Summarize, Assess, and Reflect about the article

A

K

i y d f s m F s b o n r t s

M

p v p s S

P W

1 d

Adolescent health brief

Soccer Injuries in Female Youth Players Melissa A. Schiff, M.D., M.P.H.a,b,*

aHarborview Injury Prevention and Research Center, Seattle, Washington bDepartment of Epidemiology, University of Washington, Seattle, Washington

Manuscript received June 20, 2006; manuscript accepted October 10, 2006

bstract A cross-sectional survey of injuries among female youth soccer players found 44.6% (95% confidence interval 34.9%–54.8%) had ever been injured. The injury incidence rate for the current season was 2.2/1000 soccer exposure hours (95% CI 1.5–3.1). Future studies should evaluate modifiable risk factors in youth to identify injury prevention strategies. © 2007 Society for Adolescent Medicine. All rights reserved.

Journal of Adolescent Health 40 (2007) 369 –371

eywords: Soccer; Wounds and injuries; Adolescent; Child

R t p t t

i s s w s b s s t o u n r a

w l n s t o a

Soccer is the most popular sport worldwide [1] and has ncreased in popularity in the United States in the last 20 ears, especially among youth [2]. Soccer’s popularity is ue in part to the perception that it is a relatively safe sport or children and adolescents [3]. Despite this perception, everal recent studies have found that soccer is one of the ore common sports resulting in injury among youth [4,5]. ew studies have evaluated players younger than high chool age because most of the activities are not school- ased and injury records are not routinely kept [6]. Because f the dearth of information on soccer injuries in this vul- erable age group, this study evaluated rates of soccer inju- ies, the amount of time spent participating in soccer, and he characteristics of soccer-related injuries among middle- chool-aged U.S. female soccer players.

aterials and Methods

A self-administered questionnaire was distributed after ractice sessions between May and August 2003 to a con- enience sample of 10 premier girls soccer teams out of 12 ossible teams with players ages 11–14 years. The premier occer teams are community, non-school-based clubs in the eattle area with the most skilled players. The Institutional

*Address correspondence to: Dr. Melissa Schiff, Harborview Injury revention and Research Center, 325 Ninth Avenue, Box 359960, Seattle A, 98104.

tE-mail address: [email protected]

054-139X/07/$ – see front matter © 2007 Society for Adolescent Medicine. All oi:10.1016/j.jadohealth.2006.10.012

eview Board of the University of Washington approved his study. After obtaining informed consent from soccer layers and their parents, 123 soccer players received ques- ionnaires, with 103 (82.4%) responding. Parents were able o assist their daughters with the questionnaire.

The questionnaire included questions on demographic nformation, the number of years participants had played occer, and the number of hours per week they played occer during practices and games. A soccer-related injury as defined as one that resulted in loss of participation in

occer for at least 1 day. Players were asked if they had ever een injured, the number of injuries sustained since starting occer, and if they had had an injury in their current soccer eason, defined as starting in September 2002. Regarding heir most recent injury, players were also asked whether it ccurred during a game or practice, its anatomic location, tilization of medical care and physical therapy, and the umber of days of soccer participation lost. Players also eported the number and type of other sports they played in ddition to soccer.

The incidence rate (injuries/1000 soccer exposure hours) as calculated as the number of soccer players injured at

east once in the current soccer season divided by the total umber of hours of soccer participation in the current sea- on. Injury incidence rates were calculated for games, prac- ice sessions, and by age group. The cumulative incidence f soccer injuries (injuries/100 participants) was calculated s the number of players injured at least once during a specific

ime period divided by the total number of players completing

rights reserved.

t c s a d S

R

1 m 6 2 m

p ( . ( i

2 i a i . o 2

j r m s a C 1 o

c ( l ( i i i

s 3 1 i v s

D

i c t 2 [ m m c s p h

h i m c b a

T C s

V

A

G

N

S

N

N

B

370 M.A. Schiff / Journal of Adolescent Health 40 (2007) 369 –371

he survey. The cumulative incidence was calculated for the urrent soccer season and for lifetime of the players (since tarting soccer). Means were calculated for continuous data nd proportions for frequency data along with 95% confi- ence intervals (CI). All analyses were performed using tata version 8.0 (Stata Corporation, College Station, TX).

esults

The mean age of soccer players was 12.7 years (95% CI 2.8 –13.1), with the majority in 8th grade (Table 1). The ean number of years playing soccer was 7.4 years (95% CI

.2–9.7). In addition to playing on their soccer club team, 9.4% of soccer players reported playing soccer on their iddle school soccer team. Soccer players reported spending an average of 5.6 hours

er week (95% CI 5.0 – 6.9) playing soccer, with 4.6 hours 95% CI 4.4 –5.6) spent in practice and 1.0 hour (95% CI 6 –1.4) spent in games. The majority of soccer players 69.6%) reported playing year round since they began play- ng soccer.

able 1 haracteristics of female youth soccer players on Seattle area premier

occer teams, 2003

ariable Number* (%)

ge (years) 11 12 (12.1) 12 34 (34.3) 13 22 (22.2) 14 31 (31.4)

rade 5th 6 (5.9) 6th 26 (25.5) 7th 30 (29.4) 8th 40 (39.2)

umber of years playing soccer 3–6 27 (26.5) 7–8 51(50.0) 9–11 24 (23.5)

occer-related injury Ever injured 45 (44.6) Injured during current season 32 (31.1)

umber of injuries 1 injury 11 (24.4) 2 injuries 14 (31.1) 3 injuries 12 (26.7) 4–11 injuries 8 (17.8)

umber days of soccer lost due to injury 1 day 4 (9.1) 2–4 days 13 (29.6) 5–10 days 9 (20.5) �10 days 18 (40.8)

ody region injured (includes multiple injuries) Head 4 (8.9) Upper extremity 6 (13.3) Trunk 4 (8.9) Lower extremity 35 (77.5)

t* Some of the numbers do not add to total n � 103 due to missing data.

