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Soccer: Traumatic and Overuse Injuries

ACL Tear Prevention

Along with all of the benefits that soccer has to offer, it also comes with its injuries and trials. If you have played soccer for any length of time, there is a good chance you have undergone an injury of some kind. Most of the injuries are minor, and only 1.4% of the injuries result in surgery. Most soccer injuries can be categorized as either traumatic injuries (getting slide tackled late, rolling an ankle, pulling a hamstring etc.) or overuse injuries (tendonitis, shin splints, stress injuries etc). Here at BIA, we can help get you “Back in Action” quicker and safer. 

About 42% of injuries while playing soccer come from contact with another player. This leaves a lot of injuries coming from the ground, the goal post, the ball or just from poor mechanics or preparation. Majority of injuries are lower limb injuries and are considered minor in nature, but still lead to time away from sport and/or decreased performance. Here we will talk briefly about some of the common injuries and what you can do to recover quicker and even prevent future injury and time away from the game we all love. 

As with all injuries, it is important to understand the what structure is injured. However, it is more important to determine the underlying cause of the injury. This may be obvious with overuse injuries, but the majority of traumatic injuries are proceeded by a poor movement pattern. For example, ACL tears are usually non-contact and the knee looks like this before the tear – At BIA we can get you looking like the “after” picture to make you INJURY TOUGH!

Traumatic Injuries 

Sprains and strains: Most of us have sprained an ankle or pulled a groin or hamstring at some point in our careers. These types of injuries, if not treated properly, can haunt you for a long time. Once you have had this type of injury, it will be much easier to re-injure again. At BIA, we can make sure that you recover fully and know how to train in order to decrease your rick of recurrence.

Hamstring Strain:  These are likely from sprinting or quick acceleration or deceleration. Can be anywhere along the muscle on the back of the thigh, but most commonly at the proximal attachment near the glut. This can cause difficulty with straightening the knee and walking. Typically feel better with static activities early, but remain bothersome when returning to sport. If you try and return to dynamic sport too early and without proper return to sport guidance, re-tear/re-strain is common.

Hip Flexor Strain/Avulsion fracture: This is another common strain, which can result from striking the ball or agility exercises without proper warm up. Pain in the front of the hip and pain during kicking are some common symptoms. Like hamstring strains, full recovery is important prior to return to sport. In some cases, there can be an avulsion fracture at the superior attachment, these may take a little more time with the required bone healing but the rehab is the same.

ACL and ligament tears: ACL tears are on the rise and female soccer players are 2-8x more likely to tear their ACL. These can be devastating injuries but with good rehabilitation you can be better after the injury than you were before. How is this possible? There are poor movement patterns that lead to these injuries, which affect your performance on the field as well. So as you complete rehab, you can actually perform better than before. While ACL’s usually require surgery, the MCL does not – it’s the only ligament in the body that can heal itself. The same poor movement pattern drives this injury. Finding the right PT with specializes in ACL rehab is critical to have the best outcome to prevent re-tear or tear to the other side. BIA has those specialized therapists. We also offer ACL tear prevention program called “Jump to Perform.” With the right prevention, athletes are 80-90% less likely to tear an ACL. During this class, you will also be working on speed, agility, power and jump training that can improve your game while reducing your risk for injury.

Meniscus tear: This is often hard to differentiate initially from other common landing, twisting and pivoting injuries. However, buckling, catching or clicking in your knee is a good indicator and you should have your knee assessed. It is typical of this pathology to have pain with full flexion or extension. Recent research is in favor of more conservative management vs surgery for small tears.  

Ankle sprain: This is a common injury in many sports and soccer is no different because of the required cutting and pivoting nature of the sport. Swelling, especially along the outside of the ankle, discoloration, limited range of motion and tenderness around the ankle are common. If you are unable to take 4 steps through your ankle/foot, an x-ray may be indicated. If you are able to take a few steps, although painful, the likelihood of a fracture is low. An assessment can give you an idea of return to sport timeline as different grades require different healing times. The prevalence of re-injury is high. CAI or chronic ankle instability is a serious condition, but can be improved with proprioception and stabilization exercises. We can also give advice on taping strategies, shoe selection and bracing (specific to soccer) to further reduce your risk of future re-injury. For reference, there are two types of ankle sprains, low and high, which carry different

Concussions: Soccer is one of the top 5 sports in concussion prevalence. See our concussion link for more information on concussion treatment and rehab. Concussions primarily occur with head to head, head to ground, or head to goal post – not from heading the ball. Click here for more specific information related to concussions, management, and rehab.

