Healing an overuse injury almost always requires an extended period of rest, physical therapy, sometimes bracing or casts, and
occasionally surgery. No matter the injury, there will be a long time spent off the field. Each of us knows of a player who always seems to have something going wrong physically. That player may
get labeled as "injury prone," but I believe it can really be a sign of an overused body.
Why do these injuries occur? From a scientific standpoint, the injuries occur because tissue gets repetitively loaded over time beyond the point at which it is healthy, and tissue failure occurs. Muscle fatigue, unforgiving soccer cleats, hard fields all play a role. But the bigger issue is from a social standpoint -- is there something we are subjecting young athletes to in terms of lifestyle or training that leads to overuse injury?
Many theories abound but most experts point to one main causative factor: year-round training in a single sport. What we are talking about here is structured, organized training.
I cannot recall seeing these injuries in kids playing pickup soccer, hanging out at the park, or even playing several "seasonal" sports.
Soccer's booming popularity among young athletes in the United States, combined with the potential for college scholarships and possible professional careers creates for some athletes an intense hyper-competitive environment where "success" needs to come at earlier and earlier ages. This problem is certainly not isolated to soccer, as pointed out in an excellent book, "Revolution in the Bleachers," by Regan McMahon:
Players will play for club teams (sometimes more than one club team at the same time), participate in ODP programs, and perhaps receive individual training as well. When can this body possibly heal once it has been injured?
This is a problem that has possible solutions. Competitiveness, focus, and drive are not bad things -- indeed they are admirable qualities that will serve one well through life.
But can we find for these young athletes a better balance between organized training and what in many other countries could be called "street soccer"?
The U.S. Soccer Federation recently published their guide called "Best Practices for Coaching Soccer in the United States." The authors point out that Manchester United's U-18 academy team plays a maximum of 30 games per year, with a minimum of 3 months without any games.
The "Best Practices Guide" provides good food for thought regarding age specific recommendations for number of matches, time off, travel, and tournaments. In addition, I would submit the following for your consideration:
* Listen to your body. If you're a player with an overuse injury, understand that proper time to heal will actually shorten the amount of time you're off. If you're a coach or parent, watch for signs of overuse and address these before they lead to chronic problems. If a player is destined for a professional career, time off when they are 12 will not change that.
* Consider the U.S. Soccer Federation recommendations for age specific limits on games, travel, and tournaments, as well as recommendations for time off.
* Encourage multiple sports, at least up until age 14, and as much as possible encourage unstructured "pick up" games or free play in any sport.
With some care and attention, we can lead our kids to be better soccer players and have healthier bodies to show for it.
Dr. Mishra is an orthopedic surgeon in private practice in Burlingame and Walnut Creek, Calif. He is a team physician for U.C. Berkeley, the California Victory USL-1 club, and the U.S. Soccer Federation. Mishra's Web site is www.thesoccerdoc.com.