Soccer Training Programs by the Pros

The Matchfit Method

The product is created and marketed by James Donnelly. This man is very willing to help ambitious footballers like you. The author is also a professional footballer with all the skills and experience that he thinks can help other go-getting footballers momentously. The Matchfit Method is a step-by-step Mildness, Endurance, strength, speed, Injury prevention and Nutrition system that aims at helping footballers from all parts of the world. This program provides you with the exact training routines that you need to complete. The author understands that you are already receiving training from your club training but now you need to improve in the key areas of football performance. This product is available in PDF downloadable formats. Though, some of the bonuses are available in video formats to really help you understand what is required from your side. With all the information available in those two formats, it can really helpful to you regardless of your football skills. Read more...

The Matchfit Method Summary


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The Matchfit Method Review

Highly Recommended

This is one of the best ebooks I have read on this field. The writing style was simple and engaging. Content included was worth reading spending my precious time.

This ebook does what it says, and you can read all the claims at his official website. I highly recommend getting this book.

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While my friends are driving their kids to soccer practice and dance classes Im driving my child to speech therapy and

Adjusting to your new life will take some time, especially since it was completely unplanned. In the meantime, many of your friends are doing with their children the very things that you had planned to do with yours. One way to deal with this situation is to use what's referred to as cognitive restructuring. Don't dwell on your friends' lives. Instead of telling yourself how much you wish you were driving your child to soccer practice, try telling yourself that you're doing what's best for your child right now. You may be surprised at how quickly your life will return to normal normal, at least, in the sense that driving your child to speech therapy becomes a regular part of your daily or weekly routine. While you may not be a soccer mom or dad right now, you're a speech therapy mom or dad, and you'll soon realize that you're not the only one out there. You'll be able to bond with other parents in the same situation.

Chronic Traumatic Brain Injury

CTBI has been a disorder more commonly reported among boxers however, this condition can also be encountered in football, ice hockey, soccer, rugby, and potentially any sport associated with recurrent concussion. The frequency of CTBI in sports is largely unknown. It has been estimated that the prevalence of CTBI among retired professional boxers is 17 however, the incidence or prevalence in football, ice hockey, soccer, rugby and other contact collision sports is unknown. Cumulative injury is an extremely important concept in athletic concussion. There can be significant morbidity associated with more than one concussive episode. After a second concussion, the postconcussion syndrome is more pronounced. Multiple concussions may affect personality, academic performance, and the ability to return to competition. However, long-term effects can be even more devastating.

Sportspecific Training

Objective performance scores, specific for the sport, are very valuable but poorly developed. I have tried to develop such scores for professional rugby and soccer and their validity is improving. One of the main reasons for the difficulties of objective scoring is that the functional scores used by orthopaedic surgeons or physiotherapists are developed for the general population, ranging from recreational athletes of all age groups to elite athletes from varying sports. A high shoulder or knee score compared to the general population may not indicate it is safe for a professional 12 soccer or rugby player to return to the game. Another reason is that a goalkeeper or striker in soccer, a winger, prop or full-back in rugby or a bowler or batsman in cricket may perform on the same level in the same team but the consequence of a low or high score may be very different for each of them.

Testosterone administration

This model of reciprocal effects between sex hormones and environment, although being more complex than simple hormone or experiential factors, still does not fully explain the variation in aggressive behaviour between individuals. New research perspectives will be necessary and helpful. A recent study within the theoretical framework of evolutionary psychobiology by Neave and Wolfson (2003) set an example. They argued that human males are more dominant and activated, attacking more readily within a territory defined as their own - a typical behaviour shown by males (and females) of various species, including subhuman primates. As antagonistic behaviour is related to testosterone levels, with an invasion triggering a subsequent rise in this hormone, they investigated the hypothesis that territoriality in male soccer players is positively related to levels of testosterone. They found that salivary testosterone levels in soccer players were significantly higher before home games than...

Maintaining Wellness Tip No 4 Relying on Social Supports

Candace had few hobbies in her current life but had played soccer in college. With some reluctance, she joined a group who played soccer on weekends. She felt awkward at first. They're not my kind of people, she observed. At the beginning she had to force herself to go. Little by little, however, she found that her weekends became more structured because of the soccer practices. Although she never admitted to enjoying the members of the team, she did notice that her mood brightened when she participated in an activity with them. At first she thought this was due to physical exercise, but she found that her mood also brightened when she went to pot-luck dinners or movies at the team members' houses. She eventually disclosed her illness to a few of her teammates, who weren't

Specific muscle training

One essential function of the muscles is to protect and stabilize joints of the skeletal system. Hence, strength training is also of importance in preventing both injuries and reoccurrence of injuries. A prolonged period of inactivity, e.g. during recovery from an injury, will considerably weaken the muscle. Thus, before an athlete returns to training after an injury, a period of strength training is needed. The length of time required to regain strength depends on the duration of the inactivity period but generally several months are needed. In a group of soccer players observed for 2 years after a knee operation, it was found that the average strength of the quadriceps muscle of

Skateboarding Rollerskating And Windsurfing

Co-ordination and muscle strength and should be prescribed to already fit individuals, for example soccer or rugby players, but cannot be recommended for those with poor balance and co-ordination. For example, for those with shin splints or who are recovering from knee surgery, as an alternative to bicycling and running, roller-skating is very efficient endurance training to develop quadriceps muscle strength. For ice-hockey players, roller-skating is a natural way of exercising during pre-season training. Both skateboarding and wind-surfing are excellent balance exercises for different seasons for injured martial arts athletes and gymnasts. All these sports should preferably be performed in controlled environments, with instructors.

