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The first 24 – 48 hours after an injury occurs are critical. You must use the RICE method if further damage and pain are to be avoided.

R = Rest rest the injured area to stop further damage and bleeding.

I = Ice should be applied as soon as possible as it slows down blood circulation which reduces bleeding and swelling. Do not apply ice direct to the tissue/skin, wrap it in a towel or cloth so the skin does not burn. Ice also has an analgesic effect.

C = Compression should be applied to the area as soon as possible to restrict bleeding at the injury. Pressure compresses blood vessels so preventing blood escaping through open ends of the torn fibres. Do not apply compression around a whole limb as it will starve other areas of blood.

E = Elevation allows gravity to assist the removal of swelling from the injured area and aids recovery.

Summer football tournaments are usually an enjoyable way to spend a day – even if your team doesn’t get past the qualifying rounds!

However, even the most well run tournament will present some risks to the health and safety of your players. As coach it’s your responsibility to make sure everyone is aware of these risks and takes sensible precautions.

One of the most significant risks (even on a cold day) is dehydration. It might seem obvious to you and me but you need to make sure that the children in your team bring plenty of drink (at least two litres of water or isotonic drink per person) and enough energy rich food to last the day. Not a couple of cans of fizzy pop and some crisps!

Another potentially serious risk is sunburn. I always tell my parents to make sure their children put on sun block before they arrive and bring some more to apply during the day.

By the way, don’t offer your own sun block to your players – they might be allergic to the ingredients.

Take a gazebo or tent so that players can have somewhere to rest out of the sun (or rain). And make sure someone knows how to put it up!

If the worst comes to the worst and you suspect one of your players has been adversely affected by the sun, follow the advice below (provided by St John Ambulance)

Heat Exhaustion

Heatstroke

Sunburn

This information is provided by way of general guidance only and if in any doubt and/or where injuries are clearly serious, casualties should be referred to a doctor or hospital. This information is not a substitute for formal First Aid training.

Reproduced by kind permission of the Federation of Holistic Therapists

On the whole, sport is good for children. Not only does it tackle the thorny issue of childhood obesity (and related conditions, such as type II diabetes), participating in competitive sport is also said to improve self-esteem, team spirit, self-discipline and motor skills. But although regular exercise is more favourable than sitting in front of a television screen or computer monitor with a packet of salt and vinegar crisps, some children are pushing their small bodies so hard in order to reach their sporting goals, they are causing themselves serious injuries.

If you wanna be the best…

It would seem that if you really want to make it in sport (or your parents really want you to make it in sport), you have to start training at a very early age. Let us take, for instance, four well-known sporting personalities: Tim Henman started playing tennis when he was just two years old, and was part of a training group run by former British tennis star David Lloyd when he was ten; Tiger Woods was hitting golf balls at the age of three, and won his first tournament at the age of eight; Paula Radcliffe started running when she was seven, and joined Bedford Athletics club when she was nine; and David Beckham was practically kicking a football by the time he was able to stand on his feet, and went on to win the TSB Bobby Charlton Soccer Skills Finals when he was eleven.

With today’s sporting stars starting out so young, it is not surprising that more and more children are being introduced to competitive sport at a very early age. As a result, more children are starting to trickle through to sports clinics and therapists. Although a number of injuries presented will be no different to those we would expect to see in an adult, there will be those that relate specifically to the child’s stage of physical development. So what are the ‘common’ sports injuries to be found in children, how are these caused, and how can their occurrence be reduced or prevented?

Down to the bone

In Sports Injuries: Causes, Diagnosis, Treatment and Prevention2, the authors suggest that: “a number of sports injuries observed in children are generally related to: (1) their immature skeleton, which can be more vulnerable to injury, and (2) the anatomical imbalances that can occur during the growth spurts” [e.g. when bones lengthen faster than muscle-tendon attachments, resulting in poor flexibility].

Of particular concern is the risk of injury to the ‘growth plates’. A growth plate is an area of developing tissue situated within (or at the end of) a bone. These growth plates are made of cartilage and do not, under normal circumstances, ossify until the child matures and their bones are fully developed. Consequently, children’s bones are weaker and more susceptible to fracture and overuse injuries.2 The likelihood of injury can be further enhanced if the child is experiencing a ‘growth spurt’ (growth spurts typically occur between the ages of 10-14 for girls, 12-16 for boys4).

Different bones also grow at different rates, and this in turn is influenced by the individual status of the child, such as their age, gender, growth rate, and sexual maturity. Such a range of factors render it almost impossible to judge when a child is ‘less’ likely to incur an injury: a good understanding of physical development and a sensible training plan is therefore essential for those responsible for the care of the child during their training.

Extrinsic risk factors

There are other factors, other than physical ones, that can increase the incidence of injuries in children. These include:

Pushy coaches and/or parents
It is well recorded that Andre Agassi used to have a tennis racket taped to his hand when he was just 2 years old, and that his father suspended a tennis ball above his bed for something to ‘fix his eyes on’ as a baby. Whether or not such behaviour could be considered immoral or exploitive, it is quite common in parents and coaches. Many children will be constantly pushed, and even made to ‘play through’ pain (and injury) because someone else is desperate for them to achieve.

