About Ira Guttentag, MD, FACS

Dr. Ira Guttentag is a board-certified orthopaedic surgeon and is also the Medical Director and Head Team Physician for the Tampa Bay Lightning since 2002. He is an orthopaedic consultant for the Toronto Raptors and Tampa Bay Buccaneers. In addition, he is the Team Physician for the Tampa Bay United and Florida Premiere soccer clubs, as well as a for multiple high schools in Hillsborough and Pasco counties.

He specializes in performing knee and shoulder reconstruction, ligament reconstruction, meniscus and rotator cuff repairs, and minimally invasive outpatient partial and total knee replacements.

Dr. Guttentag’s goal is to find treatment options that fit each patient’s individual needs. Whether you’re a pro or just exercise to stay fit, and whether your injury needs non-operative or surgical care, Dr. Guttentag wants to help you get back in the game.

Disclaimer: This blog is not intended to substitute professional medical advice. Always talk with your doctor before starting or stopping medications or treatments.