Patients present with either ischemia or subarachnoid bleeding Patients presenting with ischemia rarely develop

A 19-year-old college student reported to the infirmary at the university when he discovered that he could not see to his right. During the previous days he had had some discomfort in his right shoulder and in the back of his neck and head. He was an athlete and played on the volley ball and soccer teams of his university but recalled no unusual trauma. He had no past medical ills and did not smoke cigarettes or take drugs of any kind.

What do you do now

Dissections usually involve portions of arteries that are mobile. The carotid and vertebral arteries in the neck are relatively fixed at their origins from the common carotid and subclavian arteries. The vertebral arteries are anchored at their origins from the subclavian arteries and during their course through bone within the intervertebral foramina (V2 portion), and by the dura mater at the point of intracranial penetration. The short movable segments between these anchored regions are vulnerable to tearing and stretching. Dissections can involve the proximal (V portion) of the vertebral arteries usually beginning above the origins from the subclavian arteries, affecting the arteries before they enter the intervertebral foramina at C5 or C6. Vj dissections are almost always unilateral. The distal neck portion (V3) of the vertebral artery is the most frequent location for dissection. This segment is relatively mobile and so vulnerable to tearing by sudden motion and stretching as...

Sports injury incidence

Ice hockey is followed by soccer with a match injury incidence of i8-35 per i000 player-hours. There is only one study available from European team handball, showing an incidence slightly lower than soccer, and volleyball appears to have the lowest injury rate of the most popular Scandinavian team sports. There is no prospective study available from Scandinavian basketball, but other studies have shown rates just slightly higher than volleyball 18 21 .

Physical activity and osteoarthritis

A relationship between OA of the hip and knee, and heavy work or sports activities has been postulated. Sports activities with intense high impact and tor-sional loading are associated with an increased prevalence of OA 27 . Examples of such sports are soccer, American football, rugby, team handball, basketball, competitive running and water skiing 28 . Soccer and osteoarthritis Soccer is the most popular sport in the world and is believed to have some 40 million amateur participants 41 . During the last decade female soccer has become popular and now attracts a fair number of women, not least in North America. It has been estimated that at least half of the sports injuries in Europe are soccer related 42 . In a review on sports practice and OA the authors concluded that some sports, especially practiced on a high level, comprise an increased risk for OA in hip and or knee joints 27 . Soccer is such an activity with a calculated relative risk of hip and knee OA compared to controls of...

Symptoms and Incidence

An estimated 300,000 concussions occur each year from sports-related activity (Centers for Disease Control and Prevention CDC , 1997). In high school football, there are 40,000 concussions per year, for a 3 to 5 incidence (Powell and Barber-Foss, 1999). High-risk sports include contact and collision sports such as football, ice hockey, rugby, wrestling, and to a lesser extent, soccer and basketball. Women may be more prone to concussion in some sports (Tierney et al., 2005), for unclear reasons, with further research needed. Younger players also may be more prone to concussion because of less developed neck muscles and the higher relative weight of the head compared with the rest of the body. In addition, children may sustain more serious concussions because of their immature nervous system.

Treatment of knee injuries and development of osteoarthritis

No controlled studies on OA after ACL disruption comparing surgical vs. non-surgical treatment are available. The fact that an ACL reconstruction decreases the risk for a later meniscus injury appears to be an advantageous effect of surgical stabilization 63 . In a prospective uncontrolled outcome study Daniel et al. 64 concluded that patients who had undergone a reconstruction of the ACL had more radiographic OA than non-surgically treated patients, which is in accordance with the study on female soccer players cited above 59 . The suggested increased risk of OA in surgically treated patients could be caused by the fact that

All About Muscle Glycogen

Muscle glycogen is stored carbohydrate in your muscle. Imagine this After you eat and digest a meal, the amount of carbohydrate that you immediately need will get used as fuel, but the rest (up to a point) will be stored in your muscles for future fuel. Athletes in ultra-endurance sports such as soccer, basketball,

Fueling Your Body During Prolonged Endurance Activity

Some sports are so lengthy they require feedings throughout the event, to help supply your body with glucose when glycogen stores are running low. For example, marathon runners (and other endurance athletes such as soccer players) need to take about 30-60 grams of carbohydrate per hour, which translates into a mere (but important) 120-240 calories. Although it's a minuscule amount, these calories should be spread out over each hour. The simplest method is to drink one of the popular sports drinks during the event. You can hydrate and carbo-hydrate your body at the same time.

Etiology of Achilles Tendinopathy

Other activities with a predilection to Achilles disorders are volleyball, soccer, tennis, badminton, and orienteering.2- 3-26-38-40 The annual incidence of Achilles disorders is between 7 and 9 .- 39 Of these Achilles disorders, tendinopathy is the most common clinical entity, comprising 55 to 65 of cases, followed by insertional problems, comprising 20 to 25 of cases.1- 3- 26

Tendon damage accumulation

The sonographic appearances of the asymptomatic Achilles, patellar and plantar aponeurotic tendons of all 46 members of the playing staff at a single professional soccer club were compared with 15 non-athletic controls 2 . Three soccer players and two control subjects were then excluded from the study due to previous tendon symptoms. Seventy per cent of soccer players demonstrated sonographic evidence of Achilles tendon disease compared to 7 of age- and sex-matched controls, 77 of players demonstrated patellar tendon disease compared to 26 of controls and 35 of players plantar fasciitis compared to no control subjects.

