Soccer injuries among youth Andreasen I, Faun0 P, Lund B, Lemche P, Knudsen H. Soccer injuries

Scand J Med Sci Sports l!2Q 3: 62-66.

'Ibis study reports the quantitative and qualitative aspects of sports injuries in a 5-day youth soccer tournament with l2,907 players. A total of 132 injur- ies that resulted in at least one days' absence from soccer playing were of special interest. The overall injury rate was 3.6 for boys and 4.4 injuries per loo0 hours of play for girls. Statistically @Scant ly higher injury rates be- tween players in puberty and differences m type and location of injuries be- tween bays and @ were found In 77% of the cases, the injury happened while the injured player was in physical contact with another player, 59% had ball contact and 7% had no contact with any penon or ball at all. Five months later a questionnaire was send out to the serious injured players. Of 85 injured playem, 10 were absent from school or work on average U.5 days. Five had surgery. Injury prophylaxis in soccer tournaments is proposed.

among youth.

Huge international youth soccer tournaments are being held in an incr- number all over the world. Several investigations of the injury pattern of adult soccer players have been made. Most of them have been r e t r w e studies and have been based on insurance m r d s and questionnaire investiga- tions (l, 2). Only a few have been undertaken p m speclively (3,4). The injury rate in adult soccer has been estimated to be about 16.9 injuries per loo0 hours of play (4). Few studies have focused on youth soccer injuries

(5-8). Surprisingty little is known about the circum- stances under which the injuries OCCUT. Differences between boys' and girls' injuries are hardly investiga- ted.

The purpose of this study was to prospectively in- vestigate youth soccer tournaments to certify deter- minedly injury rate and type and to clarify injury mechanisms for both sexes in soccer tournaments.

Yakrlal and methods In July 1991 a large, annual youth soccer tournament called the Dana Cup took place in Hjjrring, Den- mark. A total of a907 boys and girls on 785 teams from 35 different countries participated, and matches were played during 5 days.

During the first 2 days, the league system was used. The next 2 days the cup system was used, and on the fifth day the 2 qu-g teams in the different age groups P b l e 1) played the hnaL The games were played according to the rules set down by the Federation of International Football Association (FlFA) and Danish Football Association (DBU), with the following amendments: free substitution and mandatory shin guards.

The weather was sunny to cloudy with the tem- perature 17-25 "C The grass soccer playgrounds were of high standard andannfortable due to previous rain.

The medical seMce tent was placed in the geogra- phical centre of the soccer fields used and was always staffed with at least 2 doctors between O800 and 230. Also physiotherapists, nurses and trained first aid personnel were present. Medical service was organized on a voluntary ba-

sis, and any service from personnel as well as the ma- terials used were free of any charge.

If necessary, the injured players were taken to the local hospital for X-rays or further treatment. No other hospital was situated within 35 km from the soccer fields used. If injured players consulted the hospital on their own, these patients were registered from hospital records and were included in the study the following day.

Contact to the local practioners because of trau- matic disorders did not occur. The first aid tent, the hospital and the general practioners were the only possible local medical help offered. Evexy person who applied for medical help was seen, registered and divided into 3 inw groups by a doctor:

Group A: non-sports-related injuries and illnesses The injury did not occur during practice or match in Dana Cup.

Group B: minor sports injuries

The injury occurred during practice or match in the Dana Cup. If the injury happened during a match, the player was allowed and able to play the next match or within the next 24 h.

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Soccer injuries among youth

Table 1. Number d players, games, playingtime and age grwp dassiicationfor boys and gifts in the Dana Cupsoccertwmament 1991

Number d Ptayinghours Age-(years1 Players

9,586 1,440 25,527 17-19,1&17,14.516,11.514.5,11.512.5and 1&11.5 Girls 3,321 485 8,890 17.519.5,16.517.5,14.516.5,12.514.5and 10.512.5 Bcrys

T d 12,907 1,925 34,417 10-19.5

Group C: severe sports injury

The injury occurred during match in the Dana Cup tournament. The player was not able or allowed to play the next match or withh the next 24 h or more.

The players in group C (together with a doctor) Wed in a special questionnaire and participated in the quantitative and qualitative investigation of severe soccer injuries among youth soccer players. They were followed by mail correspondence for 5 months after the injury.