Overuse Injuries

Time away from your sport does not always come from a specific incident or tackle on the field. It can come from over training, poor mechanics, or poor preparation. These types of injuries show up as tendonitis, shin splints, stress fractures, or just that nagging pain that won’t go away. We can help you recover from these injuries, but we also offer free screenings for athletes in order to assure these injuries don’t get out of hand. Our goal is to keep you playing at peak performance. Research shows that the sooner an athlete gets treated for these types of injuries, the quicker their recovery will be. So if you are not sure why that ankle is still sore, or why you get pain after “easy training sessions,” then come by one of our screens and we can give you some tips on how to decrease this pain, as well as how to make you injury tough (less risk)!

Shin splints: This is pain along the shin bone (tibia) that comes from stress along the tibia and connective tissues. Tibia is often sore to the touch and shows weakness compared to opposite leg. This is common after a sudden increase in running distance, change of surface played on, or increase in sprinting workouts. Often correlated to improper footwear, unsupportive shoes, fallen arch/collapsed arch and/or poor dosage of exercise. Weakness of the lower chain can also contribute to increased stress along these areas.

Osgood Schlatter/patellar tendonitis: This is a common injury which is more prevalent in boys age 12-14 and girls 10-13 years old, especially when going through a growth spurt. This presents as a pain just below the knee cap and typically shows a bony bump at the attachment to the knee. The quad muscle pulls on the tendon and with repeated stress (running, jumping, cutting) causes irritation/swelling and can lead to new bone growth forming the bony bump. Tight quads also contribute to this irritation.

Patellofemoral pain: More prevalent in females than males and sometimes called runner’s knee. The pain is under or around the knee cap (patella) and increases when you run, stair climbing, sitting for long periods, or squatting. There is typically a muscle imbalance and poor movement pattern that is causing this type of injury and can lead to other more traumatic injuries if not addressed. Let’s help you get that on the right track.

Illiotibial Band tendonitis (ITB): This is a typical injury of runners but can also occur in soccer. This is a friction injury that occurs on the outside of the knee as the tendon crosses the bone when you bend/straighten at about 20 degree knee bend. There can be swelling and pain can be very sharp as it goes over the bone. While the pain is at the knee, we have to look higher at the hip for the real problem – typically hip weakness, tightness, or just poor control. Shoe wear can also be a factor.

Sever’s disease (heel pain): This sounds worse than it is. There is back of the heel pain and/or swelling with running, jumping, walking and occurs frequently in adolescent boys especially during growing years. Choice of cleat is critical and orthotics that can fit in the cleat are often required along with help with hip, knee, ankle control which BIA will address. Most store bought cleats do not work in the low profile soccer cleat.  

Low back pain: 14% of soccer injuries are reported to be in the low back. The vast majority of these injuries are postural – a lack of control of the core during running, cutting, contact, etc… There can be a large contribution from poor hip or ankle mobility. Core strength is important but it’s about the ability for the core to resist movement into extension, rotation, or flexion. It’s your powerhouse!

Spondylosis/spondylolisthesis: This is a lumbar spine issue that has several causes. A young athletic population is at higher risk particularly a sport with where there is repetitive hyperextension (during heading a ball) or repetitive rotation across the lumbar spine. While not as common in soccer, it can be a source of low back pain and should be considered.

Female Athlete Triad: 2% of female athletes (of all kinds) get female triad. It is characterized by loss of a regular menstrual cycle. While it may seem like this is not a big deal, it’s actually a huge deal. Every year during our high school pre-participation exams, we find 5-6 athletes (out of 225+) that have irregular or non-existent periods- they have all been soccer players so it’s worth mentioning here. It results in decreased bone density and can lead to stress fractures and in the long-term this young female loses the opportunity to build her bone density before age 30. That’s right, after you turn 30, you can only lose bone density without medicinal intervention. The cause is low energy availability – she doesn’t necessarily have an eating disorder, she just may not be getting enough calories to support her daily activity. This is most common in endurance athletes but there has been a rise in cases in soccer players with the explosion of youth soccer and the demands of the sport. Take this seriously and contact your physician or BIA with questions and we can point you in the right direction.