SOCCER AND VOLLEYBALL INJURIES
Chris Koutures, MD
www.koutures.com
SOCCER -combination
of endurance and ballistic movement
-defined as a contact
and collision sport
-little to no use of
upper extremities (except goalkeepers)
-exposure to outdoor elements
VOLLEYBALL -more ballistic and jumping movements
-risk of injuries due to
contact with hard playing surface
-upper and lower
extremities opportune for injury
a bit of commentary: with the increased popularity of soccer and volleyball, the distinction between pre-season and in-season is often blurred. Many athletes play on one or more club teams in addition to school-based teams- often on a year-round basis. Thus, there is high potential for overuse injuries or incomplete rehabilitation of acute injuries.
In taking the history, make sure to
appreciate the amount of practice/game time, with special emphasis on
“tournaments” where several games may take place in a few day interval. Many
athletes and parents will demand immediate return to such events- which may not
be in the long-term best interest.
VOLLEYBALL: ACUTE, TRAUMATIC
SOCCER: ACUTE, AND POTENTIALLY CHRONIC
While
the acute head injury risk in soccer (contact with ground, opponents,
goalposts) has
been long appreciated, there is growing concern over the risk of cumulative
head trauma from repeated heading….
Many
recent studies have tried to examine the relationship between repetitive,
cumulative heading and brain injury. Difficulty lies within multiple
confounding variables that complicate analysis and causation.
While definitive conclusions are lacking at this time, certain recommendations and observations bear thought….
1)
More
modern, water-resistant balls less heavy (thus, use “newer” balls)
2)
Experienced
players keep rigid neck when heading, thus reducing angular acceleration of
head (thought to be protective)
-
To
reduce risk in younger players, teach appropriate technique and perhaps limit
heading until older and better neck control
3)
Assessment
and management of soccer-related head injuries no different from other
athletes.
4)
Neuropsychiatric
testing may hold promise for longer-term assessment of head injuries
5)
Long-term
damage may be more factor of multiple or severe concussions rather than heading
-
Pre-participation
screening- past head injuries= key
element
VOLLEYBALL: FAIRLY COMMON, ESPECIALLY IN HITTERS
SOCCER: MORE LIKELY
ACROMIOCLAVICULAR INJURIES
REPETITIVE
OVERHEAD ACITIVITY SEEN IN VOLLEYBALL SERVING, HITTING, AND BLOCKING CAN LEAD
TO INJURIES ABOUT THE GLENOHUMERAL JOINT.
PREDISPOSING FACTORS:
1)
MULTIDIRECTIONAL INSTABILITY:
FRONT-ROW PLAYERS TEND TO BE TALL AND LANKY= HIGHER RISK FOR LIGAMENTOUS LAXITY
SCREENING
TIPS
1.
DOUBLE-JOINTED?
2.
EXTEND THUMB MCP JOINT TOWARD
RADIUS
3.
HISTORY OF JOINT
DISLOCATIONS/SUBLUXATIONS
4.
BEWARE OF THE TALL, THIN ATHLETE
(+/- GLASSES) WHOSE ARM SPAN IS GREATER THAN THEIR HEIGHT….
MARFAN
SYNDROME
2)
POOR ROTATOR CUFF STRENGTH AND
SCAPULAR STABILITY
EARLY SEASON=
POOR CONDITIONING
MID/LATE
SEASON= FATIGUE, OVERUSE
REST
MAY BE THE MOST APPROPRIATE PRESCRIPTION
3)
IMPROPER HITTING TECHNIQUE
DROPPING
OF ELBOW BELOW SHOULDER LEVEL
INCOMPLETE FOLLOW- THROUGH
“OPENING UP” AT POINT OF CONTACT
WITH BALL
FOCUS ON PROPER TECHNIQUE
VOLLEYBALL: CONTACT WITH BALL OR
PLAYING SURFACE
SOCCER: FALLS ONTO OUT-STRETCHED
HAND
DIGGING AND DIVING ARE INTRINSIC PARTS OF VOLLEYBALL- CORRECT SLIDING AND ROLLING TECHNIQUES ARE ESSENTIAL TO PREVENT INJURIES.
FOR BOTH
SOCCER AND VOLLEYBALL…
ALWAYS BE SUSPICIOUS OF SNUFFBOX TENDERNESS AND A POSSIBLE SCAPHOID (NAVICULAR) FRACTURE
HYPEREXTENSION….
VOLLEYBALL: HITTING OR BLOCKING
SOCCER: GENERATING FORCE WITH
KICKING, HEADING
REPETITIVE AXIAL LOADING OF THE
HYPEREXTENDED LUMBAR SPINE CAN PRODUCE PAIN AND CONCERN OF SPONDYLOLYSIS OR
SPONDYLOLITHESIS
MUCH
CONTROVERSY IF SPONDYLOLYSIS (STRESS FRACTURE OF L-SPINE PARS INTERARTICULARIS)
IS CONGENITAL OR EVEN IF IT IS A RESULT OF SPORT ACTIVITY.
