Concussion
Concussion, also called a mild traumatic brain injury, is caused by a direct blow to the head. This can occur from many things in soccer including the ball, ground, and potentially another opponent. The force to the head is redirected to the brain, causing sheering forces within the skull- like a pickle in a pickle jar. If you move the jar too quickly, the pickle will hit the side of the glass. Similarly, the brain will collide with the skull when there is a blow to the head.
Signs & Symptoms
After a blow to the head the patient may have signs and symptoms such as headache, dizziness, blurry vision, fatigue, “feeling in a fog”, nausea, and many other symptoms. Usually these symptoms last 10-14 days, but some people have prolonged symptoms that can affect how they feel (physical), function (cognitive), and behave (psychiatric).
Red Flags
Recurrent vomiting, persistent confusion, vision loss, numbness or paralysis, seizures, or inability to walk or talk.
**If you or your child is experiencing these symptoms after a blow to the head, seek emergency medical attention immediately!
Prevention
Safe practices- avoid head to head collisions, decrease number of headers during practice
Hamstring, Hip Flexor, Quadriceps Strain
Muscle strains can occur at any time during the season, but usually occur at the beginning. A muscle strain usually occurs when a muscle is being pulled apart too quickly, and your body’s natural reaction is to protect itself and contract. These contradictory actions cause the muscle fibers to be pulled apart, causing pain, dysfunction, and weakness. Soccer requires changes in the speed, direction, and kicking– all of which can lead to a muscle strain.
Signs & Symptoms
Pain at the site of the strain, feeling of fatigue, bruising if severe, minor swelling, or a palpable soft spot in the muscle.
Red Flags
Large amounts of bruising could indicate a complete muscle tear, complete loss of range of motion. After a proper clinical examination, these symptoms may indicate further imaging or interventions.
Prevention
Proper, dynamic warm-up, incorporating eccentric muscle exercises into your training, maintaining good nutrition and hydration, and proper cool down and static stretching post-activity.
Lateral Ankle Sprain
This can occur in many sports, but particularly when playing soccer that requires change in speed, direction, and controlling the ball with your feet on an uneven surface. Most commonly, the foot with turn down and inward- also called inversion- causing the ligaments on the lateral side of the ankle to become stretched, or sprained. This can occur when stepping on uneven ground, on an opponent’s foot, the ball, or change of direction.
Signs & Symptoms
Immediate onset of pain on lateral aspect of ankle, swelling, bruising, pain with walking, feeling of instability
Red Flags
Unable to weight bear on involved side, excessive point tenderness of either malleoli, severe bruising may all potentially indicate a fracture.
Prevention
Ankle strengthening exercise, incorporating plyometric exercises into your training program, and wearing lace-up ankle braces during activity if history of ankle sprains
ACL Tear
Anterior cruciate ligament (ACL) is the ligament that prevents the tibia (shin bone) from translating anterior from the femur (leg bone). ACL tears can occur when the player is pivoting on one leg while changing directions, and is often a non-contact injury. Most players will hear or feel a “POP” when they fell. This ligament, unfortunately, does not have adequate blood supply in order to heal on its own and therefore needing surgical interventions to repair it. Females are more prone to this injury potentially due to the ankle from hip to the knee, quadriceps and hamstring imbalances, and gluteus weakness. All these can place the ACL in a compromised position.
Signs & Symptoms
Immediate onset of knee pain, feeling/hearing a “POP”, knee instability, swelling, and difficulty walking.
Red Flags
Excessive pain/bruising, numbness, tingling, loss of motor function, obvious deformity
Prevention
Gluteus, hamstring, and quadriceps strengthening exercises, plyometrics focusing on power and agility (especially emphasizing proper landing and deceleration mechanics), and proper footwear
MCL Sprain
MCL is the medial collateral ligament protecting the knee from valgus forces (force that forces the medial aspect of the knee to open up). MCL sprains can occur with sudden change of direction, being hit by an opponent, or landing awkwardly. This injury can also occur with an ACL tear (see above), or also a meniscus tear. Part of the MCL attaches to the meniscus and when it is stretch, can cause tension on the meniscus causing tears.
Signs & Symptoms
Immediate onset of medial knee pain, feeling/hearing a “POP”, knee instability, swelling, difficulty walking or changing directions.
Red Flags
Excessive pain/bruising (may indicate a fracture) numbness, tingling, loss of motor function, obvious deformity
Prevention
Similar for ACL tear prevention: Gluteus, hamstring, and quadriceps strengthening exercises, plyometrics (especially emphasizing proper landing and deceleration mechanics), and proper footwear
By Sarah “Ethi” House and Mo Mortazavi, MD
