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CHAPTER 27:
Soccer and Field Hockey

Not every soccer player can be a Pelé, but soccer is one of the fastest-growing participation sports nationwide, particularly among youngsters. Soccer leagues, from preschool to industrial to senior leagues, have sprung up across the country, mostly in the suburbs. The fervor of the 1994 World Cup competition in the United States will likely add to the interest in soccer. Along with this growth have come more soccer-related injuries, particularly to girls. And although soccer is perceived to be safer than football, particularly for children, soccer injuries can be severe.

      There are several reasons for soccer's popularity. It doesn't require particular physical characteristics. Smaller players can compete on an equal basis with larger ones, which is not true for such sports as football and basketball.

      Soccer requires minimal equipment and therefore is inexpensive. A local recreational department is more likely to have a soccer program than a football program, because the latter is much more expensive to run.

      Soccer is a sport that both boys and girls can play. In many soccer leagues, young girls play alongside boys. The introduction of women's soccer teams in college, along with the availability of scholarships, has given more high school players an incentive to stick with the sport. In fact, women's soccer was the fastest-growing team sport in high schools and colleges in the 1980s. More than 6 million females, from school-age to teen-age, now play soccer. With the U.S. team winning the first women's world soccer championship in 1991, even more women in this country are likely to take up soccer.

      However, parents should not be led to think that girls and boys can play soccer and never get hurt. Soccer is a collision sport and can lead to many types of injuries.

HEAD BANGING

Banging heads with an opponent while trying to head the ball can result in a variety of injuries, including a concussion. A soccer player who has a momentary loss of consciousness should not return to play until he or she has been cleared by a doctor.

      Soccer players can also break noses, cheekbones, or jaws from clashing in the air over the ball. These fractures are all serious injuries that call for x-rays and treatment by a doctor.

      Knocking heads can also cause cuts and bruises. If the cut is not deep, stop the bleeding with a towel, and then cleanse and cover the cut with gauze. If it is deep, it may require stitches. Ice bruises off and on until the swelling goes down, and rest until they are no longer very tender.

      The repeated trauma from heading the ball may lead to subtle brain damage similar to that seen in boxers. In a study of former Norwegian soccer players, 30 percent showed signs of minor brain damage, including headaches, dizziness, and neck pains. A player can head the ball several thousand times in a season. The Norwegian players averaged more than 5,000 headers per season over their 15-year careers.

SOCCER SHOULDER

When you go up to head a ball and come down on your shoulder or elbow, you can sprain the ligaments connecting the collarbone to the shoulder joint, separating the shoulder.

      A partial dislocation of the shoulder is often confused with a separation. A partial dislocation occurs when the shoulder slides partially out of joint and then pops back in by itself. This stretches the rotator cuff muscles, which hold the joint together.

      If you don't strengthen the rotator cuff muscles, each time you fall on your shoulder you will stretch them more and more. Finally, your shoulder will dislocate fully, with the head of the arm bone coming all the way out of the shoulder socket. A dislocated shoulder will not go back in by itself.

QUAD AND HAMSTRING PULLS

Pulled leg muscles are common in any running sport. Soccer demands sudden acceleration and direction changes, which make you prone to muscle pulls.

      Ice a sore muscle, 20 minutes on and 20 minutes off, until the pain subsides, and rest it during that time. As soon as the muscle can tolerate it, begin a stretching program to relengthen the muscle.

KNEE INJURIES

Soccer players suffer the same kinds of knee injuries as football players do. If you take a blow to the knee from the side with your cleats dug into the ground, you can damage ligaments or cartilage in the knee. If you feel pain on the side of the knee that took the blow (usually the outside), the injury probably is just a bruise. Ice it down for a few days, and rest it until you can cut back and forth again.

      However, if you feel the pain on the opposite side of the knee, you have probably sprained ligaments and possibly torn cartilage. The immediate treatment for a sprained knee is the RICE formula described in Chapter 4 and the use of a splint to immobilize the knee. If the knee does not improve within a day or two, see a doctor. Or if the swelling or pain is severe, see a doctor immediately. One sign of torn cartilage is buckling of the knee when you try to turn on it, even when walking.

      Any injury to a knee ligament must be considered serious. The medial and lateral collateral ligaments may heal with a rehabilitation program without surgery, but you cannot fully recover from these injuries without supervision.