Inappropriate Levels of Training
Children training in competitive sports are often unfairly treated as ‘mini’ adults. This can result in long hours of intense training that their little bodies simply aren’t physically or mentally mature enough to cope with.

Pitching them against bigger players
Children are often pitched against others of the same age who are their superior in terms of size, strength and skill. This could easily result in injury and low self-esteem.

Radically changing training conditions
If a football coach suddenly introduces the child to a different playing surface or piece of equipment, the child should be given adequate time and/or training to adapt.

Ignoring participation in other physical activities
If the child is taking part in other activities (e.g. P.E. lessons) that may affect their performance, this needs to be taken into consideration.

Reducing/ Preventing Injuries

Injuries sustained during childhood can have serious, long-term implications (see the table below). Ideally, the risks posed to children need to be reduced or minimised where possible. Allowances should be made for the fact that they are physically and mentally less able to endure the training loads placed on adults. Some key points to consider:

• The physique of some children make them ill-suited to certain sports (e.g. someone who is large and inflexible will not make the ideal candidate for gymnastics)
• Ideally, the child should be introduced to a variety of different sports to see which one they are best suited to and enjoy
• The child needs to be physically fit before they commence training
• Training should be modified when the child is experiencing a growth spurt
• Good coaching is essential. The child needs to be taught how to perform (and to fall) correctly
• Equipment, circuits, and areas of ‘play’ should be scaled down accordingly
• Children need to be supplied with protective gear that fits properly

Warm-ups and warm-downs are just as crucial to children as they are to adults. It also gets them into good training habits at an early age

It is up to those responsible for the child to ensure that they are sufficiently hydrated and protected against sunburn during training sessions as the child may not appreciate the seriousness of such things. Equally, the coach needs to know when it is time to stop training

Again, it is up to the coaches and parents to ensure that competitive events entered are well organised and do not pose any undue risks to the child
The child needs adequate rest in between training sessions and in the event of injury.

References/ Suggested Further Reading

1 DiDiori, John P. (1999) Overuse injuries in children and adolescents. The Physician and Sportsmedicine: Vol 27; No. 1. (www.physsportsmed.com/issues/199/01_99/didiori.htm)
2 Bird, S., Black, N., Newton, P. (1997) Children and sports injuries. Sports Injuries: Causes, Diagnosis, Treatment and Prevention. Stanley Thornes Ltd. ISBN 0 7487 3181 4
3 NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases. USA) (2000) Childhood Sports Injuries and Their Prevention: A Guide for Parents
(www.niams.nih.gov/hi/topics/childsports/child_sports.htm)
4 Briggs, James. (2001) Children in Sport/ Child Abuse in Sport. Sports Therapy: Theoretical and Practical Thoughts and Considerations. Corpus Publishing Ltd ISBN 1 903333 04 0

Copyright Federation of Holistic Therapists 2005

by Dr. Donald T. Kirkendall

There are more myths that coaches, players and parents may be following, but below four of the more common myths are dispelled. By following the nutritional guidelines below, players, coaches and teams can put themselves in an advantageous position before the match starts.

Myth 1: Game performance is not affected by what you eat.
Virtually every study on athletic performance for both team and individual sports shows that a diet rich in carbohydrates improves running performance. However, nutritional research from the 1970s to present day still show that soccer players choose a diet that is approximately 40 percent carbohydrates, 40 percent fat and 20 percent protein.

What is discouraging is that in the very early 70s, the Swedes conducted a study that showed soccer players with low muscle fuel (glycogen) walk about 50 percent of the game. Even 30 years later, a study showed that more than half of a national team in the 1994 FIFA World Cup thought food had nothing to do with their performance. The bottom line is that players eat what is put in front of them.
The more carbohydrates an athlete eats, the more endurance he or she will have. This means that when the end of the game approaches, the player will be able to run faster and longer if he or she consumed the proper amount of carbohydrates.

Myth 2: What you eat after the game does not matter.
At games and tournaments around the country, players will sometimes eat the worst post game snacks possible including soda, sweet drinks in soft packaging, potato chips, candy bars and fries. Everyone who has ever been to a soccer field on a weekend has seen this.

Muscles are most ready to receive a fresh supply of fuel during the first hour or two directly following exercise. The smart coaches and parents supply food that will start refilling muscles with carbohydrates at just that time.

A proper supply of carbohydrates is needed. It can come from a carbohydrate replenishment drink or other foods like bagels with jelly, pretzels, raisins or other dried fruit. This is even more critical between tournament games when the time between games is even shorter.

Myth 3: A diet is good as long as an athlete gets enough protein.
While most every survey of the athletic diet shows that players get all the protein they need from food, there is a problem. The vast majority of protein is consumed in conjunction with fat.

