Injury prevention is central to safe play. U.S. Soccer’s Recognize to Recover program provides resources and guidance to help players fight off injury so they can stay on the field. Not all injuries can be avoided, but the severity and probability of injury can be reduced through proper conditioning, training routines and good sportsmanship, making the game of soccer safer for all who participate. 

Soccer injuries typically fall into two categories:

• Those caused by use, such as muscle strains and joint pain

• Those resulting from a sudden forceful event, such as ankle sprains and knee injuries.

ACL Injury Prevention Best Practices

In order for any athlete to be at his or her very best, injury prevention and physical activity must go hand in hand. Athletic trainers play a critical role in preventing, identifying and treating injuries. U.S. Soccer’s Recognize to Recover program highlights these health care professionals and how they help protect player health and safety.

RECOGNIZE

Athletic trainers are health care professionals who collaborate with physicians to provide preventive services, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions. They work in a variety of settings including educational institutions, professional and amateur sports organizations, hospitals, clinics, corporate workplaces, public safety services, the military and performing arts. Athletic trainers must always work under the direction of a physician.

Athletic trainers must graduate from an accredited baccalaureate program and more than 70 percent have a master’s degree or higher. Upon completion of an accredited athletic training education program, students become eligible for national certification by successfully completing the Board of Certification (BOC) examination. Athletic trainers are licensed or regulated in 49 states and the District of Columbia.

Athletic trainers are trained in:

• Prevention, evaluation and rehabilitation of orthopedic injuries such as ACL sprains and cartilage tears in the knee
• Manual therapy
• Concussion management
• Cardiac arrest
• Heat stroke
• Cervical spine injury
  
   

This article is directed towards coaches and technical staff of grassroots level soccer to be able to gain an understanding of, and then implement basic monitoring practices in their own environment.

SOCCER DEMANDS

Physical demands in soccer are increasing, as is the amount of games scheduled. This affects the way players are trained at all levels of the game. Monitoring training effectively may help optimize physical and technical development as well as lowering risk of injury and sickness when:

WHY MONITOR TRAINING LOAD?

The use of monitoring techniques can have several benefits in the soccer environment. Consistent recording of the duration, content and intensity of training sessions and games can be carried out for both the team and individual players. Information collected can be used to ensure varied training prescription with high and low intensity days with periods for promoting fitness as well as recovery. As a result, the likelihood of overtraining and other negative consequences is reduced.

There are different types of ‘load’ a player experiences in soccer. Understanding contributors to training load and ways to measure this can help in planning training sessions:

Factors influencing exercise intensity

Many factors influence individual responses to exercise and should also be considered when planning training intensity:

• Field size

• Number of players per team

• Coach encouragement

• Age

• Fitness levels

• Level of play

• Weather and altitude

Rate of Perceived Exertion (RPE)

• RPE is popular for measuring training load - Seen as a global measure of exercise intensity.

• Can be used to measure load in any sport. 

• Easy to use and requires no equipment or cost.

•  Thirty minutes after a session, a player may be asked ‘How was your workout’?

• Players provide an RPE score of how hard the session was on the 0-10 scale (Figure 1).

• Session Training Load = RPE x Session Duration (minutes).

Points to consider when using RPE

• Can change depending on aims and content of a session.

• Accounts for situational, physiological and psychological factors.

• Can help with varying ‘hard’ and ‘easy’ sessions to reduce monotony of training.

• Ensures variation in training load (such as in pre-season, and weekly cycle before a game).

• Can take into account weekly activities and sports undertaken other than soccer.

• Subjective reporting may vary with age and experience.

• More experience gives appreciation for range of intensities and what is ‘maximal’ effort.

REFERENCES

Rampinini, E., Impellizzeri, F.M., Castagna, C., Abt, G., Chamari, K., Sassi, A. and Marcora, S. (2007). Factors influencing physiological responses to small-sided soccer-games. Journal of Sports Sciences, 25, (6), 659-666.

Halson, S.L. (2014). Monitoring training load to understand fatigue in athletes. Sports Medicine, 44, S139-147.

Coutts, A.J. (2001). Monitoring training in team sports. Australia’s Coaching Magazine, 24, (3), 19-24.

