By Kirk R. Davis, D.O.
The bumper sticker reads “Soccer: Everyone Plays,” is very true as there are over 200 million registered players world-wide. Excitement for this sport in this country has never been greater since the exciting United States Women’s World Cup victory.
Soccer is a game of non-stop action with long grueling seasons. Club and high school teams make seasons last nearly year round. This requires excellent physical conditioning, despite this injuries do occur. The rate of injury has been reported to be between fifteen and twenty injuries per one thousand hours of play and tends to be slightly higher in females than male participants. Acute injuries range from bumps and bruises all the way to broken bones and severe joint injuries. Overuse injuries account for almost thirty percent of the injuries in soccer and range from mild tendonitis all the way to stress fractures.
Overuse injuries are often heralded by redness, warmth, swelling, and pain called inflammation. These symptoms may start as mild aching pain after activity to mild pain while playing and progress to where athletes are unable to maintain their level of performance. Youth and adolescent players are especially at risk for overuse injuries during time of rapid growth. The areas of strong muscle pull on tendon attachments to areas of the growth plates can become inflamed. This is called apophysitis. With the repetitive running and jumping required in soccer, a common place for this to occur is where the knee cap (patella) tendon attaches to the shin bone (tibia), causing a painful bump. This is referred to as Osgood-Schlatter’s disease. Inflammation of the growth plate of the heel bone (calcaneus) is common in young soccer players and is termed Sever’s disease. Many other areas of growth plate inflammation can occur at the pelvis, hip, and hamstrings in growing muscle attachment areas. The worst case scenario in these injuries result when a stress fracture occurs about these areas. A stress fracture results from the inability of bone to continue to heal as enough for the stresses that are put upon it. Adult and older teenage players also have overuse injuries. Common areas for overuse injuries for these players include the heel cords (Achilles tendon) bottom of the foot, (plantar fascitis) and inside of the shin bone (tibia) known as shin splints.
Prevention and treatment of these injuries can easily be remembered by PRICE. Prevention is the most important part of the equation. Many of these injuries are associated with muscle tightness and overuse during these rapid periods of growth. For example, Osgood-Schlatter’s disease is often associated with tight hamstring muscles. Sever’s disease is often associated with tight heel cords. Therefore, obtaining and maintaining flexibility with appropriate warm-up and stretching exercises is vital in preventing injuries. (See last month’s Healthy Living News article on flexibility). Protection of the injured area is required to allow adequate healing to occur. This may be accomplished by padding, and bracing all the way to requiring crutches and casting. Nearing the end of long seasons adequate Rest is needed to allow injured tissue to repair itself. Ice can be used to decrease inflammation. It should be applied after activity for twenty minute internals three to four times throughout the day. Practical ways to do this at home is utilizing ice within a zip-lock type freezer bag applied over the affected area. Another option is an ice cup massage where water is frozen in a styrofoam cup, the edges of the cup are easily pealed back to create an ice block that can be massaged in a circular motion over the affected area. Compression involves the applying of an elastic wrap (ACE) or a pull-up type of neoprene brace over the affected area. Care should be taken to maintain an even pressure that is not too tight to cut off blood flow. Elevation helps decrease swelling by using gravity to assist in the process. One major error in elevation is that the affected body part has to be higher than the level of the heart. An example of this is a sprained ankle has to be higher than the knee and heart to allow the fluid to drain downhill. Therefore it is inadequate just to prop the foot on a foot rest of a recliner; one needs to lie down on the couch with the foot propped on several pillows higher than the level of the knee and the heart. Anti-inflammatory drugs (NSAIDS) are available over-the-counter. These include aspirin, Ibuprofen (Motrin), naproxyn sodium (Aleve), and ketoprofen (Orudis). Care must be taken for those with stomach or kidney problems who are going to take these medications. They should not be taken on an empty stomach or taken by individuals with ulcers. When the athlete considers to return to play appropriate rehabilitation Exercises should be started to aid in healing and to return and maintain the athlete at an appropriate level of physical condition. These include appropriate warm-up, stretching and specific strengthening exercises for the injured area.
Proper conditioning, appropriate training techniques, quality foot wear, proper warm-up and stretching, and paying attention to the body’s early warning signs could prevent overuse injuries. Early treatment with Prevention, Rest, Ice, Compression, and Elevation can shorted the time away from playing. If the signs and symptoms persist, players should get medical attention to prevent further injury.