January 2017

Soccer gets safer: Injury trends suggest prevention payoff

In the moment: Sports medicine

By Katie Bell

Collegiate soccer injuries, particularly those at the knee and in women, decreased significantly from the early 1990s to the late 2000s, according to research from George Washington University in Washington, DC. The positive trends may reflect an increase in resources being allocated toward injury prevention along with efforts to increase the safety of the playing environment, the authors said.

“Based on what we see and the existing literature regarding [injury prevention] programs, we believe they may have played a part in reducing rates of knee and ACL [anterior cruciate ligament] injuries to a certain extent among female soccer players,” said lead author Avinash Chandran, MS, a PhD candidate and research associate in the Department of Exercise and Nutrition Sciences at the university’s Milken Institute School of Public Health.

However, Chandran added, “It is important to note that this is only part of the puzzle, and it remains very difficult to understand exactly the extent of the impact that these programs may have had in this particular context.”

The study was designed to identify trends in injury incidence and severity between 1990-1996 and 2004-2009 in male and female National Collegiate Athletic Association (NCAA) soccer players. Data were analyzed from the NCAA Injury Surveillance System (ISS), to which athletic trainers associated with each collegiate program voluntarily report injuries and supporting information about the injury’s nature.

Injury events were characterized as new or recurrent, contact or noncontact, and game-related or practice-related. With regard to severity, injuries were classified as short term, long term, or requiring surgery.

The study found that in the 2004-2009 cohort, overall sex-pooled injury rates were significantly lower compared with the 1990-1996 cohort for almost every category of injury studied. Between 1990-1996 and 2004-2009, men experienced an increase in the rate of noncontact injuries, whereas women experienced a significant decrease.

Although the most common soccer-related injuries occurred at the ankle, knee, and upper leg, the researchers noted a significant decrease in the number of injuries at these sites between the two time periods. The rates of knee injuries fell by around 29% in both sexes, while the rate of ankle injuries dropped by 23% in women and by 13% in men. Injuries to the upper leg declined by 26% in women and 6% in men.

The findings were published in the December issue of the American Journal of Sports Medicine.

“Possible explanations include evolving playing styles, changes in player characteristics [physical profiles], and of course the impact of targeted prevention strategies,” Chandran said. “With females in particular, it is reasonable to suggest that certain prevention strategies appear to be successful, and we may look to improve them even further based on the success they seem to be enjoying.”

Among male players, he said, “it may not be a question of developing strategies that are new, rather a question of tailoring strategies specifically to this group [by altering even minor details].”

Holly Silvers-Granelli, MPT, a PhD candidate in the Department of Biomechanics and Move­ment Science at the University of Delaware in Newark, agreed the impact of injury prevention programs has grown in recent decades.

“The coaching and player awareness related to the existence of injury prevention protocols has certainly increased over the last decade and a half,” Silvers-Granelli said. “In addition, training methodologies have intellectually evolved.”

The study concluded public health efforts should promote the use of the ISS to better inform and evaluate injury pre­vention policies aimed at player safety. However, Chandran noted the findings may not be completely generalizable to soccer players at other skill levels.

“It’s very difficult to suggest that these results would be mirrored in other groups,” he said. “Even among young players, collegiate players experience a slightly different profile of injuries compared with younger, grade school level players.”

There are limited data on injury prevention for players aged 25 and older, but Silvers-Granelli said,  “As a clinician, I recommend these programs to all of my adult recreational and masters level patients [within reason and with respect to their individual functional abilities].”


Chandran A, Barron MJ, Westerman BJ, et al. Time trends in incidence and severity of injury among collegiate soccer players in the United States: NCAA Injury Surveillance System, 1990-1996 and 2004-2009. Am J Sports Med 2016;44(12):3237-3242.

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