Monash University Accident Research Centre Report No. 125 - 1997
Authors: A.C. McGrath & J. Ozanne-Smith
Full report in .pdf format [600KB]
Soccer is the most popular sport in the world, and one of the most popular in Australia. Soccer is characterised as vigorous, high intensity, intermittent, ball and contact sport. The characteristics of soccer along with the required functional activities obviously places great demands on the technical and physical skills of individual players. A direct blow from a soccer ball or a stray kick may result in fractures, bruising, or even death. Soccer players can also suffer from a range of overuse injuries associated with running, jumping, pivoting, heading and kicking of the ball. The overall aim of this report is to critically review both the formal literature and informal sources that describe injury prevention measures, or countermeasures, for soccer. The range of countermeasures for preventing soccer injuries is presented in this report, together with an assessment of the extent to which they have been formally demonstrated to be effective. Such countermeasures include pre-season conditioning, protective equipment including shin guards, warm-up programs, attention to environmental conditions, adequate footwear, modified rules, education and coaching, first aid and rehabilitation. Recommendations include the need to conduct more biomechanical and epidemiological research into the mechanisms of injury; further development and testing of protective equipment; improving education for both players and coaches, particularly at the wider community level; adopting modified rules for children; extending pre-participation screening to the general soccer community; providing prompt first aid; and improved injury data collections, particularly for the less formal level of play.
Soccer is characterised as vigorous, high intensity, intermittent, ball and contact sport. Functional activities include acceleration, deceleration, jumping, cutting, pivoting, turning, heading and kicking of the ball . It is obvious that the game of soccer puts many demands on the technical and physical skills of the individual player . Soccer is one of the most popular sports with over 270,000 registered Australian players and approximately 200 million players in 186 countries registered with the International Federation of Football Association . Further there is estimated to be a equal number of unlicensed soccer players .
With an increase in popularity and expectation of players, along with the characteristics of soccer, significant numbers of injuries are conceivable. Although a significant amount has been published on the epidemiology and biomechanics of soccer injuries, there are few formal, controlled evaluations of the effectiveness of injury prevention countermeasures.
This report aims to critically review both formal literature and informal sources that describe injury prevention measures (countermeasures). It provides an evaluation of the extent to which these countermeasures have been demonstrated to be effective. Unlike other literature describing soccer injuries, this report does not specifically focus on the epidemiology of soccer injuries, nor their aetiology. Instead, it presents a detailed examination of the range of countermeasures promoted to prevent soccer injuries. A brief overview of the epidemiology of soccer injuries, particularly from an Australian perspective, is given to set the scene for the subsequent discussion of countermeasures.
Recommendations for further research, development and implementation are based on the review presented here and discussions with experts acknowledged in this report. Many of the recommended countermeasures have not yet been proven to be effective and further controlled evaluation studies are needed. A summary of the countermeasures reviewed and recommendations for further research, development and implementation are given below.
LOWER LEG INJURIES AND TECHNIQUE
The nature of the game of soccer, in which players make sharp turns off a planted foot, and intense contact with the ball and other players, along with the essential underlying components of running and kicking, indicate the vulnerability of the lower extremities. The epidemiological soccer literature clearly indicates that the majority of soccer injuries occur to the lower extremities. Lower extremity injuries account for between 58% to 93% of all injuries for adults and 39.1% to 89% for children. The dominant injuries occur to the knees, ankles and shins. Countermeasures include correct footwear and shin guards.
While the vast majority of soccer injuries occur to the lower extremities, injuries to the head and neck may also occur. From the international literature, the proportion of total injuries to the head, spine and trunk areas ranges from 4-22% in adults and 9-26% in youths. Head injuries are sustained from heading the ball, ball strikes to the head and head to head contact, most often when two players attempt to head the ball simultaneously. Common head injuries include lacerations and concussion. Unlike injuries to the lower extremities, injuries to the head and neck have greater potential to be catastrophic.
Most sports can give rise to dental, mouth and face damage, though contact sports such as soccer, have been shown to have a relatively higher incidence. There is an absence of FIFA rules for protection from orofacial injury and no mention of such devices in texts for coaches and athletes.
Over a 16 year period (1979-1994), the Consumer Product Safety Commission, a United States federal government agency, reported at least 21 deaths and an estimated 120 injuries involving falling soccer goal posts had been treated in US hospital emergency rooms. These statistics do not encompass the numerous injuries that occur and do not receive emergency treatment.
RULES OF THE GAME
Pushing, holding, barging, tripping, striking or intentional kicking are not allowed in soccer and free-kicks are awarded when rules are broken. If a player commits a serious foul, abuses an official or continues to break the rules, then they can be warned with a yellow card, or sent from the field with the presentation of a red card.
A major concern to the reputation and popularity of soccer is the worldwide risk of injury and even death through crowd violence. Although Australia has been less prone to this than other countries, signs of tensions in supporting crowds have begun to emerge in recent years.
A soccer player needs to meet at least minimum physical, physiological and psychological requirements to cope with the demands of competition and reduce the risk of injury. Individual player factors are often related to soccer injuries and can be prevented through corrections in training and conditioning. Warm-up and stretching is also recommended to increase playing ability, however, its role in injury prevention is controversial.
PREVENTING OVERUSE INJURIES
Soccer players, like any athletes today, are expected to train harder and longer, and to commence at an earlier age, if they are to succeed at the elite level. It is, therefore, not surprising that there is an increasing number of overuse injuries. An overuse injury results from an accumulation of stresses to the involved tissue - bone, ligaments or tendons. Alternatively, an overuse injury could result from a previous injury for which the body compensates, by increasing the stress on another part of the body, eventually leading to tissue breakdown and overt injury at the vulnerable site.
Traditionally soccer is played on a rectangular field, predominantly a grass surface, and less commonly a surface of sand, gravel or artificial turf. During a game a player covers a large percentage of this area and suffers significant impact forces of two to three times body weight. For this reason the surface and the environmental surrounds are important factors to consider when reviewing the nature and incidence of soccer injuries.
MODIFIED RULES AND CHILDREN
Significant differences exist between child and adult athletes. Therefore injury prevention strategies for children should be considered separately to those for adults, despite the fact that their injuries may be attributed to many of the factors associated with adult soccer players.
EDUCATION AND COACHING
Education, as a component of injury prevention should cover a wide range of aspects such as facilities, training and treatment. Guidelines have been produced by the Australian Sports Commission and the Australian Soccer Federation to aid in school education programs, particularly on Rooball and progression to traditional soccer.
FIRST AID AND REHABILITATION
Injuries need to be properly managed to restrict the possibility of further damage. Overall, the treatment goals are pain relief, promotion of healing, decreased inflammation, and a return to functional and sports activities as soon as possible. This procedure may involve, first aid, taping or bracing, referral and general rehabilitation.
Indoor soccer, is played by over 100 countries with 12 million players world wide. Futsal is the only official form of indoor soccer approved under the auspices of the FIFA. While the strategy is the same in both indoor and outdoor soccer, the confined indoor area demands quick reflexes, fast thinking, and pin-point passing and leads to an increase in injuries. Indoor soccer injuries are generally similar to those of the outdoor game.
GENERAL SUMMARY AND CONCLUSIONS
This report has discussed hospital emergency department data, epidemiological data presented in the literature and the full range of injury prevention activities for preventing soccer injuries. The proportion of emergency department presentations reported for both child and adult injury in Victoria was generally within the ranges found in the literature in terms of body region and nature of injury. In addition to specific recommendations, the following more general recommendations have been made:
Risk management plans for facilities should be developed and implemented.
This project was funded by Sport and Recreation Victoria