Statistics

Our data were tested with the chi-square test, and P values are shown in parentheses. Fisher's exact test is used in special marked cases. We designated signifi- cance as Pc 0.05.

Results At the Dana Cup, 12,907 players participated in the tournament; lll6 people (9%) applied for medical help, and they were classified by a doctor to 3 injury

groups ( B l e 2). The average playing time was 2.7 h per player for both sexes. Girls applied more for medical help than boys (10% vs 7.9%, P -= 0.0oO1).

No difference in injury rate between boys and girls classified in group C was found boys: 3.6 injuries per 10oO hours of play; girls 4.4 injuries per lo00 hours of

The injury rates for boys and girls in the different age group classifications of the tournament are shown in Fig. 1 and 2. The rate of serious injuries for boys aged between 14.5 and 16 years and girls aged between 14.5 and 16.5 years differed significantly (P=O.ooOOl and P=0.043, respectively) from the other age groups. A higher injury rate for girls aged between 12.5-14.5 years (5.3 injuries/lOOO h of play) was seen (NS, Fig. 2). As expected, the most injury exposed body part was the lower extremity (7l%), but only 7 fractures occurred here, whereas the frac- tures occurred more frequently in the upper extrem- ity wb le 3). Noteworthy is the percentage of frac- tures (l&3%), in which we found about one third to be epiphysiolysis, regardless of sex.

However, girls were more injured on the trunk (13% vs 0.7%) (Fishers exact test, P = 0.038), and less in the lower extremity (60% vs 76% P=O.O44) com- pared with boys. No sta t is t idy signiscant differ-

Play-

il t 3 ??

- 2

1

0

BOYS

- Year old 10-11,5 11,5-12.5 125-14.5 14.5-16 16-17 17-19

Fig. I. Serious injuries per loo0 hours of play for the different age classes in the boys' tournament

GIRLS

10,5-12.5 12.5-14.5 14,516.5 16.5-17.5 17.5-19,5

Fig. 2. Serious injuries per loo0 hours of play for the different age classes in the girls' tournament

63

w 756 361 1,116

ence was found between injuries in the qualifying rounds and final rounds or the lint or second half of the match nor between boys or girls

The injury rate was higher in the second half for both sexes, and girls had a higher injwy rate in the

In group C, 77% of the injuries happened while the injured player was in physical contact with another player, 59% had ball contact and 7% had no contact with any person or ball at all. No differences between the sexes was seen regard-

ing contact to another person or ball at the trauma moment.

At the moment of injury, the referee judgements were free kick for 23% of the players who had physi- cal contact with another player. In Z%, the free kicks were given to the opponent. During the tourna- ment, 170 red cards were given, and only one was given when a player was seriously injured. There were no difference in the referee's judgement be- tween boys and girls.

No difference was found between being injured on one's own or the opponent's part of the field. Goal- keepers were not injured more often than other play- ers.

After 5 months, 85 (65%) of the players in injury p u p C had answered the enquiry as to how long and which kind of treatment they had had as a result of the injury. At the time of injury the registering doctor estimated the rehabilitation period for each patient.

For the 47 players who did not respond to the questionnaire, the estimation of the rehabilitation period is shown in Fig. 3 but not used in the calcula- tions. The recreational course did not differ among

4).

final rounds (NS).

19/31 14/23 3.7 3.6 sn2 2/s 3.5 5.4

(-wxl Fhel

14 = (25%) @=t75%) 3 = 0796) 15 = @3%)

Boys Girls

the sexes and they were therefore considered together.

F Q percent of the seriously injured players were playing soccer again after 1 month (Fig. 3). Sixteen children were still suffering from the injury 5 months later (Fii 4).

Of the seriously injured 85 players who responded to the questionnaire, 10 players had been absent from school or work on average lL5 days.

A total of 8.4% were hospitalized and 5.8% had surgery. Physiotherapists were used in the convales- cence period in 33% of the cases.

Dkcusslon This study differs from previous comparable studies because of the pertinent registration of injuries. The material is based on patients who applied for help at the medical service tent and hospital, which was the only organized treatment available. Few teams brought their own medical staff. Girls with minor injuries consulted ht aid or do0

tor more often then boys. Nilsson (6) 1977, Sullivan (8) 1980 and Schmidt-01-

sen (7) 1984 found about twice as large a serious in-

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soccer injuries among youth

Fig. 3. Severely injured persons and the duration on the injury (weeks)

jury rate among girls than among boys (NS) - which they relate to lack of skill among girls.