Marbled meat, ground beef, and fried chicken all are examples of protein that is combined with lots of fat. Red meat should be trimmed of fat, and ground beef should be very lean. Chicken should have the skin removed before cooking.

One place protein isn’t commonly found is the immediate post-exercise meal. A little protein helps in storing new fuel in the muscles faster than when there is no protein. Players can try to figure out a protein source after the game or drink a carbohydrate replenishment drink that contains protein.

Myth 4: Your body is the best indicator of when to drink; Mother Nature knows best.
For most mammals, it is OK not to drink until thirsty. However, the thirst mechanism of humans operates differently than the average mammal. In fact, the human thirst mechanism doesn’t even kick in until a person has lost about two percent of body weight from sweating. At this level, a decrease in performance begins to become evident.

Players should drink before starting the game, every 15-20 minutes during play if possible, and at halftime. Make sure the team has drink bottles along both sidelines and in the goals so players have easy access to fluids during stoppages of play. Don’t forget that playing in the cold is also dehydrating, so drinking fluids is just as important in cold weather.

Sprains and strains are among the most common injuries in all sports, including soccer.

Here are some facts about sprains and strains from the American Academy of Orthopaedic Surgeons.

What is a sprain?

A sprain is a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone with another. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the upper leg with the lower leg, enabling people to walk and run.

What is a strain?

A strain is a twist, pull and/or tear of a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone.

What causes sprains and strains?

A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and, in severe cases, ruptures the supporting ligaments. Typically, this injury occurs when an individual lands on an outstretched arm; slides into a base; jumps up and lands on the side of the foot; or runs on an uneven surface.

Chronic strains are the result of overuse – prolonged, repetitive movement – of muscles and tendons. Inadequate rest breaks during intensive training precipitates a strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction.

Who gets sprains and strains?

Professional and amateur athletes and the general public, as well, can sustain this injury. People at risk for the injury have a history of sprains and strains, are overweight, and are in poor physical condition.

What activities make athletes most susceptible to sprains and strains?

All sports and exercises, even walking, carry a risk of sprains. The anatomic areas most at risk for a sprain depend on the specific activities involved. For example, basketball, volleyball, soccer, and other jumping sports share a risk for foot, leg, and ankle sprains. Soccer, football, hockey, boxing, wrestling, and other contact sports put athletes at risk for strains. So do sports that feature quick starts (hurdling, long jump, running races, etc.). Gymnastics, tennis, rowing, golf-sports that require extensive gripping-have a high incidence of hand strains. Elbow strains frequently occur in racquet, throwing, and contact sports.

What are the signs of a sprain?

While the intensity varies, pain, bruising, and inflammation are common to all three categories of sprains-mild, moderate, severe. The individual will usually feel a tear or pop in the joint. A severe sprain produces excruciating pain at the moment of injury, as ligaments tear completely, or separate from the bone. This loosening makes the joint nonfunctional. A moderate sprain partially tears the ligament, producing joint instability, and some swelling. A ligament is stretched in a mild sprain, but there is no joint loosening.

What are the signs of a strain?

Typical indications include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping. In severe strains, the muscle and/or tendon is partially or completely ruptured, often incapacitating the individual. Some muscle function will be lost with a moderate strain, where the muscle/tendon is overstretched and slightly torn. With a mild strain, the muscle/tendon is stretched or pulled, slightly. Some common strains are:

Back strain. When the muscles that support the spine are twisted, pulled, or torn, the result is a back strain. Athletes who engage in excessive jumping (during basketball, volleyball, etc.) are vulnerable to this injury.

Hamstring muscle strain. A hamstring muscle strain is a tear or stretch of a major muscle in the back of the thigh. The injury can sideline a person for up to six months. The likely cause is muscle strength imbalance between the hamstrings and the muscles in the front of the thigh, the quadriceps. Kicking a football, running, or leaping to make a basket can pull a hamstring. Hamstring injuries tend to recur.

How are sprains and strains treated?

Rest, ice, compression and elevation usually will help minimize the damage. It is important in all but mild cases for a medical doctor to evaluate the injury and establish a treatment and rehabilitation plan. A severe sprain or strain may require surgery or immobilization followed by months of therapy. Mild sprains and strains may require rehabilitation exercises and activity modification during recovery.

Prevention tips

No one is immune to sprains and strains, but here are some tips developed by the American Academy of Orthopaedic Surgeons to help reduce your injury risk:

Participate in a conditioning program to build muscle strength

Do stretching exercises daily

Always wear properly fitting shoes

Nourish your muscles by eating a well-balanced diet

Warm up before any sports activity, including practice

Use or wear protective equipment appropriate for that sport

This soccer coaching risk assessment is provided as an example. You should identify the hazards at your own coaching sessions and matches and take appropriate action to minimise any risk to your players.

This soccer coaching risk assessment is provided as an example. You should identify the hazards at your own coaching sessions and matches and take appropriate action to minimise any risk to your players.