      A sudden rotation of the knee with your foot fixed to the ground, such as when you plant your foot to go upfield, can cause the worst of all knee injuries. The torque on the knee can tear the medial collateral ligament, the anterior cruciate ligament, and the medial cartilage. This injury, known as the Terrible Triad of O'Donohue, leaves you with a totally unstable knee. You will need surgery to repair each of the damaged structures and a rehabilitation program to strengthen the knee muscles.

BROKEN LEG

One of the most serious soccer injuries is a fracture of both bones in the lower leg. This injury is similar to the boot top fracture from skiing, and it is what ended Joe Theisman's career as a quarterback. In soccer, it occurs when two players going for the ball at the same time clash. If your opponent misses the ball and kicks you with enough force, it can break both the tibia and fibula bones.

      You will need to have the leg splinted before you can be transported to a hospital. Then you will need a cast or possibly surgical insertion of a pin or plate to hold the bone fragments together. These bones may take months to heal.

      If you are kicked on the outside of the leg, you will usually fracture only the fibula. This is not as serious since the fibula does not bear weight. The treatment is a cast or, if the fracture is not serious, just non-weight-bearing with crutches. In four to six weeks you may be able to return to play with a hard shin guard.

BRUISED LEG

Since soccer is a kicking sport, you're bound to get kicked in the lower leg, usually in the shin. Cuts and bruises in the shin can be painful, and they heal slowly because of poor blood supply to that area. If your opponent's cleat was dirty, which is likely, you must clean any cuts carefully and watch for signs of infection, which include redness, swelling, and heat around the cut.

      Getting kicked in the calf can also cause bleeding and bruising in the muscle. First stop the bleeding by compressing the muscle with an elastic bandage. Then ice and elevate the calf. Continue icing intermittently for several days and then begin to stretch the muscle. When you bruise a muscle, it goes into spasm and shortens, so you need to relengthen it as it heals.

ACHILLES TENDON RUPTURE

I commonly see Achilles tendon ruptures among older soccer players. In my area there are several senior soccer leagues, with players who are in their seventies. A lifetime of running in unstable soccer shoes and the accumulation of pulls and partial tears of the tendon weakens it. You should take care of any small injury to the Achilles or else, somewhere down the road, you may have to pay the price.

      If your Achilles tendon does rupture, you will need surgery to repair it if you plan to play again. Recovery from this injury is very difficult and requires a prolonged rehabilitation program. Some older players willing to hang up their soccer shoes may get by with casting the tendon for six to eight weeks and then going through rehabilitation.

ANKLE SPRAINS

Probably the most common soccer injury is a sprained ankle. Almost all soccer games below the college level are played on grass. Stepping in a hole or divot can force the ankle to turn over, spraining the ligaments. A player who steps on the side of an opponent's foot when going for the ball can also sprain an ankle.

      All but the mildest ankle sprains, which allow you to continue to play, should be x-rayed to check for a broken bone. If there is no fracture, the standard RICE formula detailed in Chapter 4 is the initial treatment and should be followed by range-of-motion and ankle-strengthening exercises.

RUNNING INJURIES

Soccer players suffer the same overuse injuries as players in all running sports, including arch pain, stress fractures of the foot, heel pain, shin splints, runner's knee, iliotibial band syndrome, and lower back pain. Virtually all of these problems can be solved by propping up the arch of the foot so that it strikes the ground properly.

      The peculiar design of soccer shoes tends to aggravate running injuries. One function of a sport shoe is to correct any abnormal action of the foot, such as pronation. Soccer shoes, however, are too soft to protect against excessive foot roll. In many young soccer players, heel pain is misdiagnosed as damage to the growing area in the heel bone or as a fracture. The pain actually is due to stress on the heel bone from excessive pronation of the foot.

      The placement of the numerous low cleats in a soccer shoe also causes instability. The cleats are much closer together than those in a football shoe, which means you are running on a narrow base. Also, the narrow, pliable shank of a soccer shoe does not resist the torque of your foot rolling over. Football shoes come in three midsole widths, but most soccer shoes use a European design that comes in only one width.

      Finally, soccer shoes have no built-in arches, as do running shoes. An arch can prevent the excessive pronation of the foot that leads to running injuries.