The injury incidence rate for the current season was .2/1000 soccer exposure hours (95% CI 1.5–3.1), with an njury incidence rate of 6.1 (95% CI 3.5–9.9) during games nd 1.0 (95% CI .5–1.8) during practice sessions. Soccer njury incidence rates were 1.1/1000 soccer hours (95% CI 03– 6.2) for 11-year-olds, 1.4 (95% CI .5–3.0) for 12-year- lds, 1.5 (95% CI .5–3.4) for 13-year-olds, and 3.7 (95% CI .1–5.9) for 14-year-olds.

The cumulative lifetime incidence of soccer-related in- uries was 44.6% (95% CI 34.7–54.8), with most players eporting two or more lifetime injuries (Table 1). The cu- ulative incidence of soccer-related injuries in the current

occer season was 31.1% (95% CI 22.3– 40.9). Stratified by ge, 8.3% (95% CI .2–38.5) of 11-year-olds, 17.6% (95% I 6.8 –34.5) of 12-year-olds, 22.7% (95% CI 7.8 – 45.4) of 3-year-olds, and 51.6% (95% CI 33.1– 69.8) of 14-year- lds had a soccer injury in the current season.

Regarding the most recent injury, over half (52.4%) oc- urred during a game. The largest proportion of injuries 40.8%) resulted in loss of play for 10 or more days. The ower extremity was the most common body region injured 77.5%), with 42.9% of these ankle injuries and 25.7% knee njuries. The majority of soccer players (63.6%) sought med- cal care, and 30.2% received physical therapy for their njuries.

Many soccer players (86.4%) reported playing other ports in addition to soccer, with 27.0% playing one sport, 7.1% playing two sports, 21.3% playing three sports, and 4.6% playing four sports. The most common sports played n addition to soccer were basketball (66.3%), track (50.6%), olleyball (22.5%), tennis (16.9%), swimming (14.6%), snow kiing (9.0%), and softball (9.0%).

iscussion

Approximately one-third (31.1%) of our study partic- pants had experienced a soccer-related injury during the urrent season. This cumulative incidence is similar to he 35% to 50% reported in European youth [7] and the 3.8% reported in Canadian female youth soccer players 8]. Many of the injuries reported in this study resulted in ore than 10 days of participation lost and the need for edical care and physical therapy. Female premier soc-

er players played an average of 5 hours per week, imilar to a recent study [8] that noted high-level Euro- ean youth soccer players participated an average of 4.8 ours per week.

The number of injuries and participation time may not ave been measured precisely because players had to recall nformation from the past. Athletic exposure time was not easured with precision and may have influenced the ac-

uracy of the injury incidence rate. Self-reported injury has een found to result in underestimation of injury rates [9]. In ddition, the cluster effect of team was not accounted for in

his analysis.

t n s o g

A

A D r s a a

R

[

[

[

[

[

[

[

[

[

371M.A. Schiff / Journal of Adolescent Health 40 (2007) 369 –371

With the large number of female youth soccer players in he United States, prospective studies of soccer injuries are eeded to better determine accurate incidence rates. Future tudies should evaluate risk factors in these young, devel- ping athletes to identify potential injury prevention strate- ies.

cknowledgments

This publication was supported by Grant/Cooperative greement Number R49/CCR002570 from The Centers for isease Control and Prevention. Its contents are solely the

esponsibility of the authors and do not necessarily repre- ent the official views of The Centers for Disease Control nd Prevention. The author wishes to thank An-Shyang Chu nd Gregory Chu for their assistance with data collection.

eferences

1] Inklaar H. Soccer injuries: incidence and severity. Sports Med 1994:

18;55–73.

2] Larson M, Pearl AJ, Jaffet R, et al. Soccer. In: Caine DJ, Caine CG, Linder KJ, eds. Epidemiology of Sports Injuries. Champaign, IL: Human Kinetics, 1996:387–98.

3] Ward A. Soccer: safe kicks for kids. Phys Sportsmed 1987;15(8): 151– 6.

4] Centers for Disease Control and Prevention. Nonfatal sports- and recreation-related injuries treated in emergency departments—United States, July 2000 –June 2001. MMWR 2002:51;736 – 40.

5] Taylor BL, Attia MW. Sports-related injuries in children. Acad Emer- gency Med 2000;7:1376 – 82.

6] Garrick JG. Sports injuries in adolescent and preadolescent girls. In: Garret W, Lester G, eds. Women’s Health in Sports and Exercise. Chicago, IL: American Academy of Orthopedic Surgeons, 2000: 7–11.

7] Junge A, Chomiak J, Dvorak J. Incidence of football injuries in youth players: comparison of players from two European regions. Am J Sports Med 2000:28;S47–50.

8] Emery CA, Meeuwisse WH, Hartmann SE. Evaluation of risk factors for injury in adolescent soccer: implementation and valida- tion of an injury surveillance system. Am J Sports Med 2005:33; 1882–91.

9] Emery CA. Risk factors for injury in child and adolescent sport: a systematic review of the literature. Clin J Sport Med 2003;13:

256 – 68.