Monthly Archives: October 2016

Rate of injuries among youth soccer players

The study, published online today in Pediatrics, found that from 1990 through 2014, the number of soccer-related injuries treated in hospital emergency departments in the U.S. each year increased by 78 percent and the yearly rate of injuries increased by 111 percent among youth 7-17 years of age. By calculating the rate using participation data, researchers were able to show that the rising number of injuries comes not just from the increase in the number of young players participating in the sport but also because players are now being treated more frequently for injuries.

“The sport of soccer has changed dramatically in the last 25 years,” said Huiyun Xiang MD, MPH, PhD, senior author and Director of Research Core at the Center for Injury Research and Policy at Nationwide Children’s Hospital. “We’re seeing athletes play year-round now thanks to club, travel and rec leagues, and the intensity of play is higher than it ever has been. These factors combine to lead to more risk of injury.”

The majority of the injuries were sprains or strains (35 percent), fractures (23 percent) or soft tissue injuries (22 percent). While concussions and other closed-head injuries (CHIs) only accounted for just over 7 percent of the injuries overall, the rate of concussions/CHIs increased 1596 percent over the 25-year study period. Athletes with concussions/CHI were twice as likely to be admitted to the hospital as patients with other diagnoses.

“While we can’t tell from our data why the rate of concussions among soccer players is increasing, it is important for athletes and families to be aware of this issue and what they can do to reduce the risks,” said Tracy Mehan, MA, manager of translational research at the Center for Injury Research and Policy. “Young athletes take longer to recover from concussions than older athletes and they can put themselves at risk for second-impact syndrome and repeat concussions if they return to play too soon — both of which can lead to serious, life-altering injuries.”

The study also found that most of the injuries occurred when a player was struck by either another player or the ball (39 percent) or when they fell (29 percent). Older children and adolescents ages 12-17 years accounted for the majority of the injuries (73 percent) and girls were more likely than boys to sustain a knee or an ankle injury.

Researchers say following a few guidelines can help keep your athlete out on the field:

  • Participate in a pre-season conditioning program that focuses on building core muscles, strengthening neck muscles, and working on hip and thigh strength.
  • Warm up before you play
  • Always wear the recommended protective gear (shin guards, mouth guards)
  • Follow and enforce the rules. Many injuries occur during illegal play or when coaches or referees don’t enforce the rules.
  • Learn about concussions. Know the symptoms of concussions and how to spot them. Encourage players to report any hits to the head even if they happen in practice. Make sure to follow concussion management and return-to-play policies.
  • Limit heading for younger players. Only allow heading once children reach 11 years of age and introduce it slowly by limiting the amount of heading in practice for children 11-13 years of age.

Data for this study were obtained from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS database provides information on consumer product-related and sports- and recreation-related injuries treated in hospital emergency departments across the country.

Diving

Competitive springboard and platform divers start training and competing at an early age. Many Olympic and world champions are 18 years of age and younger.

Diving is considered a collision sport because of the impact with the water on entry. A diver entering the water from the 10-meter platform is traveling almost 40 miles per hour. These forces are enough to break bones and dislocate joints. Divers are also at risk of injuries from hitting the board or platform as well as overuse injuries similar to gymnasts from frequent jumping, back arching, trunk flexion, and back twisting. Injuries can also occur from training on “dry land.” This type of training usually includes weight lifting and the use of spotting belts, trampolines, and springboards.

While injuries do occur in competitive diving, unsupervised or recreational diving is associated with a far greater risk of serious injury or even death. The following is information from the American Academy of Pediatrics (AAP) about how to prevent diving injuries. Also included is an overview of common diving injuries.

Injury prevention and safety tips

  • Rules. Swimmers should follow pool rules at all times, including
    • Never swim alone. The pool should be supervised.
    • Don’t run on pool decks and wet areas. Abrasions and contusions (bruises) commonly occur from careless falls.
    • Don’t dive in shallow water or any water where the depth is not known.Swimmers should know how deep the pool is and avoid diving into shallow pools less than 3 feet deep. This will help prevent serious head and neck injuries.
  • Equipment. Safety gear includes
    • Swim caps
    • Sun protection (sunscreen, lip balm with sunblock) when outdoors
  • Emergency plan. Teams should develop and practice an emergency plan so that team members know their roles in emergency situations in or out of the water. The plan would include first aid and emergency contact information. All members of the team should receive a written copy each season. Parents also should be familiar with the plan and review it with their children.

