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Soccer: Staying on the Field

Soccer: Staying on the Field

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Soccer: Staying on the Field

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  1. Soccer: Staying on the Field Andrew Getzin, MD Clinical Director Sports Medicine and Athletic Performance

  2. Overview Injury Data Hamstring strains Injury prevention

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

  4. Nature of Soccer Contact sport Low static- High Dynamic High-moderate intensity sport Physically demanding Aerobic Running: long-distance and sprinting

  5. 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

  6. 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

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

  8. 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)

  9. 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

  10. 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

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

  12. 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

  13. Taking Shoes Off Test Zeren. Clin J Sports Med 2006

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

  15. 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

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

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

  18. Chance of Recurrence After Return from Injury- Australian Football League Orchard, John; Best, Thomas M. Clinical Journal of Sport Medicine. 2002.

  19. Hamstring Return to Soccer When is the best time to return to play? When Full Range of Motion and symmetrical strength is achieved When there is no pain at full practice The day before the championship game Other

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

  21. 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

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

  23. Accidental Compensation Corporation New Zealand federal program that covers resident or visitor to New Zealand SportSmart programme

  24. 1. Screening Assessing health and fitness before playing identifies injury risk

  25. 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

  26. 3. Physical Conditioning Staying in condition means playing to your maximum potential

  27. 4. Technique Know how to play safely with good technique

  28. 5. Fair Play Good sport is about positive attitude- playing fair and enjoying the game

  29. 6. Protective Equipment Protect yourself against injury by using the right equipment

  30. 7. Hydration and Nutrition Eating the right food and drinking adequate fluid helps maintain health and sports performance

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

  32. 9. Environment It is not only the weather that counts- safe surroundings means safer play

  33. 10. Injury Management Getting the right treatment sooner means less pain and a faster recovery

  34. Thank You