Steele Canyon High School Women's Soccer

GENERAL INJURY PROTOCOL
Coaching sports can be rewarding and stressful as it is without having to worry about injuries to your players. However, there may be situations when appropriate medical personnel are not available and the care of the athlete is in your hands. Here are some general guidelines regarding injuries that often occur on the soccer field.

1. Coaches should at the very minimum be certified in CPR and First Aid. Knowing these basics will allow you to think clearly should an emergency arise.

2. Remember R.I.C.E.: Rest, Ice, Compression, Elevation. Most common injuries encountered in soccer will follow this general principle. DO NOT use heat while swelling is present to the extremity. Apply ice to the injured area for 15-20 minutes. Adding heat will increase the swelling, while ice will help decrease it.

3. Let common sense prevail. If there is a deformity, DO NOT move the athlete. Call 911 and let trained personnel handle the situation.

4. Communicate with parents and inform them of the situation if they are not on-site at the time of the injury.

5. Be conservative. If you have doubts as to an athletes' ability to play, do not let them play.

Ankle Injuries
 1. Most ankle injuries involve ligaments and tendons (i.e. sprains). In instances like this, follow the R.I.C.E. principle. These injuries often turn into recurring injuries if the athlete returns to activity too soon. If the athlete experiences pain during activity, he/she should be removed from competition. If the pain level increases in the following days, the athlete should see a physician.

2. If a deformity is present, do not attempt to put the limb in place or move the limb. Immediately call 911 or EMS personnel.
 
Deep Thigh Bruise
Usually caused by direct contact to the thigh, a deep thigh bruise is very painful and can lead to potential problems.
 1. Ice immediately with the knee in a bent position. This will help maintain flexibility to the thigh muscle.

2. Instruct the athlete to keep stretching the thigh. This will prevent swelling/blood from “settling” in the muscle and limit movement.

Knee Injuries
The knee is the most vulnerable joint in the body and should be dealt with caution. Injuries can occur to the ligaments, tendons, kneecap, cartilage (meniscus) and bones (growth plates). Here are some indications of significant injury to the knee: Hearing or feeling a “pop” or a “snap” in the knee. Feeling that the knee “gave out” Sharp pain Obvious deformity Limited movement Swelling
1. Apply ice immediately and immobilize the knee. When immobilizing the knee, be sure to splint the ankle. As a general rule to follow, the joint above and below the injured joint should be splinted.

2. In all instances involving a knee injury, the athlete must follow-up with a physician. Head Injuries There are currently many different theories regarding head injuries and concussions and how to treat them.

The following guidelines are essential to insuring safe return to play for your athlete:
1. When in doubt, keep the athlete out. Any player who appears to have suffered a concussion should be removed from participation and evaluated by a physician as soon as is practical. Players exhibiting prolonged loss of consciousness or marked amnesia should be evaluated immediately in an emergency room. Players should not be allowed to return to play if they exhibit the symptoms (headache, nausea, blurred vision, dizziness, ringing in the ears, unsteadiness, confusion) of concussions.
 
2. If an athlete loses consciousness, call 911 and activate EMS. Before this athlete can return to competition or practice, he must be cleared by a physician.

3. Athletes, in the eagerness to play, may fudge the truth when telling the coach how they feel. As part of the overall evaluation, have the athlete perform sport-specific movements on the sideline and watch for unsteadiness, lethargy, uncoordinated movements. They may lie, but their bodies won’t.

Neck Injuries
Any athlete that sustained a hit and complains of neck pain, or numbness and tingling to extremities, MUST NOT BE MOVED. Immediately call 911. If the athlete is not breathing, your priority is to get the athlete breathing, which means you – or another trained person on-site must begin CPR. However, neck injuries pose a unique problem when CPR is initiated. We encourage all coaches and staff to contact their local EMS provider and learn how and when to use ‘log rolling’ when in this situation. Soccer, like most sports, contains the risk of injury, but the use of shin guards and on-field awareness can lessen that risk. In the case of an injury, stay calm and seek medical help. The general guidelines listed above should not be used as a substitute for seeking trained personnel. Remember that a player’s health is the first priority in situations where an injury appears to have occurred, and trained medical personnel are best able to deal with such situations.