Eston, R. (2009). What do we really know about children’s ability to perceive exertion? Time to consider the bigger picture. Medicine and Science in Sports and Exercise, 21, 377-383.

Dellal, A., Lago-Penas, C., Rey, E., Chamari, K. and Orhant, E. (2013). The effects of a congested fixture period on physical performance, technical activity and injury rate during matches in a professional soccer team. British Journal of Sports Medicine, 49, (6), 390-394.

Equipment is there for a reason – to prevent injury. Players who do not wear protective equipment, or wear it incorrectly, are much more likely to get hurt. U.S. Soccer’s Recognize to Recover program provides resources and guidance to help players fight off injury so they can stay on the field.

RECOVER

Warm-up is critical. 
Players should spend at least 20 minutes stretching and warming up at the beginning of practice or before a game. Guided warm-ups prepare the body for more strenuous activities and may include a variety of exercises meant to stimulate the body and simulate game-play skills. 

Training and strengthening
Training and strengthening will enhance the body’s natural protection systems, especially for ankles and knees. Muscles around the joints can be strengthened through consistent practice of specific training exercises, like walking lunges, single toe raises and single leg hops. The affected muscles stabilize the joint and reduce the risk of injury. The upper body can be strengthened to help protect players during challenges and shielding without sacrificing speed or agility.

Injury treatment and recovery
Injury treatment and recovery are important for returning players to the field safely and preventing future injuries. Reducing swelling and pain as quickly as possible after an injury allows for faster recovery and evaluation by a doctor. After an injury, the muscle or joint will not be as strong as before the injury. A player returning to play without allowing the injury to completely heal and recover strength is at risk for a repetitive injury which is often more serious.

Remember RICE when treating a sprain or strain:

• REST – keep off the injured ankle

• ICE – apply ice to the area for twenty minutes every hour; place a towel between the skin and ice, to prevent burns

• COMPRESSION – use a wrap to stabilize the injury; start at the toes and wrap up the leg past the ankle

• ELEVATION – raise the leg to help with swelling and pain; when elevating an injured ankle, remember "toes above the nose"

Soccer Equipment
In our continued commitment to player health and safety the importance of recognizing safety standards in soccer goals and processes to ensure a safe environment for all players is paramount. Ensuring education and awareness with steps to maintain and secure goals to prevent injury is vital for all coaches and referees as we build a safety culture in our game. 

A proper warmup is an important first step to preventing injury in soccer. U.S. Soccer’s Recognize to Recover program highlights the elements of an appropriate warmup to maximize the injury prevention benefits before any game or practice.

A good warmup creates a foundation for good performance. In youth soccer, an appropriate warmup should last at least 20 minutes. Numerous studies show the dramatic effect a proper warmup has in reducing injuries on the field. During the warmup, players prepare mentally as well as physically. A good warmup helps players focus their attention on the game or practice that follows, increasing the level of performance.

Warmup exercises typically concentrate on preparing the body for play. These physical activities target different muscles which are important for maximizing soccer performance. In doing so, the warmup also helps protect the player from injuring these different muscles.

Jog Before You Run

Warmup activities should build in intensity and lead into the activity which follows, whether a game or practice.

Start Slow
Begin the warmup with low intensity movements like jogging, skipping and shuffling side-to-side. Increase the heart rate gradually to be ready for the practice or game to start.

Stretch
Stretching is extremely important. Stretching should be dynamic, not done standing still. Incorporate full range of motion stretches into low-intensity movements, like walking or jogging.

Include a Ball
Integrate ball skills into the warmup, such as dribbling at slower speeds. This is an opportunity to work on technical skills and become more acquainted with the ball.

Progression of Activities

A typical warmup progresses from linear to multi-directional activities. Initial warmup exercises should have players moving along a straight line. Once muscles have begun to warm, exercises can incorporate changes of direction to increase the intensity and effectiveness of the warmup.

The warmup should finish with accelerations, sprints or high- intensity changes of direction to simulate actual game-play situations to make sure the player is prepared for the game or practice session.

