Risk Factors for Lower Extremity Overuse Injuries in Female Youth Soccer Players

Abstract

Background:Youth soccer injuries are common and of increasing concern, with sport specialization occurring at younger ages. Limited research is available regarding overuse injuries and risk factors in young female athletes.Purpose:To identify the number and rate of overuse injuries in female soccer players (ages 12-15 years), describe the anatomic location and type of injury, and evaluate contributing risk factors.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 351 female youth soccer players, ages 12 to 15 years, from Washington State were evaluated from 2008 to 2012. Players with lower extremity overuse injuries were identified through weekly emails and were interviewed by telephone to obtain data on injury type and body region. We evaluated the association between overuse injuries and preseason risk factors, including joint hypermobility, hip and knee muscle strength, and jump biomechanics, using Poisson regression to estimate relative risk (RR) and 95% CIs.Results:The incidence rate for first-time lower extremity overuse injuries was 1.7 per 1000 athlete-exposure hours (AEH; 95% CI, 1.4-2.2), and that for repeat injuries was 3.4 per 1000 AEH (95% CI, 2.1-5.6). Knee injuries accounted for 47% of overuse injuries. Increased valgus was associated with a 3.2-fold increased risk (95% CI, 1.52-6.71) for knee injury. A 1–standard deviation (SD) increase in hamstring strength was associated with a 35% decreased risk (RR, 0.65; 95% CI, 0.46-0.91) for overuse knee injuries, and a 1-SD increase in quadriceps strength was associated with a 30% decreased risk (RR, 0.70; 95% CI, 0.50-0.98). A 1-SD increase in hip flexor strength was associated with a 28% decreased risk (RR, 0.72; 95% CI, 0.51-1.00) for overuse knee injuries, and a 1-SD increase in external rotation strength was associated with a 35% decreased risk (RR, 0.65; 95% CI, 0.46-0.91). Playing on more than 1 soccer team was associated with a 2.5-fold increased risk (95% CI, 1.08-5.35) for overuse knee injuries, and participating in other physical activities was associated with a 61% decreased risk (odds ratio, 0.39; 95% CI, 0.15-0.81).Conclusion:In this study, lower extremity overuse injuries in female youth soccer players affected primarily the knee. Lower knee separation distance, decreased lower extremity strength, and playing on more than 1 soccer team increased injury risk.

Overuse injuries are prevalent in children’s competitive football: a prospective study using the OSTRC Overuse Injury Questionnaire

“…These findings are in line with previous studies on female youth football players27 29 and children (aged 8 to 15 years) from various sports including football 30. O’Kane et al 29 investigated risk factors for overuse knee injuries and found that increased knee valgus, decreased lower extremity strength and playing on more than one team were associated with increased injury risk in female football players aged 12 to 15 years. Similar risk factors have been associated with acute knee injuries as well 31 32.…”

Sport Specialization and Risk of Overuse Injuries: A Systematic Review With Meta-analysis

“…The application of the inclusion and exclusion criteria during the full-text review resulted in the exclusion of 7 studies. Two studies were removed because they were not explicitly focused on overuse injury, 24,25 1 was removed because the comparison was between athletes with high specialization in team sports and athletes with high specialization in individual sports, 26 1 was removed because the authors did not directly compare specialized and nonspecialized groups and the measurement of specialization was not clearly defined, 27 and 3 studies were removed because the athletes fell outside of the established age range, 28 -30 leaving 5 studies from which data were abstracted and synthesized in the results.…”

Investigation of knee control as a lower extremity injury risk factor: A prospective study in youth football

“…The visual assessment of frontal plane knee control correlates well with the FPKPA, when assessment if performed by experienced observer. 30 Previous studies on young athletes have shown that reduced frontal plane knee control is associated with higher risk of future injuries, 29,39,44,45 although all the studies are not in agreement. 46 As reduced knee control has been identified as an injury risk factor, using movement control tests to identify athletes who could reduce their injury risk by improving knee control seems sensible.…”