Preventing and Treating Common Soccer Injuries

Soccer is a dynamic sport that involves numerous movements including, but not limited to, running, sprinting, kicking, jumping, tackling, twisting, cutting and turning. It requires both strength and endurance, especially in the muscles and joints of the lower extremity. Running, sprinting, and jumping during soccer involves nearly the full range of motion of the hip, knee, and ankle joints. Unique to soccer, the motion of kicking involves extension of the hip and flexion of the knee followed by forceful flexion of the hip and extension of the knee with the ankle joint maintaining plantar flexion throughout the entire kicking phase. There are numerous other movements involved in soccer, however their involvement is much more complex.

 

The muscles that need the most attention when playing soccer are the core (abdomen, obliques, lower back), hips (gluteals, hip-flexor, quadriceps, hamstrings), and calf (gastrocnemius, soleus). The most common problems in soccer players often arise in the hip muscles due to strength imbalances between the quadricep and hamstring musculature. Soccer players are notorious for having over-developed quadriceps from the repetitive kicking action, so to avoid injury it is imperative to balance the quadricep/hamstring muscle ratio, which in turn will reduce the incidence of muscle strains.

 

As with any sport, soccer athletes will benefit from a performance training or strength and conditioning program throughout the on and off-season. The purpose of an off-season performance-training program is to increase athletes’ performance level while reducing the potential for injury. Performance training for soccer should be specific to the demands of the sport. In general, an off-season program should focus on strengthening the core musculature of the spine (abdomen, obliques, lower back) and hips (gluteals, hip-flexor, quadriceps, hamstrings). However, just because soccer is a lower-extremity dominant sport with greater injuries to the bottom-half, this is not a reason to neglect the upper-extremity when it comes to training. Off-season conditioning will include attention to developing strength, power, speed, and agility. Once the soccer season begins it is still important to continue a conditioning regimen. An in-season program should focus on maintaining the gains accomplished during the off-season, while continuing to increase performance and prevent injury throughout the season.

 

A great example of a performance training program is the PEP program, which was designed by the Santa Monica Sports Medicine Research Foundation. The program consists of a stretching, strengthening, plyometric, and agility routine which focuses on increasing the strength and coordination of the musculature surrounding the knee joint.

A wide array of injuries can occur when playing soccer, however there are a few injuries that are more commonly seen when dealing with the sport of soccer. The most common injures consist of ankle sprains, knee sprains, muscle strains, meniscus tears, and concussions.

Ankle Sprain

An ankle sprain is the result of an unnatural sideways or twisting motion of the ankle joint that results in the stretching or tearing of the ligaments supporting the ankle joint. The best way to prevent an ankle sprain is to increase strength and flexibility in the muscle groups that help to support and stabilize the ankle joint. It is also important to train the proprioceptive capabilities of the ankle so that it can respond quickly to conditions that may lead to injury.

Knee Injuries

A knee sprain means there is partial or complete tearing to one or more of the ligaments within the knee joint. The most commonly injured knee ligaments in soccer players are the Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), and Medial Collateral Ligament (MCL).  The mechanism of injury is often from landing on the leg then quickly pivoting in the opposite direction, an aggressive slide tackle, or from a direct blow to the knee.  The PCL crosses behind the ACL and is less likely to be injured when compared to the ACL. The most common mechanism of a PCL sprain in soccer is falling on a bent knee.  The MCL is located on the medical side of the knee joint and is caused by a valgus stress being placed on the knee.  The MCL is the most commonly injured ligament in the knee.
Knee ligament strains cannot always be prevented, however increasing the strength and flexibility of the muscular structures surrounding the knee can be of great help in providing extra support to the knee joint, which in turn can reduce the incidence of injury.

A meniscus tear is commonly referred to as torn cartilage in the knee. There are two menisci in the knee, medial and lateral which act as a cushioning that help disperse weight across the knee joint. The most common mechanism of injury when dealing with a meniscus tear is twisting the knee in a bent position when the foot is planted on the ground. A few recommendations to avoid a meniscus tear include strengthening the surrounding musculature and learning the correct techniques when cutting, pivoting, and jumping.

Muscle Strains

A muscle strain is the tearing of muscle fibers that occurs from overstretching the muscle. The most common symptoms are sudden pain and weakness that often occurs as a result of an explosive movement such as sprinting. The most commonly injured muscle groups when playing soccer are the hamstrings, quadriceps, gastrocnemius, and adductor muscles. The most effective way to prevent muscle strains from occurring is to increase the strength and flexibility of the specific muscle group.

Concussion

A concussion is a traumatic injury to the brain that is caused by a blow to the head or body, which may or may not result in a loss of consciousness. The most common mechanism of injury in soccer is hitting an opponent’s head while heading the ball.  A concussion can sometimes be hard to diagnose, but the most common signs and symptoms are headache, dizziness, confusion, nausea, blurred vision, and impaired balance. If any of these symptoms occur it is important to seek medical assistance as soon as possible. As far as preventing a concussion, the use of protective headgear has been shown to decrease the number of concussions in soccer players. Strengthening the muscles in the neck may also help to reduce the incidence whiplash related concussions.