In our study, the serious sports injury rate resulting in more than one day's absence from soccer was found to be equal for boys and girls (3.6 vs 4.4 injur- ies per lo00 hours of play and an average 2.7 h of play per player). Girls might have become more skilled since 1977, 1980 and 1984 or maybe there is not an inverse relationship between skiU and injury.

The injury rate in the different age classes is signif- icantly elevated for boys between 14.5 and 16 years old and girls between 14.5 and 16.5 years. The large physical changes in puberty could be the reason for the higher incidence of injuries in these age classes. During puberty, boys develop higher stamina, strength and speed than girls. Girls' physical changes during puberty are less pronounced in these qualities (l2,U). During puberty, it takes time to coordinate these new qualities - in this learning phase of new physical qualities, soccer playing could be more haz- ardous in relation to injury.

The peak injury incidence in puberty partly blurs the credibility of an increasing injury rate with in- creasing age in youth soccer players.

Injury location, in our study, is in concordance

Fig. 4. Location of injury in 16 players who had injury more than 24 weeks after the tournament

with other studies (4,6,8,10) Wble 6). We found no differences between boys and girls (injury group C) when studied together, with one exception: girls were more often injured on the trunk (13%) than boys (0.7%).

In the literature, the vast majority of soccer injur- ies occur in the lower extremity. The lower extremi- ties account for 73-88% of the injuries in senior play- ers (10,14,15) and for 6568% of the injuries in adults

We found that 7l% were injured in the lower ex- tremities (hip to toes).

Compared with adults (3, youth players can be ex- pected to have a higher incidence of head, face, and upper extremity injuries due to more frequent falls, illegal ball upper extremity contact or increased fra- gility of the upper extremity epiphyses (9,12,13).

We found that 18% of the seriously injured persons had a fracture. That is about twice the percentage of fractures seen in adults (4,10,U). "'his might be ex- plained by the decreased strength of growing epiphy- seal plates of long bones to external load (9).

About 60% of the fractures were situated in the upper extremity, mainly in the lower arm and wrist, a location that is almost found in adolescents (1).

(698).

Table 6. Soccer injury kxath as a percentage d total serious injuries

Athlete Reference Head or face (%) Upper exbernity (%) Groin, hip or th i i (%) Knee (%) Leg (%) Ankle (%) Total injuries

Youth DanaCUp9l 9 14 9 21 15 24 132

Youth N i b (6) 10 15 12 14 13 16 858 Youth SuHim (8) 15 17 12 41 34

-d (4) 27 20 12 17 256 Albert (10) 7 8 20 18 4 25 142

Senior

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The referee blew a whistle in only 34% of the serious injuries, and only one red card was given in relation to serious injury. We suggest that illegal pushes, kicks and upper extremity contact with another player should be prophylactically punished harder by the referee in youth soccer. In 25% of foul play injuries, the injuries afflict the player who viol- ates the rules, the same tendency as in other studies

We found a higher rate of injuries in the second half of the match and the injury rate among girls was higher in the final rounds. None of these findings were statistically significant, but they could suggest that fatigue plays an injury-predisposing role, and that girls became more tired than boys. Another sug- gestion is that the intensity of play was somewhat higher in female games.

No relationship between being injured on one’s own or the opponent’s part of the soccer field was found. This is in accordance with previous studies (5). Data from Sullivan (8) claim a higher injury rate for goalkeepers in youth soccer but this was not con-

The severity of an injury can be evaluated by defin- ing an injury in terms of the length of time lost from soccer playing. The players (35%) who did not return the questionnaire were estimated to suffer from mainly short lasting injuries. During the first month after the injury, about 50% recovered (Fig. 3). Injur- ies lasting more than 5 months or injury with perma- nent damage were few (16 children), and they were primanly located in the knees and ankles.

Of 85 seriously injured players, 10 children had been absent from school or work for a mean Il.5 days because of the in&, the rest had no sick leave. Only 33% had had help from physiotherapists in convales- cence.

We conclude that youth soccer is a relatively safe sport, it has a low iniury rate and the injuries are mostly minor, despite the hi& intensity of play in tournaments.

(4914,E).

firmed in this Study.

Acknowledgements Funded in part by the Danish Research Council for Sports and the Dana Cup tournament management.

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