Join Now | 
HomeAboutContact UsPrivacy & SecurityAdvertise
Soccer America DailySpecial EditionAround The NetSoccer Business InsiderCollege Soccer ReporterYouth Soccer ReporterSoccer on TVSoccer America Classifieds
Paul Gardner: SoccerTalkSoccer America ConfidentialYouth Soccer InsiderWorld Cup Watch
RSS FeedsArchivesManage SubscriptionsSubscribe
Order Current IssueSubscribeManage My SubscriptionRenew My SubscriptionGift Subscription
My AccountJoin Now
Tournament CalendarCamps & AcademiesSoccer GlossaryClassifieds
Injury management: The return-to-play decision
by Mike Woitalla, November 22nd, 2010 5:54PM

MOST READ
TAGS:  high school boys, high school girls, youth boys, youth girls

MOST COMMENTED

Interview by Mike Woitalla

One of the toughest decisions in youth soccer is determining when a player who has suffered an injury is ready to return to action. Dr. Dev K. Mishra, who has served as team doctor at the professional, national team, college and high school level, is the founder of SidelineSportsDoc.com. We asked Dr. Mishra for advice on making the return-to-play decision.

SOCCER AMERICA: What’s the most important thing to keep in mind when determining if a player is fit to return to action?
DR. DEV MISHRA:
The emphasis on the sideline has to always be directed toward athlete or child safety. The emphasis is always on erring on the side of caution.

SA: Because a premature return can lead to a more serious injury?
DR. MISHRA:
Yes. In my clinical practice over the last 15 years I see one or two kids each week with a significant injury that started out as some kind of minor injury. For whatever reason they kept playing and that minor injury turned into something more significant.

Sometimes it was because they were put back in the game too soon. Sometimes it was because they failed to report it to the coach.

If you think a kid’s not really ready, it’s better to sit them – maybe lose them for a few days – rather than to let them get back in before they’re ready and lose them for weeks or months.

SA: What’s the optimal approach to take in making a decision?
DR. MISHRA:
What I’d love to see is that the real decisions on return to play – if it’s a significant injury – is not in the hands of the coach, it has to be in the hands of a trainer or physician – someone who’s really trained and qualified to make that decision.

But there are settings where someone who is professionally qualified isn’t there to make a remove-from-play or return-to-play decision. In that case, it’s really going to come down to the coach. It has to be the coach who has the knowledge to be able to intervene.

SA: What if a young player insists she or he is ready to play?
DR. MISHRA:
This is where the decision becomes really tough. You really need to be their advocate -- to be their voice.

As the kids gets older, they’re going to have better reasoning abilities. They’re also going to have other motivations to stay in the game – and perhaps not tell you stuff. That’s when you really have to have some judgment and the decision can be very difficult.

SA: We hear about pros playing with injuries all the time …
DR. MISHRA:
That’s a totally different setting. Those are not minors. They can undergo treatment with informed consent. It’s completely different for a kid.

With kids, you have to make the tough decision for their own good. What if you’re at an away tournament? What if it’s your star player? What if you have to play a man-down? You still always want to err on the side of safety.

SA: Are there any rules of thumb, such as looking for a limp?
DR. MISHRA:
In soccer, we’re mostly talking about lower extremities – hip, knee, ankle, foot.

The safest thing to do is confirm that the kid is really pain free. If you’re deciding on return-to-play, it’s really a black-and-white approach.

If the kid is pain-free, no swelling, normal ability to jog, cut, sprint and jump with normal strength – they can return to play. That’s basically saying if a kid gets back to “normal” – they can play.

But there are subtleties that make it complicated, which is why it is always advised to consult a medical professional when there is any doubt.

(Dev K. Mishra, the founder of SidelineSportsDoc.com, is an orthopedic surgeon in private practice, Burlingame, Calif. He is a member of the team physician pool with the U.S. Soccer Federation and has served as team physician at the University of California, Berkeley.)


(Mike Woitalla, the executive editor of Soccer America, coaches youth soccer for Rockridge SC in Oakland, Calif. His youth soccer articles are archived at YouthSoccerFun.com.)



No comments yet.

Sign in to leave a comment. Don't have an account? Join Now




AUTHORS

ARCHIVES
FOLLOW SOCCERAMERICA

Recent Youth Soccer Insider
Landon Donovan's Path to Greatness    
The latest edition of our "When They Were Children" series looks at Landon Donovan's childhood soccer ...
Are the Best Refs the Ones You Don't Notice?    
After a few of the games I have refereed, a spectator approached me and said, "You ...
Jill Ellis: Players like to problem-solve (Q&A Part 2)    
Coach Jill Ellis, currently leading the USA in qualifying play for the 2015 World Cup, has ...
Jill Ellis: Coaches must find their own voice (Q&A Part 1)    
Coach Jill Ellis, currently leading the USA in qualifying play for the 2015 Women's World Cup, ...
Is there a place for 'small' clubs in the USA?     
There is not only a place for small soccer clubs in this country but small youth ...
The 'Sisterhood' factor in coaching girls (Joan Steidinger Q&A)    
Sport psychologist Joan Steidinger's female clients often reported that their coaches told them they need to ...
Kids love going for goal     
The article A Great Start to Practice: Free play!, which questions the traditional training formula of ...
The Two-Ref System Revisited    
Two years ago, I wrote about The Two-Ref System: Its Flaws and How to Cope. The ...
The case for a full-service club: rec to comp    
How important is it for a club to offer all levels of play -- rec to ...
Crucial Concussion Evaluation Info for Coaches     
How should a coach evaluate a young athlete for a possible concussion?
>> Youth Soccer Insider Archives