Oct. 1, 2004
J. Marc Davis, P.T., ATC-L
Physical Therapist/Athletic Trainer
University of North Carolina
Youth soccer has become quite the American success story. In just over a quarter of a century the sport has risen from virtual obscurity to become a major component of most municipalities' recreational programs.
According to American Sports Data Inc., soccer was the only team sport to have increased participation for the decade ending in 2000. As with all sports there are inherent risks involved in playing soccer and injuries do occur. Most injuries involve the lower extremity especially the ankle and lower leg but serious even life threatening injuries though rare, do happen.
Parents and coaches need to be prepared to handle these emergencies. With good planning, adequate equipment, and a basic knowledge of first aid any soccer coach or parent can learn to care for an injured athlete. It is highly recommended that all coaches and team managers be trained in basic first aid including CPR and parents should also consider under going this training.
Basic Treatment: Preparation and Planning
Being able to provide care for an injury requires having knowledge of basic first aid, access to adequate first aid supplies and equipment at all practices and games, and having a basic emergency plan of action outlined in advance.
A well stocked first aid kit (can be obtained at most medical supply houses or sporting goods stores) is a good start but several additional items should be included: a pair of crutches, plastic bags for ice, chemical cold packs if regular ice is not available, a SAM splint (definition below), an arm sling, additional elastic wraps, and a pair of 7 ¼ inch bandage scissors. Each parent does not need to carry all this equipment but one person should be responsible for being certain that it is available.
An emergency plan of action should outline individual responsibilities in the event of an accident or injury. It should include planning for minor and major injuries including who would provide first aid, who would call 911 if needed, who would meet and direct the paramedics, and who would contact parents if they were not present.
The National Athletic Trainers Association (www.nata.org.) is an excellent resource for help in developing a plan. Many parks have emergency plans posted at their venues and most major tournaments have medical care available on site but at practices and regular games the availability of on site medical care is variable and the care of an injured player usually falls on the team's coaches and parents
Minor Injuries -- Treatment
Most injures encountered will be sprains, strains, contusions, abrasions, or blisters. The RICE principle is used to treat sprains (ligament injuries), strains (muscles injuries), and contusions (bruises). RICE stands for:
R - Rest - The injured part should be placed in a position of comfort. If a fracture is suspected a SAM splint can used to immobilize the site. It is an aluminum splint that can be molded to fit the body part and trimmed with scissors if needed. Elastic bandages hold the splint in place. Crutches should be used if an ankle, knee, or leg is too painful for weight bearing; a sling for a painful wrist, elbow or shoulder.
I - Ice - This is used to control pain and swelling. Chemical cold packs are available and are useful if regular ice is not available but they do not stay cold for long. Ice should not be left in place for more than 20 minutes at a time but it can be repeated often, usually 20 minutes on then 20 minutes off. Always check the skin frequently for signs of frost bite with prolonged use of ice.
C - Compression - Elastic wraps are used to provide circumferential pressure about the injured part. This aids in reducing swelling. They should not be applied to tightly, only about one half the tension should be pulled from the wrap.
E - Elevation - Swelling can be further reduced by elevating the injured part higher than the heart.
Abrasions commonly result from contact with ground and most frequently occur at the knee and elbow. These should be gently cleaned with mild soap and water being certain to remove any foreign material from the wound. The wound then is covered with an antibiotic ointment and a non-adherent dressing. It is best to keep the wound moist and not allow a scab to form. The wound will heal from the inside out and there will not be continual reinjury by having a scab knocked off over and over. The wound should be watched closely for signs of infection such as increased pain, redness, and skin warmth.
Blisters are best treated with prevention. Blisters can be almost eliminated by breaking in new shoes gradually, wearing shoes that fit properly, and wearing clean and dry socks. If a blister is small (less than the diameter of a nickel) and non painful it can be padded, not drained, and watched closely. If the blister is large, painful, and in a spot where there is a lot of pressure it should be opened, cleaned, padded, and watched closely for signs of infection. It is important to note that universal precaution to prevent the spread of blood borne pathogens require that any open wound be immediately covered to prevent the possibility of transmitting disease through contact with another individual's blood.
Major Injuries Successfully managing a major injury requires quickly obtaining medical care beyond the scope of basic first aid. This means prompt notification of emergency medical providers while basic first aid is given to the injured athlete. An emergency action plan is the outline to follow in this event in order to expedite the entry of the injured athlete into the emergency care system. Severe injuries that can be expected in soccer are fractures and/or dislocations with obvious bony deformity, and head injuries.
In the event of a serious fracture or dislocation the injury player should not be moved and no attempt to splint or reduce the injury should be undertaken until the rescue squad arrives. The player should be reassured and kept still until advanced medical care is available. Head injuries most commonly occur when player collide in an attempt to head the ball. (Editor's note: Head injury will be discussed in greater detail in the concussion article.)
Symptoms of a head injury include unconsciousness, dizziness, headache, blurred vision, confusion, nausea, and light sensitivity. A player does not have to be rendered unconscious to suffer a head injury. A player reporting any of these symptoms following a blow to the head should not be allowed to return to play and medical follow up is recommended. If an athlete is unconscious, a neck injury is always suspected and they should be assessed for breathing and pulse, not moved unless CPR is warranted, and the emergency action activated.
Other major injuries though rare include cardiac/respiratory arrest and severe bleeding. In both instances activation of the emergency action plan is crucial. Cardiac/respiratory arrest is suspected anytime a player becomes unconscious especially if there is no apparent trauma involved. Initiation of CPR is paramount in handling this situation. Severe bleeding is treated by applying direct pressure to the wound and transporting the individual to an emergency facility. Tourniquets should not be used; they can cause permanent and unnecessary tissue damage.
Heat Illness can range from simple dehydration to heat exhaustion to muscle cramps to heat stroke and the best treatment is prevention. It takes about 10 days to acclimatize to working in the heat so early season practices should be graduated in time and intensity to allow for this. Ample amounts of water need to be available at all games and practices, and players should be encouraged to drink at frequent intervals. If severe environmental conditions exist (high temperature and humidity) practices should be modified, game times shortened, and water breaks allowed during games. If parents desire to provide a commercial sports drink, they should be certain that it is a fluid replacement beverage and not an energy drink. The high sugar content of energy drinks delays the absorption of water in the gut which slows rehydrataion, and if the drink contains caffeine it could actually increase dehydration.
Symptoms of heat exhaustion include profuse sweating, lethargy, clammy skin, nausea, vomiting, and headache. They player should be placed in a cool shady spot, cooled with ice towels, and given cool water or a fluid replacement drink. They should be monitored closely and medical care sought if their condition worsens. Muscle cramps are treated with gentle stretching to the involved muscle, rehydration, and the application of ice. Symptoms of heat stroke include disorientation, hot dry skin, unconsciousness, and possible seizure. It is a medical emergency and requires immediate activation of the emergency action plan. First aid for this condition requires rapidly cooling the individual any way possible; ice towels, immersion in an ice bath, or placing them under a cool shower until the paramedics arrive.
Summary Youth soccer can be a wonderful experience for a child and his or her family, and that experience can be enhanced by having a good system in place in the event an injury occurs during practice or games. That system consists of having trained first aid providers at all events, having a simple but well designed emergency action plan, and having basic first aid supplies and equipment on site.
Most of the injuries that occur can be handled with basic first aid but parents and coaches should never hesitate to activate the emergency plan if a severe injury is suspected. It is not possible in the limited scope of this article to discuss every possible scenario that might be encountered with youth soccer but the basic concepts of care have been explained and that should help parents and coaches be prepared to deal with the unexpected.