As the popularity of soccer has grown in the United States, so has the annual rate of soccer-related injuries in kids.
Increased prevention efforts
Injuries more than doubled – jumping 111 percent between 1990 and 2014 – researchers report.
Concussions made up only 7 percent of these injuries. But the yearly rate of concussions shot up nearly 1,600 percent over 25 years, the researchers said.
"The increasing number and rate of paediatric soccer-related injuries, especially concussions, underscore the need for increased prevention efforts," said lead researcher Dr Huiyun Xiang. He's director of the Centre for Paediatric Trauma Research at Nationwide Children's Hospital in Columbus, Ohio.
Both the number and rate of soccer-related injuries increased significantly over the study period, he said.
"This means that the increase in injuries doesn't just come from more children playing soccer, but that athletes may be getting injured more frequently," Xiang said.
Some of the increase is because more athletes are reporting injuries, especially concussions, due to more education and awareness, he said.
Higher intensity and duration
Some of the increase also came from more girls playing soccer, Xiang said. "As girls picked up the sport in greater numbers over the past 25 years, they accounted for more injuries as they were learning how to play the game," he said.
In addition, some of the increase came from the higher intensity and duration of playing at middle school and high school levels, Xiang said.
"Two-thirds of the injuries in our study occurred among 12- to 17-year-olds, and the rate of injury was three times higher among this age group than among the younger athletes," he said.
These kids are more likely to be playing soccer at school and with local and travel teams throughout the year than they were at the beginning of the study, Xiang said.
"They also tend to have a more aggressive style of play than younger athletes and have higher energy impacts when they are injured due to their larger body size," he said.
For the study, Xiang and his colleagues collected 25 years of data on soccer injures from hospital emergency departments. They looked for injuries that occurred to players 7 to 17 years old.
Nearly 3 million soccer-related injuries sent children and teens to emergency rooms over the study period, the researchers found.
Too many emergency room visits
In addition to concussions, the researchers found that most injuries -- such as sprains, strains and broken bones -- occurred when a player was struck by another player or the ball (39 percent) or when they fell (29 percent).
Most injuries (73 percent) were among older children and teens 12 to 17. Slightly more males were injured – 56 percent.
One sports medicine expert thinks too many kids are going to the emergency room with injuries that can best be handled by their family doctor.
"We need to address the problem of a huge number of kids going to the emergency room when they should be going to their primary care doctor," said Dr John Kuluz. He's director of traumatic brain injury and neurorehabilitation at Nicklaus Children's Hospital in Miami.
"We need to know how many really benefit from going to the emergency room," he said.
Parents and coaches should be educated about the criteria for sending children to the emergency room, Kuluz said.
For example, a lot of children with concussions go to the emergency room who don't need to go, he said. "The only time you should go is if there are serious symptoms such as recurring vomiting or changes in consciousness or loss of consciousness, Kuluz said.
To help reduce the rising number of soccer-related injuries, Xiang offered these recommendations:
- Take part in a preseason conditioning programme that focuses on building core muscles, strengthening neck muscles, and working on hip and thigh strength.
- Warm up before play.
- Wear recommended protective gear – shin guards and mouthguards.
- Follow and enforce the rules. "Many injuries occur during illegal play or when coaches or referees don't enforce the rules," Xiang said.
- Learn about concussions. "Know the symptoms and encourage players to report any hits to the head even if they happen in practice. Make sure to follow concussion management and return-to-play policies," he said.
- Ban heading (hitting the ball with the head) for younger players. "Only allow heading once children reach 11 and introduce it slowly by limiting the amount of heading in practice for children 11 to 13," Xiang said.
The report was published in the journal Paediatrics.