TURF TOE

Soccer played on an artificial surface can lead to a sprained big toe, or turf toe, due to the stress of running on a hard surface.

GOALIE INJURIES

Guarding the goal puts the goalie in a unique position. In addition to being vunerable to all of the preceding injuries, goalies have problems peculiar to their position.

      When diving to stop shots, goalies often land on their hips and suffer cuts, scrapes, and bruises over the hip bones. In some cases, blood collects in a goalie's hip and must be drained. The immediate care for cuts and scrapes is to stop the bleeding and cleanse and cover the injured area. Ice bruises intermittently until the swelling goes down and rest until the area is no longer tender. Goalies should wear adequate padding to protect their hips.

      Because they dive so often, goalies have a much higher incidence of partial and full shoulder dislocations. They also dislocate and break fingers from the impact of the ball coming at them at high speed. You may be able to pull on a dislocated finger and put the joint back in place. Buddy-tape it to the finger next to it, and you can get back in the game. But make sure to have the finger x-rayed, because it may be broken.

      Landing on the point of the elbow can leave a goalie with Popeye elbow, a form of bursitis that causes little knobs to swell up behind the elbow. This may also cause little bits of bone to chip off of the elbow. The elbow should be rested until the swelling goes down and iced during that time. Most likely, the blood and fluid will also need to be drained from the area. A goalie should wear elbow pads to protect against this injury.

      Goalies may also suffer the same shoulder and elbow injuries seen in the throwing sports, but they are relatively uncommon in soccer.

FIELD HOCKEY

Field hockey is an open-field game that's similar to soccer in many respects. As in soccer, the object of the game is to score a goal, but a stick, rather than the foot, propels the ball. Field hockey, like soccer, is a running game in which the contact is supposed to be incidental, yet injuries occur quite often.

      Runner's knee and shin splints, and the related tibial stress syndrome and tibial stress fracture, are common field hockey ailments because of the constant running. An orthotic can correct the foot strike to relieve these pains, and legstrengthening exercises can help prevent a recurrence.

      A slash of a field hockey stick can easily bruise another player's leg. A bruise should be iced immediately and the leg rested. I have even seen sprained knees and cartilage tears from blows by the stick to the outside of the knee.

      An ankle sprain can result from stepping on another player's foot or in a rough spot on the field. Treat the ankle sprain with the RICE fomula in Chapter 4, followed by an aggressive range-of-motion and strengthening program, as illustrated in Chapter 13. A severe sprain should be x-rayed to check for a fracture.


How to Improve Your Game

Since soccer is a running game played on a huge field with practically no time allowed for rest, cardiovascular conditioning is of the utmost importance. Soccer players are never out of the action for long. You may be able to rest momentarily when the play is across the field, but you're quickly on the go again.

      You need to work on your agility and speed as well as your endurance. You not only need to be able to run fast, but you must also be able to dribble and kick the ball at the same time, all while evading opponents.

      As part of your training, practice running both long distances and sprints. Or you can incorporate both into one workout. Jog for a quarter-mile and then sprint for 50 yards. Repeat to the point of muscle exhaustion.

      Work on your distance before you begin sprint work. This will give you a good aerobic base for sprinting.

      Running uphill is great for endurance and good for the legs. However, it can be hard on the knees, so be alert for any kneecap pain. Also, if you run uphill, you must run down again, which causes pounding on the knees.

      Warmup activity for soccer can be anything from a slow jog around the field to calisthenics. Make sure to stretch out the lower body.

      Since you need strong legs, concentrate strength-training workouts on the lower body. In particular, do the Leg Extension, Leg Curl, and Leg Press, which are part of the strengthening program of Chapter 1; Toe Raise with weights, as described in Chapter 12; and 90-90 Wall Sitting, as illustrated in Chapter 20.

      Exercises that strengthen the neck muscles can help soccer players with their headers. Work with a partner and do the neck exercises outlined in Chapter 5.

      Look for soccer shoes with wide cleats, builtin arches, and a wide shank for better foot stability, although such shoes may be hard to find. If you develop a running-type injury, wear sneakers or cross-trainers during practice, and wear soccer shoes only during games.

      A field hockey player needs to improve her running skills. She should run long distances to build a good aerobic base for endurance, and then intersperse these distances with sprints to increase speed. Pay particular attention to strengthening the legs and arms during strength training.




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