Achilles Paratenon Disorders

SYMPTOMS There is gradual onset of diffuse exercise-induced pain or ache and swelling around the Achilles tendon, often around the mid-portion. It is common in runners and during pre-season training in soccer, rugby and similar sports. AETIOLOGY Para-tendinosis is defined from histopathological findings as a paratenon condition with an initial inflammation, changing into fibrosis, thickening of the tendon sheath and adhesions. This condition may or may not be symptomatic. It can be

Acute Hip Injuries 31 Acetabular Labral Tears

An acetabular labral tear commonly occurs with hyperextension and external rotation of the femur. There is a high incidence of acetabular labral tears in athletes who participate in sports that require frequent external rotation at the hip joint, such as soccer, hockey, golf, and ballet. Some tears have also been attributed to running and sprinting. Major trauma, such as hip dislocation, can also result in acetabular tears.

Groin Strain or Hip Adductor Strain

During a sudden change of direction while running, and quick starts and stops. Factors such as weakness or tightness of the adductor muscles can predispose an athlete to a groin strain. This injury is commonly seen in soccer players as well as football, ice hockey, basketball, tennis, and baseball players.

Ansar Mahmood and Nicola Maffulli

Achilles tendinopathy is common among athletes, particularly those involved in very strenuous and sudden takeoff maneuvers during their sport. This includes participants in racquet sports, track and field, volleyball, and soccer.1 Due to greater participation in recreational and competitive sporting activities, the incidence of Achilles tendinopathy has recently increased (see Case Study, below). However, Achilles tendinopathy does not exclusively affect athletes. Health professionals in both primary and secondary care are increasingly consulted by patients suffering from Achilles tendinopathy. Familiarity with the management options is important to best advise individual patients.

Medial and Lateral Meniscus

Medial meniscal injuries usually occur when an athlete is attempting to cut with a fixed foot. Damage results when rotational forces are applied to the knee while it is partially flexed with the foot on the ground. Medial meniscal injuries are commonly seen in sports such as soccer and football. Unfortunately, the medial meniscus is often damaged in conjunction with ligamentous injuries.

Management guidelines

Showed that effects of mild head injuries can be assessed by neuropsychologic tests and that the majority of players typically returned to their baseline score within 10 days after injury. In soccer, Mastser etal. 23 recently suggested that participation in amateur soccer might be associated with chronic MTBI based on impaired scores in memory and planning tests compared to a control group. Lovell et al. 18 and Maroon et al. 24 based on their own preliminary work developed specific protocols for testing US professional athletes. These tests are currently being used in all teams in the National Hockey League and most teams in the National Football League. The test is based on a baseline neuropsychologic computer-guided assessment. The group based in the University of Pittsburgh Medical Center for Sports Medicine has emphasized the importance of baseline data. Individual players vary tremendously with respect to their levels of performance on tests on memory, attention concentration,...

Transient pain and paresthesia of the upper extremity

A correctly performed heading in soccer demands technical skills that should be aimed for in organized training of younger players. Improper heading tech nique or associated collisions with an opponent may result in long-term complaints. Soccer seems to include more close contact, and it is reasonable to enforce standing rules and increased severity of penalty for dangerous play. The mass of the football is about 400 g and it may hit the head at speeds exceeding 100 km h. Based on various assumptions, the calculated force against the head may exceed 2000 N. The forces that have to be counteracted by the neck muscles can thus be far beyond the forces occurring in common car collisions.

Case story 651 continued

During the spring he increased his activity level to regularly exercising 4-6 times a week, and the radiating pain and weakness of the calf muscles in the left leg gradually disappeared. He was not able to return to soccer and missed matches in the European Cup. By the beginning of June he had returned to office work. He continued to exercise regularly, and in November he tried to perform specific goalkeeper sessions including jumping, twisting and fighting for the He eventually retired from soccer, but returned to full-time work. At the clinical examination 2 years after the injury the flexibility of his lower back was still markedly reduced for lateral bending and forward flexion and backward bending. The lumbar lordosis was straightened and he had a minor left scoliosis and protective muscle spasm. The fingertip to floor distance was about 40 cm. He had no muscle atrophy. The neurologic examination revealed normal findings except for dorsiflexion of the left ankle. Lasegues test...

Evaluation Standardized Tests

Tactical creativity tasks are relatively highly standardized. Athletes view brief video sequences of a sports game (e.g., basketball, soccer) in which attacking players play against defending players. At the end of the video clip, the final image appears frozen with one player in possession of the ball. The participant takes over the role of the ball holder in the video clip, identifying all opportunities that might possibly lead to a goal basket. The motor executions (e.g., pass with the nondominant hand foot, indirect pass) should also be mentioned. Athlete's answers were noted on a specially designed sheet that Table 1 Statements of soccer coaches from the National Team and the '1. Bundesliga' in Germany

Analysis Game Observation

Technological advancements allow the automatic recording of position data of players and the ball enabling reconstruction of tactical patterns. Furthermore, it is now possible to classify action processes in soccer by means of neural networks and to check the identified process types with regard to their effectiveness. In particular, activities can be recognized which indicate creativity, i.e., activities which are original as well as adequate solutions to the situation. For example, in soccer, a rare combination of several passes which leads to a goal. A central aspect of game analysis is to quantify the complex qualitative information of a game such as soccer or basketball. The focus of such quantification is on the frequency and success of specific actions such as passes or moves. Once the position-oriented tactical patterns can be recognized by means of a correspondingly trained neural network, it is no problem to automatically count transitions between such patterns with respect...