Common injuries

Shoulder injuries

Shoulder injuries typically occur during water entry when arms extended overhead get forced back. Athletes usually feel the shoulder pop out of joint when their shoulders are dislocated. Most of the time the shoulder goes back into the joint on its own; this is called a subluxation (partial dislocation). If the athlete requires help to get it back in, it is called a dislocation. Risk of dislocation recurrence is high for youth participating in these sports. Shoulder strengthening exercises, braces and, in some cases, surgery may be recommended to prevent recurrence.

Chronic shoulder pain is usually due to a pinching of the rotator cuff (the tendons around the top of the shoulder). This is more common in athletes with weak shoulder blade muscles. Symptoms include a dull pain or achiness over the front or side of the shoulder that worsens when the arm is overhead. Treatment involves exercises to strengthen the shoulder blade muscles and the rotator cuff.

Neck injuries

Repetitive extension of the neck on water entry can cause an irritation of the neck joints. This results in muscle spasms and stiffness when rotating the neck or looking up. Athletes with tingling or burning down the arm may have a cervical disc herniation or “stinger” and should see a doctor. Stingers are stretch injuries to the nerves in the neck and spine. Because the force of impact is greater with 10-meter platform diving, there are more complaints of neck problems with tower divers.

Elbow injuries

Elbow pain can occur when an athlete’s elbow hyperextends on entry into the water. The ulnar nerve (“funny bone”) can be stretched and cause pain, numbness, or burning down the arm into the fingers. If the ligament of the elbow is stretched, it can cause pain, weakness, and instability of the elbow. Athletes with pain on the outside of the elbow may have a condition called osteochondritis dissecans. This condition can cause an inability to straighten the elbow and locking, catching, or swelling of the elbow. X-rays may beneeded to confirm diagnosis.

Wrist/hand injuries

When divers enter the water, they grasp their hands one on top of the other with the palm facing toward the water. As they try to “punch” a hole in the water, thewrist gets bent backward. Doing this repetitively causes pain, swelling, stiffness, and irritation of the wrist joint. This can be treated with rest, ice, and nonsteroidal antiinflammatory drugs. Taping or bracing the wrist can also prevent further injury.

When divers reach for the water and attempt to grasp their hands for entry, they occasionally hyperextend the thumb. This causes a sprain to the base of the thumb. Symptoms include pain, swelling, instability, and weakness of the thumb. This can be treated, and may be prevented, by taping the thumb while diving. Occasionally, a custom thumb splint or even surgery is necessary to stabilize the thumb.

Low back pain

Spondylolysis, stress fractures of the bones in the lower spine, is due to overuse from arching or extending of the back. Symptoms include low back pain that feels worse with back extension activities. Back or reverse dives are often more painful. Treatment of spondylolysis includes rest from diving, physical therapy to improve flexibility and low back and core (trunk) strength, and possibly a back brace. Athletes with low back pain for longer than 2 weeks should see a doctor. X-rays are usually normal so other tests are often needed to diagnose spondylolysis. Successful treatment requires early recognition of the problem and timely treatment.

Disc injury may cause low back pain that occurs with flexion—including pike and tuck dives. The pain is usually worse on one side, extends into the buttock, and occasionally down the leg. Disc-related pain can also occur with sitting, lifting, jumping, and twisting. Successful treatment requires early recognition of the problem and timely treatment.

Knee injuries

There are thousands of jumps in practice for each dive seen in competition. Jumping causes pressure on the kneecap and can result in pain in the front of the knee. Patellar tendonitis (also called jumper’s knee) causes pain
just below the kneecap. Treatment requires identifying and addressing the causes of the pain.

The number of dives performed; dry land training; poor flexibility; strength imbalances; and malalignment of the hips, knees, and feet can also contribute to knee pain. Because corrective shoes, orthotics, and knee braces aren’t practical while diving, physical therapy, patellar taping, and training modifications are the mainstays of therapy.

Other medical issues

Divers are at risk for a variety of medical concerns as well, including

  • Swimmer’s ear and sinusitis from too much water in the ear
  • Ruptured eardrums from impact in the water and acute pressure changes
  • Cuts, scrapes, bruises, fractures, and head or facial injuries from hitting the board, platform, or pool deck
  • Sunburn or rashes from the sun

Water Polo

Water polo is an intense sport that requires athletes to tread water and swim for long periods. There is a version for younger athletes that allows them to stand in shallow water or hang onto the side of the pool, but this is illegal in competitive water polo.

