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
SOCCER AMERICA: What’s the mostimportant 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 childsafety. 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 clinicalpractice 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 injuryturned 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 youthink 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 forweeks 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 toplay – 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 qualifiedto 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 toplay?
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 tohave 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 judgmentand 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. Whatif 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 thereany 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 todo 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, normalability 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, thefounder 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, coachesyouth soccer for Rockridge SC in Oakland, Calif. His youth soccer articles are archived at YouthSoccerFun.com.)