Information compiled by U.S. Soccer's Manager of Sports Medicine Administration Hughie O'Malley and Athletico trainers Lynn Grosman and Rich Monis. For more information please contact O’Malley at homalley@ussoccer.org or 312 528 1225. - ussoccer.com -

Training Techniques, And Their Effect on Frequency of ACL Injuries in Female Soccer Players? By Holly J. Silvers, MPT Director of Research / Physical Therapist Santa Monica Orthopaedic & Sports Medicine Research Foundation Anterior Cruciate Ligament injuries are among the most common of all sports-related knee injuries, affect the lives of more than 250,000 people in the United States each year. Studies conducted during the past three decades have indicated that female athletes sustain non-contact injuries to the ACL of the knee more frequently than their male counterparts. In a study conducted at Duke University, Drs. Bing Yu and William E. Garrett, Jr. found that female recreational athletes incur non-contact ACL injuries 7.3 times more often than that of male recreational athletes. ACL injuries are often season-ending and require reconstructive surgery and four to six months of rehabilitation. Players who opt to delay an ACL surgery often suffer secondary injuries such as meniscal tears, articular cartilage injury, or medial and lateral collateral ligament injury. Possible prevention strategies for ACL injuries were discussed at a panel briefing during the American Academy of Orthopaedic Surgeons Annual Meeting in San Francisco, Calif. earlier this year. According to research presented, four risk factors have been studied in order to understand the causes of ACL injury: anatomy, hormones, environmental factors and biomechanics. The studies, including the one conducted at Duke University, indicate that by intervening just within biomechanics, there can be a decrease in the number of significant knee injuries in the female athletic population. The Santa Monica Orthopaedic and Sports Medicine Research Foundation has collaborated with U.S. Soccer, FIFA, University of Southern California and the Centers for Disease Control to better understand the mechanism of injury of non-contact ACL injuries and has worked diligently to develop an effective prevention program. These researchers completed a randomized controlled trial with sixty-one Division I NCAA women s soccer teams in the 2002 season. Each team was randomized to one of two groups: those performing the program (intervention group) and those who continued to do what they were doing in previous seasons (control group). The study was conducted for 14 weeks over the course of the fall season. The athletes in the intervention group performed a twenty-minute alternative warm-up called the PEP Program (Prevent Injury and Enhance Performance). This intervention group demonstrated a 100-percent decrease in non-contact ACL injuries during practice and an overall 45-percent decrease in non-contact ACL injury (game and practice) compared to the control group. Additionally, the rate for ACL injury was reduced even further a 72-percent reduction, when analyzing the last six weeks of the season. This is because muscle adaptation and neuromuscular training takes approximately four to six weeks to make an effective change in an athlete. This research indicates that a program that addresses landing technique, core stability, balance and proprioception (joint awareness) can effectively decrease the incidence of ACL injuries in the soccer athlete. Dr. Timothy E. Hewett of the Cincinnati Children s Hospital and the University of Cincinnati College of Medicine, noted at the conference that sports programs commonly use training programs for athletes in order to reduce significant injuries. Hewett and his colleagues initiated a study to examine the effects of a comprehensive training program in order to analyze injury rates, performance and biomechanics in female athletes. The athletes trained three days a week for 90 minutes followed by 15 minutes of stretching exercises. The results demonstrated that females increased speed during timed sprints after training. The study also demonstrated significant desirable biomechanical changes during a landing maneuver following the training. In contrast, the control group demonstrated no significant increase in any of the above measured parameters. Overall, these studies and the research that was presented show that by focusing on a player s movement patterns, individual performance deficits can be determined. By giving all players a comprehensive intervention or a warm-up program, such as the PEP Program, these deficits can be addressed. As the research shows, with the use of a program, that the players are more likely to continue performing at a high level without incurring season ending injuries. For information on the research presented in this article and the PEP Program including a downloadable .pdf describing its components, visit the Web site at www.aclprevent.com - www.ussoccer.com -