Recovery is an important component to the design and application of periodization in soccer. An extensive schedule of practice and games, in addition to other stressors outside of the sport can compound the level of fatigue experienced by an athlete. U.S. Soccer’s Recognize to Recover initiative promotes achieving balance between training and competition with both recovery and rest to help ensure athletes are physically and mentally prepared to perform.

ACTIVE RECOVERY

Involves low to moderate-intensity exercise that can be carried out after practice and games (also referred to as “cooling down”) or be a separate bout of physical activity held on a rest day. The duration of active recovery can be 15 to 30 minutes of land-based or water-based exercise, or a combination of the two. Active recovery on land can be continuous light aerobic work, or light resistance training – such as body weight strength exercises – all of which can be completed outdoors or at a local gym. Active recovery in water can include activities, such as swimming or simulated running in-place or jogging along the length of the pool.

DYNAMIC & STATIC STRETCHING

Two styles of stretching that are frequently incorporated into warm-up and cool-down periods, respectively. Dynamic stretching is performed by moving a limb in a slow and controlled manner through its full available range of motion. The motion can be repeated several times with small increases in the speed of movement as the available range of motion increases. Static stretching entails selecting a target muscle that is slowly lengthened and held in a comfortable range for 15 to 30 seconds. As the position is held, the feeling of the stretch diminishes, and the athlete can move gently into a deeper stretch and hold again.

CONTRIBUTOR

Patrick Mannix, U.S. Soccer

REFERENCES

Bompa, T. & Haff G. 2009. Periodization: theory and methodology of training. Champaign, IL: Human Kinetics.

McAtee, R. & Charland, J. 2007. Facilitated Stretching. Champaign, IL: Human Kinetics.

Reilly, T. & Ekblom, B. 2005. The use of recovery methods post-exercise. J Sports Sci, 23 (6): 619-627.

Rey, E, Padrón-Cabo, A. Costa, P. & Barcala-Furelos, R. 2017. The Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players. J Strength Cond Res.

SLEEP & PERFORMANCE

• Sleep has various physiological and cognitive benefits.

• Quality ‘deep’ sleep can aid restoration of energy levels and repair of exercise-induced damage.

• Sleep quality can be helped by quality protein intake, adequate hydration and sleep-promoting foods.

• Sleep deprivation may have potential effects on strength, power, endurance, reaction times and cognitive function.

• Similarly, poor sleep can lead to immunosuppression, lack of energy, growth and repair (needed for adaptation). As a result, there is greater susceptibility to infection.

SLEEP AIDS

• High-carbohydrate meals and milk-based drinks can optimize recovery and sleep quality.

• Ensure a comfortable sleep environment (pillows, mattress, sheets, eye mask, black-out curtains).

• Dehydration is especially enhanced during air travel. Drinking extra 200-500ml can help offset this.

• Napping and sleep extension has been shown to improve mood, alertness, reaction times and other physical performance markers.

• Timing of light exposure is critical to sleep onset. Exposure to darkness helps increase melatonin levels to induce sleep onset.

• One nap per 24 hours, for approximately 20 minutes, in youth athletes has been suggested to be most beneficial. Napping can repay debt from sleep deprivation.

• Warm bath/showers can help increase sleepiness and time-to-sleep.

• Time zone changes are common, domestically and abroad. Set watch to local time in day(s) before. Practice meal and sleep times more closely to travel destination to aid body clock adjustment.

SLEEP HYGIENE RECOMMENDATIONS

IMPACTING FACTORS

• Alcohol and caffeine can impair time-to-sleep and sleep quality.

• Night games reported to affect soccer players duration/quality of sleep and perceived recovery.

• Congested training and game schedules can compound reductions in sleep quality and recovery.

REFERENCES

Fullagar, H.K. et al. (2016). Impaired sleep and recovery after night matches in elite football players. Journal of Sports Science, 34, (14), 1333-1339.

Fowler, P.M. et al. (2017). Greater effect of east vs. west travel on jet-lag, sleep and team-sport performance. Medicine and Science in Sports and Exercise, 49, (12), 2548-2561.

Reilly, T. (2009). How can travelling athletes deal with jet lag. Kinesiology, 2, 128-135.