Recovery from Heart Valve Surgery

Some patients will be taking coumadin (warfarin), an anticoagulant or blood thinner. As long as coumadin is being taken, patients should avoid all vigorous contact sports such as rugby, soccer, and football. Dangerous sports like skydiving, in which one might receive blows to the head or begin bleeding, should also be avoided.

Chronic myotendinous groin injuries

Iliopsoas Muscle Inflammation

Chronic groin injuries are in some cases preceded by an acute episode, but more frequently the athlete has no recollection of this. A pattern of a sudden increase in training, including the intensity, the training methods or the total amount, in the period before the appearance of injury is typical. For example, an iliopsoas-related overuse problem can typically be sustained by increased repetitive hip flexion as when running uphill or by intensive kicking exercises in soccer or football. Fig. 6.3.11 (a) Static adduction against soccer ball for 30 s with 10 repetitions to reactivate the adductor muscles. (b) One foot sliding with pressure against the floor to activate the adductors and abductors, both eccentric and concentric, since both the sliding leg and the standing leg will be active. Fig. 6.3.11 (a) Static adduction against soccer ball for 30 s with 10 repetitions to reactivate the adductor muscles. (b) One foot sliding with pressure against the floor to activate the adductors...

Functional instability

Inferior Humeral Head Osteophyte

Ankle braces may also lead to a reduction in the incidence and severity of acute ankle sprains in competition (Bahr 2001), such as basketball (Sitler et al 1994), men's football (soccer) (Surve et al 1994, Tropp et al 1985) and women's football (Sharpe et al 1997). Although the studies reviewed provide important information regarding efficacy of tape or a brace, criticisms have been made regarding study design, external validity, confounding variables and sample size (Sitler et al 1994). These should also be considered before selecting the appropriate technique or device. sprains in female soccer players. Journal of Athletic Training 32(1) 21-24 Sitler M, Ryan J, Wheeler B et al 1994 The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball. A randomized clinical study at West Point. American Journal of Sports Medicine 22(4) 454-461 Spanos S, Brunswic M, Billis E 2008 The effect of taping on the proprioception of the ankle in a non-weight bearing...

PCS Organic or functional

There is some evidence to suggest that repeated mild TBIs can cause permanent brain damage (Ewing et al., 1980 Gronwall & Wrightson, 1975). Gronwall and Wrightson assessed twenty young adults who were subjected to two successive concussive injuries and compared these to individuals who had had only a single concussion and to a nonconcussed control group. The patients who were subjected to the dual concussions featured a lower rate of information processing than that noted in controls or in subjects who were concussed once only. These patients also took longer to recover to the level of processing speed noted in those experiencing a single concussion. These investigators contend that concussion seems to be cumulative in its effect on performance of the PASAT. Soccer players who suffer repeated concussions perform worse on neuropsychological testing (Matser, Kessels, Lezak, Jordan, & Troost, 1999), and soccer players known for heading the ball have been reported to show a higher...

Spondylolysis and Spondylolisthesis

Patients may complain of a history of mild lower back pain that has become worse and progressive to the point that participating in activities that require lumbar extension is not tolerated. Often, the patient may report participation in gymnastics, swimming, football, or soccer. The pain may refer to the buttocks and posterior thighs.

Acute and overuse injuries

The pattern of injuries in children is similar to that of adults with a few exceptions. The fact that the child is growing with open epiphyses implies a risk of damage to the growth plate. In practice, however, growth plate injuries from sport are relatively rare. Problems located in the foot and ankle are the most common complaints and may be due to both acute and overuse injuries 68 however, knee injuries are also frequent, particularly in sports such as downhill skiing, gymnastics, team handball and soccer 69 . Injuries of the hip are less common, and it is difficult to assess how much sport contributes to the numerous complaints of back pain. Overuse and acute injuries to the upper limb include glenohumoral instability, shoulder disloca Boys participating in soccer, basketball and football seem to be at greatest risk for acute injuries. Sprains (injury to ligaments) or strains (injuries to muscles or tendons) are common, whereas fractures are less frequent. First aid in acute...

Joseph Yu and William E Garrett Jr

Calf Muscle Tear Ultrasound

The term tennis leg arose because many patients suffering this injury were playing tennis at the time of injury. To understand why tennis leg is an injury of the middle-aged tennis player, one needs to consider the factors that may cause the gastrocnemius muscle to stretch and rupture. The flat-heeled tennis shoe allows excessive ankle dorsiflexion, which tightens the heel cord distally, while sudden knee extension increases the tension on the muscle belly proximally.6 Tennis is an active cutting sport that requires players to perform sudden movements that place the gastrocnemius in a position of risk. Of sports in which this age group generally participates, golf, swimming, walking, and jogging are not cutting sports. Other sports that do require cutting, such as football, basketball, and soccer, usually do not have much participation by individuals in their 40s and 50s in the United States.

Dr Frank H Bassett III

Bassett III (right center with hat ), in his familiar surroundings on the sidelines of a Duke football game. He is standing by Dr. William E. Garrett, Jr., at the time a Duke orthopedic resident. Dr. Garrett is immediate past president of the American Orthopaedic Society for Sports Medicine and has a career in the care of collegiate, Olympic, and professional soccer athletes. Figure 1-5 Dr. Frank H. Bassett III (right center with hat ), in his familiar surroundings on the sidelines of a Duke football game. He is standing by Dr. William E. Garrett, Jr., at the time a Duke orthopedic resident. Dr. Garrett is immediate past president of the American Orthopaedic Society for Sports Medicine and has a career in the care of collegiate, Olympic, and professional soccer athletes.