A look at muscle cramps and what can be done to prevent them. DEALING WITH MUSCLE CRAMPS Potential Causes and Prevention Methods For Dealing with Cramping Muscles Muscle cramping is not an uncommon problem among athletes. Although it is not entirely clear what causes muscle cramps, they are often instigated by loss of fluids and minerals during a hard workout or game. Sometimes muscle cramps can be serious enough to take a player out of a competition. According to U.S. Men s National Team Strength and Conditioning coach Pierre Barrieu, even though the causes of muscle cramps are not entirely known, that does not mean measures cannot be taken to prevent them. Potential Causes of Muscle Cramps Actually, science hasn t figured it out completely, Barrieu said about the causes of muscle cramps. Probably one of the reasons is dehydration, another one is lack of minerals that is affecting the regular muscle contracting mechanism. It also has something to do with the central nervous system. Dehydration is certainly one of the most common factors that contribute to muscle cramps, which are often coupled with large losses of minerals such as sodium, calcium and potassium through sweat. Fluid, mostly water, makes up more than 70 percent of the human body. Along with the loss of sodium a mineral that initiates signals from nerves, which in turn leads to muscle movement and other minerals, the loss of fluid in the human body may cause muscles to become irritable. When the muscles are irritated in such a way, any slight stress, such as movement, may cause the muscles to contract and twitch uncontrollably. Another factor in muscle cramping may be flexibility. Most people tend to relate lack of flexibility and stretching to pulled muscles, however, according to Barrieu, if the muscle is tight, it tends to cramp a lot easier than other muscles. Preventing Muscle Cramps Since the majority of muscle cramps are associated with loss of fluids and minerals as well as tight muscles, the most obvious preventative measures are to keep well hydrated, replace the sodium and other minerals lost through excessive sweating and stretch adequately. You definitely want to make sure that your players don t get dehydrated, said Barrieu. Same thing with minerals. When it comes to the Men s National Team, Barrieu makes sure players are hydrated and get plenty of salt. Salt not only replenishes sodium lost through sweat, it also retains water, which helps players stay better hydrated. Barrieu also makes sure that players get enough minerals such as potassium and calcium and works on flexibility daily, making sure that players muscles are not overly tight, especially since some players are more prone to cramps than others. Stretching properly on game day is particularly important because of the intensity of the workout. Another way to prevent muscle cramps is not only to pay attention to hydration, but also to make sure to avoid dehydration by staying away from alcohol, said Barrieu. When you drink alcohol you definitely expose yourself to cramps, Barrieu said. The reason is that alcohol is sucking a lot of water out of your cells. You definitely have to stay away from alcohol if you re an athlete and you don t want to cramp. Relieving Muscle Cramps Sometimes muscle cramps occur despite an athlete s efforts to prevent them. When muscles cramp during a workout, they can be relieved by: 1. Stretching. A muscle cramp is the contraction of a muscle, so what the athlete needs to do is try to relax that particular muscle, which often brings to mind the typical image of a person stretching, Barrieu said. 2. Drinking fluid. If the muscle cramping is extreme (whole body cramping), fluid should be given through an IV, said Barrieu. However, players should try to rehydrate with a fluid containing electrolytes, such as Gatorade, so that the muscle may receive the minerals it requires to function properly. According to research from U. Connecticut, oral rehydration (drinking) offeres psychological and physiological recovery benefits not obtained from IV treatments. 3. Adequate recovery. This actually means resting and trying to make sure that the muscle is not active until the central nervous system recovers and no longer sends signals to that muscle to contract. So while the exact causes of muscle cramps may be unknown, cramping can often affect a player s productivity on the field, which makes preventing muscle cramps very important. Adequate hydration, stretching and staying flexible and making sure that the proper mineral levels are maintained are all key factors in avoiding muscle cramps. Also important is avoiding alcohol and other such drinks that dehydrate the body, and making sure that if a player s muscles do cramp, that player allows the affected muscles to relax and recover completely. Information obtained from Men s National Team Strength and Conditioning coach Pierre Barrieu and the Gatorade Sports Science Institute, www.gssiweb.com. - ussoccer.com -