Athletes in field sports like football, lacrosse, and women’s soccer especially, are plagued by non-contact soft tissue injuries. These refer to things like muscle/tendon strains and ligament sprains, but occur specifically when the athlete did NOT experience a collision with another player. Most frequently, they occur when the athlete is performing a rapid change in direction to react to a play or an opposing athlete. This may seem strange as running, cutting, jumping, and changing direction are all common in sport; ninety-nine times out of one hundred my child does these moves without a problem. What is different about the one time when they got injured?
To answer that question, we need to have an understanding of what happens to these tissues during these athletic movements. Simply put, when muscles contract and relax they shorten and lengthen, respectively. These muscles attach to tendons, which in turn pull on the bones to which they are connected. Similarly, ligaments attach one bone to another bone, such as the Anterior Cruciate Ligament (ACL) connecting the femur and tibia. During athletic movements like the ones we discussed above, these structures undergo high amounts of force, and injuries result when the amount of force exceeds the strength the tissue can withstand at that moment in time.
Unfortunately, there is no magic formula to prevent these injuries 100% of the time (though many a snake oil salesperson may say otherwise). However, there are several factors that we can work on to decrease the likelihood of them happening to ourselves and our young athletes. Here are four important factors to consider in reducing injury risk for these soft tissues:
Muscle Strength - As we mentioned above, these types of injuries most frequently happen when the body is receiving/producing a lot of force. For example, you may know someone (or be someone) who has pulled a hamstring from sprinting for the first time in a long time. While your athlete may be in good shape, strengthening the muscles of the legs will only improve their ability to absorb force. Research has shown that soccer players participating in resistance training decrease their risk of injury significantly1; this means that just spending time on the field is not enough. The FIFA Medical Assessment and Research Centre devised a warmup/strengthening program (seen below) that has been shown to help reduce injury risk through field-strengthening exercises, but this should be supplemented with moderate intensity weight training to reduce risk further.
Fifa 11+ Injury Prevention Program for Soccer Players 2
2. Quality Sleep: While this tip may seem like a no-brainer, it is critically important to reducing injury risk! Many adults themselves do not achieve the recommended amount of sleep; about one-third of adults are getting less than 7 hours per night. However, the situation is even worse for kids; about half of 13-18 year olds get less than the 9 hours that are recommended for their age group. This absolutely predisposes youth athletes to higher injury risk - one study found that student athletes who did not get sufficient sleep had their risk almost doubled - about 1.75 times higher than their well-rested peers3. While things like decreasing screen time before bed, cooler sleeping environment, and complete darkness can help increase sleep quality, the quantity of hours is the biggest factor. So next time you’re tempted to wake your sleeping teenager at 11am on a Saturday, maybe think twice!
3. Eating sufficient calories: Making sure your athlete is taking in enough calories can affect injury risk in several different ways. As we discussed, soft tissue injuries occur when the amount of force placed on a tissue exceeds how much stress it can withstand. Often this happens when a very high-force movement happens during a game, like a rapid acceleration, deceleration, or change of direction But, if the athlete has not been properly fueled over the course of several weeks, the muscles, tendons and ligaments may not have recovered from previous practices, workouts, and games, leading to a compromise in tissue strength. As a result a movement/amount of force that normally would have been absorbed may exceed the strength of those compromised tissues. Making sure your athlete is getting adequate calories and nutrients can ensure they are recovering fully.
Another condition to consider with respect to eating enough is Relative Energy Deficiency in Sport, or RED-S for short. This is a phenomenon where athletes, typically those who benefit from being smaller for their sport like weight-class athletes, dancers, or runners, do not take in enough energy (calories) to maintain their health. This predisposes them to higher injury risk, both for muscles and bone fractures. While this condition is less common in athletes who do not have weight classes and who need to be powerful (such as soccer players), it is still something to be aware of. Look out for extreme fatigue, obsessive tendencies, loss of menstrual cycle in female athletes, and frequent ‘nagging’ injuries.
4.Stress management: Did you know that college athletes are almost three times more likely to sustain an injury during finals week than during any other time during the season4? That is a huge increase! High academic and personal stress absolutely contributes to injury risk. Obviously we do not have a ton of control over the amount of stress in our athletes’ lives; there is no ‘easy button’ for life. But this is an important consideration for mitigating injury risk. Since we know these periods add to overall stress, we can modify other factors around workload and recovery accordingly. Have your athlete aim to get some extra sleep, decrease intensity of workouts, and maybe eat more nutrient-dense meals during these periods.
There are few things more frustrating for athletes than having to stand idle due to an injury. Some may be simple accidents, bad luck, or bad decisions, but with proper training, recovery, and nutrition, we can decrease our risk for sprains and strains. These tips may not make you bulletproof, but they can keep you on the field, playing longer, stronger, and healthier overall. Give these tips a try; they might be the difference between kicking the ground on the sidelines and kicking the game-winner!
Thanks for reading!
Jesse Brown, PT, DPT
Along with his education as a Doctor of Physical Therapy, Jesse brings an extensive background in exercise to the clinic. With experience across all different types of weight training, including Olympic-style weightlifting, CrossFit, and powerlifting, you can be sure that Jesse has the expertise to help you get where you want to go!
When he’s not helping individuals in the clinic, Jesse can be found practicing what he preaches - lifting the bar. He is an avid weightlifter, competing and refereeing locally through USA Weightlifting.