Acute ligament injuries

Atfl Lateral Malleolus

Between 2 and 6 per 100 participants per season. It has been estimated that these injuries constitute approximately 25 of all time loss due to sports injuries to the ankle, especially in sports that involve running and jumping, e.g. soccer, basketball and volleyball. Although many of these injuries are not serious per se, they are very costly to society due to their high incidence. Injury of the anterior tibiofibular ligament (anterior syndesmosis ligament) is sometimes seen in soccer players after external rotation of the foot, in dancers after forced dorsiflexion of the foot or in alpine skiers after combined external rotation, axial compression and forced dorsiflexion. When this injury is suspected, a complete radiographic examination of the lower leg should be performed to rule out a fracture of the proximal fibula. This ligament injury is painful, and heals slowly, but residual disability with recurrent instability episodes is not frequent. A supination trauma is associated with...

Ligament Injuries Of The Finger Metacarpophalangeal Joint

Brewerton View Hand Ray

Figure 41-21 Magnetic resonance imaging of the hand in a 38-year-old indoor soccer player who sustained an ulnar-side stress to the index finger when he hit the retaining wall of the field. The imaging study demonstrates complete disruption of the radial collateral ligament of the index finger metacarpophalangeal joint with associated ulnar subluxation of the joint. Figure 41-21 Magnetic resonance imaging of the hand in a 38-year-old indoor soccer player who sustained an ulnar-side stress to the index finger when he hit the retaining wall of the field. The imaging study demonstrates complete disruption of the radial collateral ligament of the index finger metacarpophalangeal joint with associated ulnar subluxation of the joint.

The magnitude of the problem

A consistent finding across these studies is that in the total population, soccer is the number one sport in terms of the absolute number of injuries (Table 3.1.1). After soccer, other team games such as European team handball, volleyball, basketball and ice hockey also cause a significant proportion of the absolute number of injuries. Note that the proportions vary considerably between countries. A good example is ice hockey and skating injuries, which are common in Sweden and Finland, but rare in Norway. It is important to note that this injury pattern is a result of not only the risk involved when playing each of these sports, but also differences in participation rate for each sport. Soccer is a very popular sport in all of the Nordic countries, and ice hockey is very popular in Sweden and Finland, but not in Norway. This is reflected in concomitant differences in the number of injuries seen between these countries (Table 3.1.1). Consequently, these studies provide information...

Effects of running training

The prevailing view is that light or moderate, or at times even strenuous, physical exercise is beneficial to articular cartilage and joint structures (Fig. 1.7.5). This kind of activity strengthens joint structures, articular cartilage included, having also the capacity to prevent degenerative ailments of the musculoskeletal system, such as osteoarthritis. The high prevalence of knee osteoarthritis in former soccer players and American football players has been attributed to the high incidence of ligament, meniscal and joint injuries. There is some data showing that long-distance runners are prone to acquiring radiographic signs of knee or hip osteoarthritis. Radiographs of athletes may show signs of 'penarthropathie sportive', i.e. periarticular bone changes and calcification of ligament and tendon insertions, while at the same time the joint space may be normal in weight-bearing radiographic studies. The marginal lips or 'osteophytes' in the radiographs have been considered as...

Running On A Hard Surface

Running is one of the most popular sports in the world. This not only covers marathons and track and field running - running is also part of the training in virtually all other sports, including soccer, rugby, handball and triathlon. Running is a very efficient method for maintaining or improving cardiovascular, respiratory and musculo-skeletal fitness and increasing the structural strength of the musculo-skeletal system. It is also an effective way of improving the tensile strength of the lower limbs. Modified levels and intensities of running can also be used as alternative training for most athletes with certain types of injuries. However, before running on a hard surface, such as roads or astroturf, the patient must be able to withstand the repetitive eccentric impact to the lower limbs, as each stride will create an impact force of five to ten times body weight for a fraction of a second. Since each stride stresses the same structures, their tensile strength and endurance lie...

Step 2 Challenging Negative Thoughts

Jacob, the soccer coach, learned to evaluate the evidence for and against his automatic, self-blaming thought that I'm no good with kids. There was plenty of evidence to the contrary, given the many positive comments he received, on an ongoing basis, from his wife, the soccer players, and their parents. He was able to generate more balanced thoughts Sometimes the kids get uncooperative when I'm not feeling my best Coaching can be a difficult task no matter how good you are Today the kids were getting overstimu-lated and weren't in the mood to learn. His mood tended to improve upon introducing and repeatedly restating to himself these countervailing thoughts.

Physical Examination

Caveau Double

Inborn errors of metabolism are well known to cause diseases such as gout, in which uric acid is overproduced or underexcreted by the kidneys. Poorly controlled metabolic diseases such as diabetes or hemochromatosis might lead to arthropathies. Mechanical or traumatic factors cause OA in soccer players but not in long-distance runners, indicating that the type and direction of joint stress might be more important than the stress itself. Adduction moment is associated with OA disease severity. Obesity is also an identified factor in OA of the knee, possibly because of metabolic influences as well as mechanical forces (Eaton, 2004).

