1. In youth soccer, most lower body injuries come from non-body contact and occur more in competition than training or practice sessions. While training injury incidence rates usually do not change with increased player age, match injury incidence tends to increase with age through all age groups
2. The time of the adolescent growth spurt (girls usually age 12-14 and boys usually age 13-16) seems to have an increased vulnerability for traumatic injuries. Afterwards athletes seem to be susceptible to cumulative overuse injuries.
3. Knee injuries occur in 7% to 36% of injured players and are seen more frequently in females Middle school soccer playing females have a higher rate of anterior knee pain issues than volleyball or basketball players. Any single-sport adolescent female has a higher risk of anterior knee pain issues.
4. Adolescent female soccer players suffer a roughly 3-6 times increased risk of ACL rupture compared to boys playing the same sport. Several factors have been proposed for the increased risk, such as anatomic differences, hormonal contributions with menstrual cycles, and higher-risk single-leg landing, turning, and jumping positions.
5. Female adolescent players who completed certain Neuromuscular Training Programs intended to reduce knee injuries have been shown enjoy significantly reduced ACL injury rate compared with players with low compliance.
6. Ankle injuries account for 16% to 29% of injuries and are more frequent in male and older players Ankle contusions more common in younger players due to the more ground-oriented game, while in older players ankle sprain tend to occur due to the more aggressive and faster game.
7. Taller players are more likely report more overall injuries than shorter players, and more apt to suffer knee injuries often by playing more physically demanding positions with jumping and abrupt turning.
8. Shorter players are often recipients of intense and often violent direct contact to the foot and ankle regions.
9. Greater exposure to training and competition leads to a greater risk of injury due to the high intensity of the activities.
10. The higher incidence of injury during matches than training highlights the need for education and prevention programs in youth soccer. These programs should focus on coach education aimed at improving skills, techniques, and fair play during competitions with the goal of reducing injuries.
What ideas do I have to help reduce these risks?
- Find ways to make evidence-based injury prevention programs standard practice for all young players
- Ensure proper Certified Athletic Trainer or other medical coverage
- Place large emphasis on fair play and rule enforcement
- Caution with players tending toward year-round or single-sport emphasis at/near their peak growth periods
What ideas would you add to help young soccer players reduce lower body injuries?
When an athlete presents to me with concerns over multiple ankle sprains or on-going ankle swelling, what thoughts go through my mind?
- Inadequate Rehabilitation of Previous Ankle Injuries
- The number one risk factor for future ankle injury is under-rehabilitation of a past ankle injury.
- Ankle sprains are defined as stretching or partial/complete tears of the ligaments that connect bones on the outside and inside of the ankle joint. The majority of ankle injuries are caused by rolling in of the foot (called an inversion ankle injury) and cause damage to the anterior talofibular and calcaneofibular ligaments on the outside of the ankle. Injuries with rolling out of the foot are less common and cause injury to the deltoid ligament on the inside of the ankle.
- The healing process with a damaged ligament leads to scar tissue formation at the site of the tear. Trying to come back too soon after an ankle sprain will limit the scar formation and predispose the ankle to future injury.
- Even with appropriate recovery time for scar formation, a sprained ligament is never completely as strong as prior to injury. Undertaking an appropriate rehabilitation program that builds up the strength and proper firing patterns of the peroneal muscles on the outside of the ankle can help compensate for the reduced ligament strength and reduce risk of later injury. Increasing strength of the muscle above the ankle, including the hip rotators, can also reduce the risk of future ankle problems.
- Underlying Structural Abnormalities such as Tarsal Coalition
- The ankle joint is defined as the "upside-down U shaped mortise space" between the tibia (shin bone), fibula (thin bone on outside of lower leg) and the talus (first bone of foot). Below this mortise ankle joint are the sub-talar joints which include connections between the heel bone (calcaneous), talus, navicular (bone on top of inside foot arch) and cuboid (bone on outside of foot).
- Abnormal bone or fibrous soft tissue bridges between these tarsal and sub-talar region bones can develop as part of on-going foot development or after an injury and can lead to restrictive motion of those sub-talar joints causing increased stress and higher risk of ankle sprains.
- What are physical exam findings that suggest tarsal coalition?
- Ask patient to walk with the feet turned in- they cannot turn feet in sufficiently to walk on the outside of the feet
- Ask the patient to stand on toes with heels raised- when viewed from behind, the heel bone will not turn in (invert) suggesting reduced subtalar motion
- Often these subtle physical exam findings are the best initial clues for discovering tarsal coalition
- X-ray examination may show osteophytes (extra bone) on the front aspect of the talar neck (white arrow below), a prominent lateral process of the calcaneous, and narrowing of the joints below the talus (black arrow below). In many cases, Magnetic Resonance Imaging (MRI) or CT Scan might be needed to better define the anatomy
- Osteochondral Lesions of the Talar Dome
- The top part of the talus bone (known as the dome) is covered by articular cartilage, and one or more ankle injuries can cause damage to the cartilage and underlying bone known as an osteochondral lesion.
- Osteochondral lesions are notorious for not appearing on initial x-rays taken at the time of injury. Don't be fooled or lulled into complacency with normal early x-rays and an ankle that isn't getting better.
- A classic presentation is the case of an ankle sprain which never fully recovers and results in chronic swelling of the ankle joint associated with clicking, catching, or locking sensations.
- Often, repeat x-rays taken weeks to months after the injury may reveal signs of an osteochondral lesion (black arrow) with separation, fragmentation, and irregularity seen at the talar dome. MRI might be used to better categorize the nature of the injury.
This blog post is not intended to diagnose or treat any ankle or other injury. If you have concerns over repetitive ankle injuries or recurrent ankle swelling, please contact me or your sports medicine specialist for a proper evaluation or treatment plan.