HOW
TO PREVENT VARIOUS TYPES OF LOW-BACK/LUMBAR PAIN…
1)
REDUCE
HYPEREXTENSION MOVEMENTS
2)
HAMSTRING
FLEXIBILITY
3)
HAMSTRING
FLEXIBILITY
HIP/PELVIS
VOLLEYBALL:
OCCASIONAL RISK OF AVULSION FRACTURE
SOCCER: AVULSION
FRACTURE, OSTEITIS PUBIS
|
ANTERIOR
SUPERIOR ILIAC SPINE |
SARTORIOUS |
|
ANTERIOR
INFERIOR ILIAC SPINE |
RECTUS
FEMORIS |
|
ISCHIAL
TUBEROSITY |
HAMSTRINGS |
|
ILIAC
CREST |
ABDOMINAL
OBLIQUES |
RAPID
BALLISTIC MOVEMENTS (JUMPING, KICKING, STARTING TO SPRINT FROM A DEAD STOP) CAN
LEAD TO EXTREME STRESS ON IMMATURE APOPHYSEAL SITES WHERE MUSCLES ATTACH TO THE
PELVIS. PAIN IN ANY OF THE ABOVE ANATOMIC SITES , ESPECIALLY IN ATHLETES UNDER
17 Y/O, SHOULD RAISE SUSPICION OF AN AVULSION FRACTURE.
SOCCER
PLAYERS ARE ALSO AT-RISK FOR OSTEITIS PUBIS: SCLEROSIS AND INFLAMMATION
IN THE PUBIC SYMPYSIS REGION AT THE INSERTION OF THE HIP ADDUCTOR MUSCLES.
PROPOSED RISK FACTORS:
1)
KICKING
LEG CROSSES OVER PLANT LEG DURING FOLLOW-THROUGH
2)
CROSS
LEG RUNNING GAIT
3)
ABUNDANCE
OF QUICK, REPETITIVE CUTTING AND TURNING
DIFFICULT
AND LENGTHY TREATMENT COURSE- FOCUS ON STRETCHING, TECHNIQUE MODIFICATION,
ANTI-INFLAMMATORIES (? STERIOD INJECTION)
KNEE
ANTERIOR
CRUCIATE LIGAMENT TEARS
VOLLEYBALL:
LANDING, MALROTATION ON EXTENDED KNEE
SOCCER: PLANT,
TURN ON EXTENDED KNEE
FEMALE>MALE INCIDENCE, ?
EXACT CAUSE…
OVERALL INCIDENCE IS ALSO
RISING….
ONE
RECENT THEORY =ON LANDING FROM A JUMP, FULLY EXTENDED KNEES ABSORB LESS
REACTIVE FORCE THAN EVEN SLIGHTLY FLEXED KNEES,
PROPOSED
RECOMMENDATIONS:
1)
TEACH
ATHLETES TO LAND WITH KNEES SLIGHTLY BENT
2)
DUAL
LEG LANDING VERSUS SINGLE LEG LANDING
3)
FOCUS
ON QUADRICEP STRENGTH, ESPECIALLY VASTUS
MEDIALIS OBLIQUE
4)
INCREASE
PROPRIOCEPTIVE SKILLS
5)
HAMSTRING
FLEXIBILITY
FOOT/ANKLE
ACUTE=
INVERSION
CHRONIC=
IMPINGEMENT
JUMPING
AND LANDING CREATES A PLANTARFLEXED
POSITION THAT INCREASES RISK FOR ACUTE INVERSION OR CHRONIC ANTERIOR OR
POSTERIOR IMPINGEMENT.
IN
SOCCER, QUICK TURNS OR CUTS LEAD TO ACUTE INVERSION INJURIES, WHILE REPETITIVE
KICKING OF THE BALL IN A PLANTARFLEXED POSITION CAN LEAD TO OSTEOPHYTE
FORMATION AND IMPINGMENT.
SCREENING:
1)
EVALUATE
JOINT LAXITY, PROPRIOCEPTION, AND OVERALL STABILITY
-USE TAPING, BRACING, AND APPROPRIATE BALANCE OR
STRENGTHENING EXERCISES
2)
TWO
LEG LANDING REDUCES CHANCE OF INJURY DURING A JUMP
3)
CHRONIC
PAIN MAY INDICATE INADEQUATE REHABILITATION OR POSIBILITY OF IMPINGEMENT
GUIDELINE
FOR SUCCESSFUL PARTICIPATION IN SOCCER
(PUTUKIAN,
1994)
1.
PREPARTICIPATION EXAM (FOCUS ON
JOINT LAXITY OR PREVIOUS INJURY)
2.
PROPHYLACTIC BRACING AND TAPING
FOR LAXITY
3.
FUTHER EVALUATION AND STRENGTH
TESTING FOR KNEE LAXITY
4.
OPTIMIZE CARDIO-VASCULAR
CONDITIONING- ENDURANCE AND INTERMITTANT SPRINTS
5.
PROPER WARM-UP PRIOR TO PRACTICE
AND GAME- NO SHOOT ON GOAL BEFOREHAND
6.
FLEXIBILITY: ADDUCTORS,
HAMSTRINGS, QUADS, GASTO-SOLEUS, ITB, NECK
7.
FLEXIBILITY PROGRAM AFTER
PRACTICE AND GAMES
8.
ENSURE ADEQUATE EQUIPMENT:
SHOES, CLOTHES, +/- MOUTHGUARD
9.
ENSURE USE OF SHIN GUARDS
10.
PROPER NUTRITION AND HYDRATION
11.
ADEQUATE STRENGTH OF TRUNK,
ABDOMEN, L/S SPINE, NECK, LOWER EXTREMITY
12.
SPORT-SPECIFIC PROPRIOCEPTION:
BALL JUGGLE, BALL WORK
13.
EMPHASIS ON PROPER JUMP LANDING
(FLEXED KNEE, DOUBLE LEG)
14.
PRACTICE MOTOR COORDINATION,
BALANCE, AGILITY
15.
ENSURE PROPER SKILLS: HEADING,
BLOCK TACKLE
16.
SMALLER BALL FOR YOUNGER
PARTICIPANTS
17.
DO NOT ALLOW MOVING OR HANGING
ON GOALS, SECURE AND PAD ALL GOALS
18.
PROPER ATC, PARENT, COACH, AND
PLAYER COMMUNICATION REGARD INJURY AND INJURY PREVENTION
19.
PROPER PRACTICE AND GAME
SUPERVISION