Special precautions for certain disabled groups

For persons with osteogenesis imperfecta contact sports like football (tackle), ice hockey, sledge hockey and soccer should be discouraged due to the risk of fractures. Similarly it is not recommended that individuals with hemophilia take part in football (tackle) or ice hockey 58 .

What is a sports injury

Most sports injuries are specific to the sport and the level of participation for example, 70 per cent of keen runners will be affected by a lower limb injury during their career, usually through over-use soccer players have a high risk of traumatic ankle or knee injuries from tackles. The incidence of injury in soccer is between 15 and 20 injuries per thousand activity hours, with the highest risk during games. The figures are somewhat higher for rugby between 20 and 40 injuries per thousand activity hours and with higher risks of upper limb injuries, in particular those of the shoulder joint. Golf is a low-risk sport but a knee or shoulder injury can affect performance and the ability to walk a five kilometre course. Within any particular sport, different positions and roles carry different risks. For example, in cricket a fast bowler may struggle to perform with

Treatment Options

Examen Otoscopique Normal

Most patients with isolated ACL injury do well with activities of daily living. They typically can participate in limited sporting activities, but will have difficulty with vigorous activity. Daniel et al4 divided various sports and occupations into tiered levels based on the intensity of the activity. Sports that require jumping, pivoting, and hard cutting such as basketball, football, and soccer are considered level I sports. Sports such as baseball, racket sports, and skiing require lateral motion but less jumping and hard cutting than level I sports and are considered level II. Sporting activities that do not require cutting, pivoting or lateral motion such as jogging, running, and swimming are considered level III. Additionally, Daniel et al4 expanded this classification to include occupations that similarly require cutting and pivoting type maneuvers. The challenge to the surgeon is to decide which patients will benefit from operative or nonoperative management....

Risk Factors For Overuse Injury

Until recently, sports medicine has been primarily focused on the treatment of acute injuries or those injuries that occur in a single episode or event. These injuries most often occur during full-contact sports like football, soccer, and hockey. However, the focus on acute injuries is not as relevant as it once was. The recreational athlete of today is typically involved in repetitive sports such as running, aerobics, swimming, and or overhead sports. Athletes involved in these sports are less likely to experience an acute injury, yet are more susceptible to injury secondary to repetitive microtrauma. Younger athletes continue to involve themselves in organized year-round sports and are predisposed to similar overuse injuries.

Contusion of the Anterior Tibia

Rarely, blows to the tibia may cause a fracture. Much more commonly, these contusions cause a painful soft-tissue injury. This type of injury is seen in youth soccer or sports in which direct blows to the subcutaneous border of the anterior tibia causes hematoma formation. If the hematoma is subperiosteal, it causes severe pain and may result in a significant bony prominence in that area as it consolidates. The use of shin guards for soccer serves to almost eliminate this unless the shin guards are too short, in which case, contusions above the level of the shin guard can occur. While it is impossible to definitively rule out a fracture without a radiograph, percussion of the heel and gentle tor-sional stressing by rotating the foot may be helpful. Palpation of the noninvolved posteromedial aspect of the tibia may be nontender, thus supporting absence of a fracture. The contusion injury resolves with conservative care, and symptoms are in large part in proportion to the amount of...

Apophyseal Avulsion Injuries

An apophyseal avulsion fracture of the pelvis is a fracture through the physis of a secondary center of ossification. These commonly involve the anterior superior iliac spine, anterior inferior iliac spine, and ischial tuberosity apophysis. These fractures occur almost exclusively in 11- to 17-year-old patients. They are most commonly seen in soccer, track, football, and baseball. In most cases, these fractures occur during fast running, hurdling, pitching, or sprinting.15 These injuries usually do not occur due to direct trauma. They may occur as a consequence to a hip dislocation. Fractures of the anterior superior iliac spine result from the pull of the sartorius and the tensor fascia lata muscles. Fractures through the anterior inferior iliac spine result from pull of the straight head of the rectus femoris muscle. A forceful sprint or a swing of a baseball bat will typically avulse the anterior superior iliac spine.

The inguinal canal and associated structures

The etiology to these lesions is sometimes a traumatic episode where the athlete overstretches the front of the groin and lower abdomen, as in a forceful sliding tackle in soccer. In other cases the athlete cannot recall any single episode precipitating the pain but recalls it as developing gradually, often in connection with overuse over a period of time. The patient will often have multiple diagnoses contributing to the groin pain. Adductor-related pain, iliopsoas-related pain, sacroiliac pain and low back pain are typically concomitant findings in these patients 11,16 . Which lesion was the primary lesion resulting in the other(s) is seldom clear it is often a question of 'the chicken or the egg'.


It is not documented that a corset is effective for pain relief or healing of the lytic defect in patients with acute pain and a positive bone scan. Treatment involves training modification, anti-inflammatory medication and proprioceptive exercises to activate the transversus and multifidus muscles (Figs 6.5.27 & 6.5.28) 36 . The physiotherapist should instruct, give feedback and supervise treatment over a few sessions. Progression is made not so much by increasing the number of repetitions as by integration of the stabilizing activation of the deep trunk muscles in more complex motions (from four-foot kneeling to the soccer kick) (Fig. 6.5.28). Surgery is indicated in grades III and IV and in grade II if conservative treatment does not improve function.

