Soccer: Staying on the Field

Andrew Getzin, MD Clinical Director Sports Medicine and Athletic Performance [email protected]

www.cayugamed.org/sportsmedicine

Overview

• Injury Data • Hamstring strains • Injury prevention

Statistics • Most popular sport in the world • 200,000 professional soccer players • 240 million amateur players

Nature of Soccer

• Contact sport • Low static- High Dynamic • High-moderate intensity sport – Physically demanding • Aerobic – Running: long-distance and sprinting

Injury Incidence- ER visits • 1990-2003, 2-18 years old • 1,597,528 injuries over 13 years • Mean age = 13.2, Gender = 58.6% male • Body parts: – Wrist/hand 20.3%, ankle 18.2%, knee 11.4% • Diagnosis: – Sprain/strain 35.9%, contusion/abrasion 24.1%, fracture 23.2% Leininger, AJSM 2007

Injury Incidence- US High Schools • 2.39/1000 hours of participation – Higher rate during competition (4.77) than practice (1.37) • Diagnoses – Ligament sprains 26.8%, muscle strains 17.9%, contusion 13.8%, concussion 10.8% • Body part – Ankle 23.4%, knee 18.7%, head/face 13.7%, thigh/upper leg 13.1% Yard. AJSM 2008

Risk Factors • Increasing age • Female gender (schmidt-Olsen 1991, Concussion and ACLs, Putukian, 2002) • Prior injury- i.e. ankle (Soderman, 2001, Emery, 2006) • Position?

Injury Rates

• Overall injury rates – Higher than American Football, basketball, field hockey, rugby (Wong 2005) • Concussion rate – Similar to American football, ice hockey (Al-Kashmiri, 2006)

Hamstring Anatomy

• Muscles – Semimembranosus – Semitendinosus – Long and short head of biceps femoris – Hamstring portion of adductor magnus • Originate from the pelvis and insert distally into the knee

Hamstring Mechanism of Injury

• Sprinting or Jumping • Usually occurs with eccentric loading- slowing down • Poor flexibility?

• Strength imbalance • 62% occur in competition, 32% in practice • Increased risk at end of halves and with prolonged training • 34% recurrence rate

Clinical Presentation and History • Sudden onset of pain in posterior thigh • May or may not have a pop • Loss of strength • Transient sciatica

Physical Exam

• Area slightly swollen, tender, may or may not have ecchymosis • Important to palpate hamstring for possible defect or avulsion • Passive knee extension and hip flexion increased pain • The more proximal to the origin the injury- the longer the return to play

Taking Shoes Off Test

Zeren. Clin J Sports Med 2006

Imaging

• Limited role for plain x-ray, can help exclude avulsion fracture • MRI helpful with prognosis, often serial MRI • ?worth the cost

Early Treatment: day 0-7, Inflammatory phase The correct early treatment for an acute hamstring strain includes: A: RICE (rest, ice, compression, elevation) B: Immobilization C: Advil and/or Tylenol as needed D: all of the above

Sub-acute Treatment

All are appropriate sub-acute treatments except: A. Initiate range of motion exercises a few days after the injury B. Progress to jogging when ready C. Gradually initiate eccentric loading D. Play X-box all day while resting your hamstring

Hamstring Rehab • 24 athletes with acute hamstring strain • Stretching and strengthening group • Progressive agility and trunk stabilization group • RTP 37.4 vs. 22.2 days Sherry and Best. J Ortho Sports PT 2004

Chance of Recurrence After Return from Injury- Australian Football League Orchard, John; Best, Thomas M.

Clinical Journal of Sport Medicine. 2002.

Hamstring Return to Soccer

When is the best time to return to play?

A. When Full Range of Motion and symmetrical strength is achieved B. When there is no pain at full practice C. The day before the championship game D. Other

Hamstring Injury Prevention

• 30 players from Sweden premier division • 10/15 hamstring injuries in the control group • 3/15 hamstring injuries in intervention • Intervention improved running speed Askling. Scand J Med Sports 2003

The PEP Program: Prevent Injury And Enhance Performance Decrease in ACL Injuries in trained Female athletes • 2001: 88% • 2002: 78% Mandelbaum,. Am J Sports Med 2005;33:1003-1010

Decrease in Ankle Injuries

• 116 male and female volleyball teams from Dutch 2 nd and 3 rd division • Control group and intervention group did balance training • Significant decreased risk of ankle sprain- in individuals with previous sprains Verhagen. AJSM 2004

Accidental Compensation Corporation • New Zealand federal program that covers resident or visitor to New Zealand • http://www.acc.co.nz/i ndex.htm

• SportSmart programme

1. Screening

Assessing health and fitness before playing identifies injury risk

2. Warm-up, Cool Down and Stretch

The right preparation for mind and body makes for a better performance. Cooling down helps the body to recover and is a good time for flexibility

3. Physical Conditioning

Staying in condition means playing to your maximum potential

4. Technique

Know how to play safely with good technique

5. Fair Play

Good sport is about positive attitude- playing fair and enjoying the game

6. Protective Equipment

Protect yourself against injury by using the right equipment

7. Hydration and Nutrition

Eating the right food and drinking adequate fluid helps maintain health and sports performance

8. Injury Reporting

Gathering information about injuries and monitoring how and when they occur help in injury prevention- and improve the game for everyone

9. Environment

It is not only the weather that counts- safe surroundings means safer play

10. Injury Management

Getting the right treatment sooner means less pain and a faster recovery

Thank You