Interview by Mike Woitalla
The turf war between youth organizations ensures an endless fountain of championships and the tournament industry has made playing three to four games in one weekend a common part of youth soccer. We asked Dr. Dev K. Mishra what coaches can do to when their teams are faced with game overload. Dr. Mishra, the founder of SidelineSportsDoc.com, is an orthopedic surgeon who has served as team doctor at the professional, national team, college and high school level.
SOCCER AMERICA: Despite the fact that the U.S. Soccer Federation discourages youth teams from playing multiple games in a weekend, youth coaches continue to send their teams to tournaments that require three of four games in two days. …
DR. DEV MISHRA: So much is out of the coaches’ hands. There are certain tournaments that they feel obligated to participate in either to enhance the stature of their team or to expose their players to the best competition, and maybe to college coaches. They are doing what they feel is best for their players and are generally not in control of the tournament schedules.
The multiple-game in a short period tournament format doesn’t seem to be going away any time soon.
SA: Besides the fact that player-development experts say the practice-to-game ratio is out of whack in American youth soccer, what do we know about the perils of squeezing in too many games?
DR. MISHRA: There is some good research on injury rates from multiple matches in a short period of time from the professional ranks.
“The American Journal of Sports Medicine” recently published a well-conducted study out of Glasgow Celtic over the course of two seasons ("Effect of 2 Soccer Matches in a Week on Physical Performance and Injury Rate"). In a very sophisticated way, they took a look at performance parameters and also at injury rates. The variable was the amount of time between games.
Bear in mind these are really high-level professional athletes with access to probably the best medical care that you can find.
They found that for the performance parameters there were no significant differences related to time between games. They attributed this to training methods, nutrition, and some other recovery efforts they did between matches. But the injury data was really different.
Essentially what they found was a six-fold increase in injuries if the games were played less than four days apart.
It’s hard to fully apply those findings to youth sports, but it’s reasonable to assume that if there’s a proven higher injury rate for four days or less apart for professional players than at least to some extent that same rationale would be applicable to youth players playing two games in one day or three games in a weekend.
SA: So what can a youth coach do to help ensure the health of his or her players when faced with such a schedule?
DR. MISHRA: The coach will need to go into a tournament with the awareness that some players will need to be subbed out more frequently and get some rest.
Hopefully, the coach will be able to take as large a roster as possible and be able to have a player rotation – either per game or within games and give certain players rest.
The coach would need to take injury complaints seriously and have a really low index of suspicion when a young player says that they’re hurt. Or if they’re just not functioning at their maximum – at that point they probably need a little bit of rest even if they’re not injured -- because the risk of an injury is high if they’re not playing at 100 percent.
SA: How about pre- and post-game?
DR. MISHRA: The pre-match preparation is going to be important. Some of the things that have been suggested are to modify training and decrease physical intensity going into a multiple-game situation.
You want to really pay attention to the pregame nutrition and hydration too, generally emphasizing carbohydrates and minimizing fats. It can make a positive difference even in the young players.
And pay attention to the postgame as well. After that first match research shows that the first 20 minutes are the best time to re-hydrate and get some carbs and protein back in the body.
Also, the team should engage in some form of cool-down.
At a lot of the larger, more reputable tournaments there will be certified athletic trainers on site and players, if necessary, should utilize the professional trainers to help them with injury recovery. Ice, massage and active stretching.
Icing down sore areas such as thigh, hamstrings, calf, knee, ankles can help recovery.
SA: Are there methods used at the higher levels that youth coaches can look to?
DR. MISHRA: There are some modalities from the collegiate or professional teams used after a match that might not be available to youth teams, but some of the things mentioned above can definitely help.
Deep tissue massage has been helpful to promote muscle recovery if someone’s got soreness in the thigh or their hamstring.
And the old standby for doing a post-match dynamic cool-down and a passive stretching routine can be helpful.
For a lot of these things we don’t have hard science behind it in terms of the youth sports experience but we have good science behind it in terms of adult athlete experiences. I think we can reasonably say that these things will help and certainly not hurt the young athlete who has to play in multiple games.
SA: I’ve heard some people defend the tournament format of several games in two days by saying they played pickup soccer all day when they were kids and it wasn’t a problem. Is that a fair comparison?
DR. MISHRA: My personal feeling is that we see far fewer injuries with pickup games and unorganized play than organized play. But I don’t have hard evidence to support that. That’s based on personal experience.
I think the opinion is shared by a number of sports medicine professionals but to my knowledge it has not been proven scientifically.
There’s so much subjectivity when you talk about playing pickup soccer or an organized practice, the definitions can be very blurry and overlap each other considerably.
My personal feeling as someone who sees kids every week in my office, is that the injury patterns that you would get from playground sports compared to an organized youth sport, no matter what the sport, is the injury patterns tend to be very different.
In organized sports we see more overuse type injuries. Things that can go on and last for weeks and weeks and be very nagging. We see other types of injuries like ankle sprains, ACL tears, shoulder dislocation that tend to be very sport-specific as opposed to free-play injuries.
SA: It would seem that an organized play environment – especially a tournament with several games in a short period of time -- creates intensity much different than the atmosphere at pickup games or practice and could contribute to increased injuries. …
DR. MISHRA: The fact that teams line up against each other with uniforms, the game on the line and maybe with a trophy at stake, whatever the sport, introduces a level of competitiveness and intensity that’s totally part of human nature. It’s not a bad thing. It’s generally a good thing. We all have our own kids engaged in those activities.
But it does introduce something in terms of the physical demands that translate to injury.
If you’re playing in a park and you don’t feel like playing, you go sit down and wait for the ice cream truck or something. So there’s self-regulation that takes place before an overuse injury happens.
(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 East Bay United in Oakland, Calif. His youth soccer articles are archived at YouthSoccerFun.com.)