Photo: Courtesy of Stats Dad.com

I plan on writing a series of articles regarding soccer related injuries in young players throughout the year. Let me first say that I am not a doctor, nor do I work in the medical field, and the information provided is based on research that I have done citing expert opinions within the sports medicine community.

The purpose of this article is to address knee injuries, more specifically ACL (anterior cruciate ligament) injuries, which can be devastating, often entail with lengthy recovery times, and can sometimes end a player’s soccer career entirely.

Damage potential short and long term

ACL injuries can have far reaching impacts including secondary injuries such as injury to the menisci and can also cause damage to the articular cartilage of the femur, patella or tibia. ACL injuries can also contribute to the early onset of osteoarthritis. The economic burden of ACL injuries is also something to consider: nearly $2 billion every year is spent in the US on MRI scans, surgeries, post-op bracing, and rehab—all related specifically to ACL injuries.

While youth soccer still has a relatively low injury rate compared to other youth sports, most injuries that occur seem to occur in lower limbs such as knees and ankles. In addition, female soccer players are 2 to 10 times more likely to experience ACL injuries than their male counterparts. Why, you ask? Well, mostly it comes down to anatomy and form. Girls are built differently than boys in many ways, but the anatomical differences that increase their risk for ACL injuries are: 1) wider hips and 2) knees that are closer together. These anatomical differences can subsequently have a direct impact on their form while playing.

Around 70 percent of all reported ACL injuries are non-contact type injuries, while the remaining 30 percent involve contact from an outside source such as another player, a goal post, or an object on the field. If 70 percent of reported injuries are non-contact, and so result from the individual player’s own body force alone, can these injuries be prevented or dramatically reduced?

The PEP Program

There have been many studies devoted to this topic and, as a result, preventative training programs have popped up to combat the number of ACL injuries that occur every year. The one study that really caught my eye was “The PEP Program,” which was developed by the Santa Monica Sports Medicine Research Foundation. While this study was targeted towards injury prevention (specifically ACL injuries) in female soccer players between the ages of 14 – 18, it  can be equally beneficial for male soccer players. In fact, Holly Silvers, who spearheaded the development of the PEP Program study, has been contacted by several MLS teams about the program might be beneficial to them.

The study cites that “the PEP program consists of a warm-up, stretching, strengthening, plyometrics, and sport specific agilities to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint.” OK, that sounds like a lot but in real time this is a 15-20 minute program which can be done before every practice and game in place of usual warm-ups. The only equipment needed is soccer balls and cones (which most teams have in abundance) so there are no additional costs associated with the program. Here’s the best part: in the first year of the study there was an 88 percent reduction in the occurrence of ACL injuries within the teams training with the PEP program. The second year showed a reduction rate of 74 percent. Since its development, 65 NCAA Division I women’s soccer teams have implemented the PEP Program and injuries were reduced three-fold compared to a control group. These numbers are significant as well as encouraging for such a common yet chronic injury that plagues so many soccer players in the US.

Useful for players under 14?

There are no statistics (that I have found) on the PEP program having the same impact for players under 14. However, most reported injuries occur in players over 14. Some hypothesize that the increased injury rates for female players over the age of 14 has a direct correlation to puberty and I would assume (again, I’m drawing my own assumptions based on my research) that the non-contact injuries mostly occur from more skilled maneuvers such as sudden deceleration with side-cutting moves and landing from a jump (such as after going up for a head ball). These types of advanced maneuvers typically occur with more frequency in older players. There is no downside reported to incorporating this training for younger players so it seems like a logical conclusion that starting early and training this way throughout a player’s career would be more beneficial than no preventative training at all.

I would encourage parents and coaches to consider incorporating this training for both male and female players, whether it’s the PEP program or one of the similar programs that have evolved from studies performed all over the world. Some physical therapists and trainers also offer preventative training on a one-on-one basis if this training is not available through your child’s team.

My hope is that this article will start the dialogue and research of injury prevention for parents of young soccer players and to serve as a catalyst for youth coaches to incorporate preventative programs into their training. I believe that this could serve our young athletes well by not only lengthening their soccer careers but preventing long term issues related to knee injuries sustained in their youth.

Links

The Santa Monica Sports Medicine Research Foundation PEP Program pdf:

The HarmoKnee Preventative Training Program

Article on ACL prevention training in younger athletes

Article about neuromuscular training to prevent future injury after ACL reconstruction

Registration for EPYSA/Safe Kids Southeastern PA Coalition – Youth Sports Safety Clinic on June 21