Knee Injury Precautions

This is my knee story. It was my junior year of high school. Midway through the soccer season and 20 minutes into the first half, I had a breakaway on goal. However, just before shooting on goal, a defender was able to get a touch on the ball knocking it away. Instead of making contact with the ball, I made contact with his leg. In doing so, I hyper-extended my right knee. As I was carried off the field, I knew something was not right. However, after 10 minutes of ice and a shot of endorphins, the knee felt great. I felt great. I was ready to go back in.

As I recall, I proceeded to have a great game … amazing what some endorphins will do. But it all came to an explosive end five minutes before the end of the game. I went up for a header, landed awkwardly on my right leg and BOOM! My knee, and more specifically, my ACL exploded. For those of you unfortunate enough to have had a similar experience, you know the sound I’m talking about. I still can’t believe no one else heard the explosion.

Since the knees were never designed to take the twisting, torquing, cutting, and physical demands associated with soccer, many soccer players have their own knee story or stories. There is a very good chance that if a soccer player plays soccer long enough, the knees will sustain some type of trauma or injury. Because of this likelihood and based on my own experience, I believe knee injuries need to be addressed in a special way.

When I coached, I had the following rule: when a player sustained any type of knee injury, whether it was a ‘knock’, a small tweak, or slight hyper-extension, he or she was done for two weeks. It did not matter how good the player was, what important games were coming up, or how well the player was moving around or feeling; he or she was not allowed to practice or play for two weeks. No ifs, ands, or buts!

Besides not playing, I also asked the parents of the injured player to do the following:

• Start icing the knee immediately–20 minutes on, 20 minutes off.
• Take their child to see a doctor, preferably an orthopedic surgeon, within a few days of the injury. If the injury looked bad, I would recommend the emergency room.
• Stress to their child the importance of resting the knee during school–no recess or lunchtime high-jinks.

As a coach, if you chose to follow this rule or already have a similar rule, you will undoubtedly deal with players pleading with you that they are fine and parents who are positive you are overreacting. No matter. You are doing what is in the best long-term interest of the player. Make sure to share this rule with players and parents at the beginning of the season so there are no surprises.

Author’s Note: Though this post is about knees, I believe any leg injury should be treated with precaution. Ankle, heel, toe, calf, hamstring, quadriceps, or groin injuries should all require some type of rest as well as a professional exam. Having a player play with any type of leg injury that has not had time to heal could have negative long-term consequences. At the youth level, compromising any one of these leg parts is simply not worth it.

Effort and Playing Time

One of the most difficult parts of coaching youth soccer is allocating playing time. As a coach you want to be as equitable with the playing time as possible. For house (or non-competitive, non-traveling) teams, this was always easy. My philosophy was to give each player the same amount of playing time, regardless of skill. Only disciplinary issues would result in less playing time.

With competitive teams, playing time became much more difficult to manage. I still tried to be as equitable as possible but now skill level, attitude, score, and effort also contributed to or resulted in a lack of playing time.

For me, the most important trait in a competitive youth player is effort—the more effort put forth in a game and the more energy expended during game, the more playing time the player receives. I’m a strong believer that at the end of every game, a player should be very tired and have very little energy left over.

To illustrate how effort impacted the allocation of playing time with two charts.  The first chart illustrates the playing time during a game for Players A and B early in the season (x-axis). Both players start the game (green line). Player A puts forth much more effort and expends much more energy that Player B (y-axis). Both are taken out at the same time to recuperate (yellow double line). Because I like Player A’s effort, I put her in after a short rest. Even though Player B has completely recovered her energy, she remains on the bench because of the lack of effort exhibited on the field (red double line). Player B does make it back into the game but if the effort is not there, her playing time remains less than Player A’s playing time.

It is important for Player A to understand that she needs to be taken out of the game. If she did not come out, all of her energy would be used up before the end of the game (green dashed line). As a coach, I would much rather have her on the field at the end of the game. In addition, by taking her out, others get a chance to play.

The second chart illustrates what the playing time may look like midway through the season for Players A and B. Player A is still getting the same amount of playing time. However, Player B is getting less playing time because the effort is still not there.

Player B should not lose hope. If I see more effort and energy during the game (and during practice … what they say is true, “you play the way you practice”), playing time would increase.

If you are a coach or a parent, show these charts to your players/child so they understand that effort can make all the difference in the world … and not just in soccer.