Acute and overuse injuries are common in water polo. Acute injuries usually occur when guarding a player or wrestling for the ball. Overuse injuries are often the result of repeated swimming and throwing motions and treading water. As in many sports, the risk of injury increases with age due to the style of play, contact forces, and size of athletes. However, the risk of injuries can be reduced.

The following is information from the American Academy of Pediatrics (AAP) about how to prevent water polo injuries. Also included is an overview of common injuries.

Injury prevention and safety tips

  • Sports physical exam. Athletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for routine well-child checkups.
  • Fitness. Athletes should maintain a good fitness level during the season and off-season. Preseason training should allow time for general conditioning and sport-specific conditioning. Athletes with poor stamina are more likely to get hurt both in and out of the water. Also important are proper warm-up and cool-down exercises.
  • Technique. Athletes should learn and practice safe techniques for performing the skills that are integral to their sport. Athletes should be confident in their ability to swim in close spaces with others. If not, they should begin playing in the shallow end in case they need to stand. Athletes should work with coaches and athletic trainers on achieving proper technique.
  • Equipment. Safety gear should fit properly and be well maintained.
    • Polo caps with ear guards to reduce the risk of ear injury
    • Mouth guards
    • Swim goggles
    • Sunscreen protection (sunscreen, lip balm with sunblock) when swimming outdoors
  • Environment. Pool water should be checked by persons in charge of pool maintenance. Excess chemicals and chlorine may cause eye irritation and skin rashes. Hypothermia may occur when playing in cold water.
  • Rules. Water polo can be very rough. Much of the “contact” takes place underwater, where referees cannot see well. These fouls are often missed and can lead to injury. Parents and coaches should encourage good sportsmanship and fair play. For instance, athletes should never dunk an opponent under the water.
  • Emergency plan. Teams should develop and practice an emergency plan so that team members know their roles in emergency situations in or out of the water. The plan would include first aid and emergency contact information. All members of the team should receive a written copy each season. Parents also should be familiar with the plan and review it with their children.

Common injuries

Eye injuries

Eye injuries commonly occur in sports that involve balls but can also result from a finger in the eye. Any injury that affects vision or is associated with swelling or blood inside the eye should be evaluated by an ophthalmologist. Water polo players should wear swim goggles during practice and competition. The AAP recommends that children involved in organized sports wear appropriate protective eyewear.

Head injuries

Concussions often occur when an athlete gets hit in the head by another athlete (usually from their elbow). A concussion is any injury to the brain that disrupts normal brain function on a temporary or permanent basis.

The signs and symptoms of a concussion range from subtle to obvious and usually happen right after the injury but may take hours to days to show up. Athletes who have had concussions may report feeling normal before their brain has fully recovered. With most concussions, the player is not knocked out or unconscious.

Prematurely returning to play after a concussion can lead to another concussion or even death. An athlete with a history of concussion is more susceptible to another injury than an athlete with no history of concussion.

All concussions are serious, and all athletes with suspected concussions should not return to play until they see a doctor.

Shoulder injuries

Shoulder injuries usually occur from repetitive throwing and swimming motions. This may be due to weak muscles in the back and trunk of the body. Usually rehabilitation exercises focused on good posture and muscles of the shoulder blade and core, icing, medication, and rest are all that is necessary for treatment.

Finger injuries

Finger injuries occur when the finger is struck by the ball or an opponent’s hand or body. The “jammed finger” is often overlooked because of the myth that nothing needs to be done, even if it is broken. If fractures that involve a joint or tendon are not properly treated, permanent damage can occur.

Any injury that is associated with a dislocation, deformity, inability to straighten or bend the finger, or significant pain should be examined by a doctor. X-rays may be needed. Buddy tape may be all that is needed to return to sports; however, this cannot be assumed without an exam and x-ray. Swelling often persists for weeks to months after a finger joint sprain. Ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and range of motion exercises are important for treatment.

Knee injuries

Patellar pain syndrome is a common overuse injury from prolonged kicking and treading water. It causes pain in the front of the knee, sometimes associated with a bump, and can be severe. It is treated with ice, stretching, NSAIDs, and relative rest.

Athletes should see a doctor as soon as possible if they cannot walk on the injured knee. Athletes should also see a doctor if the knee is swollen, a pop is felt at the time of injury, or the knee feels loose or like it will give way.