Every injury is different in nature depending on the area affected and the severity of the injury. Below are a few tips in treating the common injuries sustained in soccer players.

Ankle Sprain

The initial treatment of an ankle sprain should include rest, ice, compression, and elevation (RICE) to control swelling and pain. Physical therapy is often useful in restoring range of motion and muscle strength to help stabilize the ankle joint. Bracing or taping may also be used to help provide support when returning to activities.  Balance or proprioception exercises are important once the initial pain goes away to help restore the function of the ankle.

Knee Injuries

The treatment of a knee sprain will depend on which ligament is actually affected. Initially, treatment should begin with the RICE principle to decrease pain and swelling. Next, the focus should be on restoring full range of motion within the knee joint. If the affected ligament is not completely torn rehabilitation exercises should begin through physical therapy. The goal of physical therapy is to restore the strength and flexibility of the surrounding musculature to help better support the knee joint. If the affected ligament is completely torn, surgical intervention may be warranted.

 

MCL sprains are graded on the severity of the ligament tearing, where grade I means that the ligament is only stretched or a few fibers are torn and grade III means a complete tear.  MCL sprains can generally be treated non-operatively, even grade III tears.  The more severe the tear, the longer it takes before the ligament is healed enough to return to sports.  Healing time can range from 2 weeks for some grade I tears up to 8 weeks for some grade III tears.  Often, a special hinged knee brace is used to treat MCL sprains/tears, which selectively limits motion and helps to protect the ligament from stresses while healing.

 

ACL injuries are treated differently than MCL injuries, as most ACL tears are complete ruptures that will not heal on their own.  After an ACL tear, the knee will be unstable during the complex cutting and twisting motions required in soccer.  A brace alone cannot provide the stability to the knee that is needed for soccer.  ACL tears are treated surgically by reconstruction the ACL with a graft, and there are several graft options available.  Rehabilitation for ACL reconstructions may take 9-12 months to allow the graft to incorporate into the body and restore the strength and proprioception of the knee.

Muscle Strains

Acute muscle strains should be treated with the RICE principle to help control inflammation and pain. Physical therapy is commonly used to regain range of motion, strength, and flexibility of the specific muscle group. A compression sleeve may also be used to help provide compression and decrease pain when returning to activities.  With muscle strains, it is important not to return too fast before the muscle has had time to heal, as the muscle will be more vulnerable to repeat injury.

Concussion

A concussion is one of the most serious injuries that an athlete can sustain. There are several grades of a concussion depending on the severity of the symptoms. This is determined by performing an on-field evaluation that tests the athlete’s physical and cognitive abilities. Often the athlete should be referred to a physician for further evaluation to rule out the possibility of severe injury. Once evaluated, the best treatment for a concussion is rest, physical and mental, so the brain can heal as fast as possible. Once all symptoms have subsided, an athlete should begin a gradual return to activities at a pace that does not cause any symptom to return.

[toggle name="Can a brace help me prevent knee injuries during soccer?"]Bracing has never been shown to conclusively decrease the rate of knee injuries in any sport. However, athletes with a previous injury such as an ACL tear that has been reconstructed may receive a significant psychological benefit from bracing during their initial return to sports.[/toggle]
[toggle name="Do soccer shin guards prevent the risk of leg injuries?"]While shin guards are generally mandatory equipment for organized soccer, many recreational players choose to play without them. They obviously help prevent painful contusions to the lower leg from direct blows, but biomechanical testing has shown that they also reduce the risk of tibia fracture.[/toggle]
[toggle name="Are soccer shoes important in preventing injuries?"]Yes, the right type of shoe is very important in soccer and a mismatch in the type of shoe that you are wearing and the playing surface may put you at increased risk of injury.[/toggle]
[toggle name="What type of shoe should I wear for soccer?"]The most versatile type of shoe is a molded or bladed 12-cleat shoe, but you may want to consider several different types of shoes if you play of many different types of playing surfaces. A specialty store will be able to help fit you with the type of shoe that fits your needs.[/toggle]
[toggle name="What is the best way to prevent injuries during soccer?"]While all of the injury prevention topics covered in this spotlight can help reduce your risk of injury, perhaps the single most important thing you can do to prevent injuries is to perform a proper warm-up before play. A good warm-up would consist of some light aerobic activity, dynamic stretching, and skill drills.[/toggle]

This article was written in conjunction with Marti Greer, MS, ATC, RT(R), an employee of KORT Physical Therapy and the Head Athletic Trainer for Assumption High School. Marti is nationally certified with the National Athletic Trainers Association Board of Certification. She has a Master of Science Degree in Movement Science with a specialization in Athletic Training from Barry University (Miami, FL) and a Bachelor of Science Degree in Athletic Training from Eastern Kentucky University (Richmond, KY). Marti is also nationally registered as a Radiologic Technologist.