Occurrence of stress fractures

Breithaupt reported in 1855 metatarsal stress fractures in soldiers after long marches. A stress fracture is a dynamic, metabolic process of bone, in which remodelling dominates over repair, and is related to overuse impact. The character of the load and the degree of training seems to be of importance for the occurrence of stress fractures. Of 324 consecutive patients with stress fractures 84 were athletes at district or national elite level, while the remaining 15 were sedentary individuals 8 . The incidence of stress fractures has been reported to be 5-15 of all sports injuries in different populations, with a higher incidence among runners 18,19 . The tibia is the most common location of stress fractures. The incidence of stress fractures in the tibia among track and field athletes has been reported to be 10 , and among young elite orien-teers lower than 1 during 1 year, whereas among elite soccer players there were no stress fractures.

Nature of sports injuries

As an example, studies from European team handball show that there is a high incidence of anterior cruciate ligament (ACL) injuries, especially among female players. Myklebust et al. 26 and Strand et al. 27 have found an incidence of 0.91 and 0.82 per 1000 player-hours for women during competition in Norwegian team handball, compared with 0.10 injuries per 1000 player-hours in soccer 28 . This means that the rate of ACL injuries in handball almost equals the rate of ankle sprains in volleyball 29,30 . Since one can

Exercise and sports possibilities

The Paralympics includes many sports, such as archery, shooting, fencing, judo, power-lifting, wheelchair rugby, soccer, swimming, table tennis, wheelchair tennis, riding, cycling, track and field events, wheelchair basketball, volleyball (Fig. 3.5.7), goal-ball for the visually impaired and yachting in summer competitions, and both Nordic and alpine skiing and skating and sledge events in winter competitions.

Etiology of tendon overuse injury

Therefore, it seems that the etiology in chronic tendon injuries is multifactorial. However, these factors may not play an equal role in different individuals. For example, in young athletes with healthy tendons, repetitive mechanical loading of the patellar tendon may be the major factor for tendon overuse injury, whereas in aging patients a sedentary lifestyle combined with pre-existing tendon degeneration may contribute to the tendon becoming symptomatic. On the other hand, all explosive start-stop or jump sports, such as basketball, volleyball and soccer, predispose the participants to tendon overuse injury in the knee. Deceleration and jumping entail eccentric muscle contraction, which results in tension that would be much greater than with concentric muscle contraction. As a result, if the large contraction is repeated, tendon microstructure damages are likely to occur.

Classical reference

Ekstrand J, Gillquist J, Liljedahl SO. Prevention of soccer injuries. Supervision by doctor and physiotherapist. Am J Sports Med 1983 11 116-120. This study is recognized as the first randomized controlled trial (RCT) examining the effects of an injury prevention program in sports. Ekstrand and his coworkers used the classic four-sequence injury prevention approach in a series of studies. Firstly, they described the magnitude of the problem of soccer injuries in terms of their incidence and severity, demonstrating an incidence of 7.6 injuries per 1000 practice-hours and 16.9 per 1000 game-hours. Secondly, they described risk factors and injury mechanisms in their cohort. Among several factors identified in their first studies, the content of the warm-up the teams used appeared to be inadequate, previous injury and persistent instability was a significant risk factor for reinjury to the ankle and knee, and traumatic lower leg injuries occurred in players with inadequate or no shin...

Biomechanics of human skeletal muscletendon flexibility

Physical activity is important to maintain good health, and human movement is not possible without some degree of the fitness component commonly called mus-culoskeletal flexibility. Flexibility training is thought to be an important and effective training stimulus for maintenance and augmentation of flexibility. Clearly the demands of participation in sports require a certain sport-specific musculoskeletal flexibility. In sports such as gymnastics the necessity for immense flexibility is obvious however, reaching for a ball in soccer, clearing a hurdle or performing a tennis serve may also require a certain sport-specific flexibility, which may be achieved by specifically designed flexibility training programs. However, it should also be kept in mind that an individual's existing flexibility may be an inherent characteristic or a sport-specific adaptation, and not just the result of flexibility training 109 . Although there is presently no universally accepted definition of...

Ankle joint injuries Ankle arthroscopy

Ankle arthroscopy is a valuable tool in the diagnosis and treatment of various intra-articular ankle disorders. Visualization of intra-articular pathology without arthrotomy is possible, thus reducing the risk of surgical complications. Indications for ankle arthroscopy are osteochondral fractures, chondral lesions, soft tissue impingement, bony impingement, post-traumatic osteoarthritis and loose bodies. Chronic pain at the anterior aspect of the ankle joint is rather frequent in athletes, e.g. soccer players, and is often referred to as 'footballer's ankle', and is also a frequent indication for arthroscopy 47 .

Acute myotendinous groin injuries

The iliopsoas can be strained by a forceful flexion against resistance as occurs when the ground is mistakenly kicked instead of the ball, or in eccentric contraction, e.g. when the thigh is forced into extension. The adductor muscles are usually strained in eccentric contraction, e.g. in a forceful abduction, often with some degree of hip joint rotation, as in a sliding tackle in soccer.

Case Study

A 38-year-old, self-employed computer software engineer, who played soccer once a week, attended the Fracture Clinic 2 days following an injury to his right Achilles tendon (AT). While participating in a soccer match, he pushed off on his left foot and felt something give at the back of his ankle. This resulted in acute severe pain, and he was unable to bear weight or drive home following the injury. At the Accident Unit, he was radiographed, and a clinical suspicion of Achilles tendon rupture was formulated.


