Preventing Soccer Injuries: Be concerned about "under-recovery" rather than "over-training"
Garrett S. Hyman, MD, MPH

I'll tell you right up front… I have a serious conflict of interest in writing this article! I earn a living treating youth sports injuries as a sports medicine physician. Yet I promise that I embrace a goal of helping to reduce the number of athletic injuries in our community. I have a passion for soccer-related injuries in particular. This has everything to do with the fact that I'm a lifelong soccer player, and all three of my children play competitive youth soccer. They all 'cut their teeth' in the MIFC system. Like many of you, I've spent many a rainy weekend on the soccer pitch sidelines supporting my children. And I've witnessed firsthand a number of injuries in my own kids, some of which in hindsight could've been prevented. In this article, you're going to learn three things. First, I'm going to show you that sports participation is good for your kids. Then, just when I've fully elevated your mood with a parental pat-on-the-back for signing your kids up for soccer, I'm going to pile drive you to the ground and alert you that playing sports is verifiably risky. After that rollercoaster ride, I'm going to make an argument for greater parental vigilance in monitoring their own kids "state of well-being."

Sport participation is healthy. Research has shown that youth athletes derive a multitude of benefits from regular exercise and sport participation. Likely physical benefits include lower body fat and less risk of becoming overweight or obese, higher muscle mass, stronger bones, healthier heart and lungs, and an increased chance of being physically active as an adult. Youth athletes demonstrate better markers of psychological health including higher self-esteem and lower levels of depression, more social connectedness, and fewer problem behaviors such as aggression or delinquency.

Young athletes also enjoy opportunities to elevate their social well-being related to chances to make new friends, exposure to positive role models, and opportunities for travel. Academic performance is generally better, and middle school and high school athletes have higher grade point averages than non-athletes. High school athletes have higher graduation rates and lower dropout rates and are more likely to attend college. Youth athletes also show more positive health behaviors like eating more fruits and vegetables, watching less television, and are less likely to smoke cigarettes.

As we all know, sport participation also carries risk. According to the Centers for Disease Control (CDC) approximately 30 million children participate in youth sports, and a recent NY Times article reported that 2.3 million kids between 6 and 12 years old play soccer. Injury statistics from the American Orthopedic Society for Sports Medicine (AOSSM) suggest that 22% of youth soccer players are injured during soccer participation each year. In 2009, the Consumer Product Safe Commission reported that about 88,000 soccer players ages 5 to 14 present to an emergency room (ER) each year due to injury.

Parents, coaches, and players can learn to mitigate these risks. My first recommendation would be for parents and coaches to teach players to listen to their bodies and not try to play through an injury. This means empowering your kids to rest and recover if and when their bodies hurt. Aches and pains after sports participation should resolve in healthy children within a week in most cases, and certainly by two weeks in almost all cases. It is not normal for a healthy kid to continue to experience pain. Coaches and parents should check in with their youth athletes and ask how ready their bodies feel, for example on a 1-10 scale (this would be most developmentally appropriate and work best for kids aged 10 and over). Pain is subjective, as is this scale, but over time with a few data points one can get a sense of how a child's response relates to performance and mindset.

My next recommendation is to place a focus on recovery (i.e. restorative rest) after match play or high intensity training. Current research describes the need for 3-4 days rest after match play for adequate physical recovery. Less recovery time increases risk of injury, a problem with the current structure of youth soccer in the U.S. in which our youth athletes routinely compete in 3-6 matches over 3 consecutive days of a weekend tournament. As a part of recovery, athletes should get adequate sleep (8-10 hours, more in younger ages) and replenish burned calories with adequate protein and carbohydrate intake. Coaches should consider exercise 'recovery days' that involve varied training techniques, often termed 'periodicity' (i.e. stretching, lower intensity, technique-focused drills, tactics).

I'm of the opinion that in order to make strides in reducing injuries in youth soccer we need system-wide change. I can tell athletes they need more rest until the proverbial cows come home, but as long as the athletes feel pressure from their coaches, their club, their parents, and their peers to push themselves to participate even while injured, progress will remain at a standstill.