Co-ordination, balance, proprioception and core stability are terms frequently used in sport but rather difficult to define. They involve the ability to perform, or regain, controlled movements, in a sport-specific, safe and precise way. We cannot pin-point each and every control mechanism but there is lots of experience to apply to sport. Tai chi is an excellent example of a method that aims completely to regain full body and mind control, so essential for elite sports. Martial arts and dancing focus on this type of training, which is a key to successful performance. Unfortunately, most contact sports such as soccer, rugby and ice hockey often neglect this type of training. For years I have tried to convince physiotherapists and coaches to learn from this not only would it reduce the number of injuries and their consequences, but it would enhance performance and their players' ability to undertake effective rehabilitation when injured.

Dental Injuries

Participation in contact sports such as hockey, boxing, soccer, baseball, football, and wrestling can result in dental trauma. In the United States, the National Youth Sports Foundation estimates that more than 5 million teeth will be avulsed in sporting events each year. The Centers for Disease Control and Prevention in 2001 estimated that approximately one third of all dental injuries in the United States are sports related. After trauma, the dentition should be examined for fractures and mobility. Injuries to the teeth and supporting structures should be treated emergently.

Aerobic training

The dissociation between changes in V02max and muscle adaptation by means of training and detraining is illustrated by results from two studies. In one study long-distance runners were kept inactive for 2 weeks (first week with the leg in a cast) which did not result in a change in V02max 60 . On the other hand, the detraining period led to a 25 decrease in performance in an exhaustive run (from about 18-13.5 min) which was associated with a 24 lowering of the activity of the oxidative enzyme succinate dehydrogenase (SDH). During the following 2 weeks of retraining VO2 max did not change, whereas performance and SDH were still lowered by 10 and 20 , respectively. The level of inactivity does not have to be as extreme as in this study to have a marked effect on performance and muscle respiratory capacity. In another study top-class soccer players abstained from training for 3 weeks 61 . It was found that V02max was unaltered, whereas performance in a field test was lowered by 8 , and...

Frames of Mind

Similarly, Chinese Americans whose American identities were evoked adopted more stereotyp-ically American preferences (e.g., for individuality and competition over collectivism and cooperation) compared with when their Chinese identities had been triggered (LeBoeuf, 2002 LeBoeuf & Shafir, 2004). Preference tends to align with currently salient identities, yielding systematic tension anytime there is a mismatch between the identity that does the choosing and the one likely to do the consuming, as when a parent commits to a late work meeting only to regret missing her child's soccer game once back at home.


In this 38-year-old soccer player with a trauma 12 months previously, magnetic resonance imaging (MRI) revealed a complete rupture (A) with an extended defect of the deep portion of the Achilles tendon close to its distal insertion (B), whereas the superficial layer was ruptured more proximally (C), which had hidden the rupture by clinical investigation. The lines BB and CC indicate the level of the transversal plane shown in Fig. b and c respectively Fig. 10.3. In this 38-year-old soccer player with a trauma 12 months previously, magnetic resonance imaging (MRI) revealed a complete rupture (A) with an extended defect of the deep portion of the Achilles tendon close to its distal insertion (B), whereas the superficial layer was ruptured more proximally (C), which had hidden the rupture by clinical investigation. The lines BB and CC indicate the level of the transversal plane shown in Fig. b and c respectively

Precrash measures

In sports, examples of athlete-related precrash measures include increasing the skill level of an alpine skier to prevent falls or improving neuromuscular control around the knee or ankle to prevent the athlete from landing without proper alignment. Examples of precrash environmental measures include modifying the friction of the playing surface (too high may lead to twisting injuries to the lower extremity, too low may lead to slipping and falling injuries) or rule changes to avoid dangerous plays (e.g. checking from behind in ice hockey to avoid injuries to the spine, or a red card for tackling from behind in soccer). Equipment-related precrash measures include modifying shoe friction or cleat length to the playing surface and weather conditions. Several RCTs have applied precrash measures or actions to examine the efficacy of the intervention on occurrence of sports injuries. One of the very first was the study of Ekstrand et al. (for a detailed description, see 'Focus on Research'...

Return to Play

Long-term cognitive deficits from concussion or repetitive blows to the head are also a concern. Repetitive concussions, especially if severe, might put athletes at risk for permanent neurologic deficits (Guskiewicz et al., 2003). However, no evidence indicates that repetitive nonconcussive blows, such as those sustained from heading a soccer ball, lead to short-term or long-term neurologic impairment.

Case story

A 32-year-old-soccer player with a history of ankle problems for more than 5 years initially sustained a serious inversion trauma of the ankle. The ankle was swollen and he was unable to bear weight. Radiographic examination did not reveal any skeletal injuries. The patient was treated with compression bandaging and range of motion exercises. He was allowed to return to sports (soccer) after 4 weeks. He did not, however, recover fully. His ankle repeatedly gave way, combined with swelling and pain. In spite of this he was able to continue playing soccer using an ankle tape. The problem has increased and he has now been forced to quit playing soccer. The most important factor at this stage is the almost total lack of rehabilitation. The player was allowed to return to sports without a proper rehabilitation, and furthermore there was a delay in returning to sport of several weeks. With a well-conducted rehabilitation program, most players are able to return to sports such as soccer...


At the beginning of the camp, Frank was shy and somewhat withdrawn. However, as the week progressed, he became a natural leader of the group. He was vocal in his emotions and an active participant in the sharing of stories. After the camp was over, he continued to attend monthly meetings. In the years that followed, he also became involved in his high-school's task force for grief intervention and was actively involved in the consolation of classmates who lost a loved one. He graduated high school in the spring of 2006 as the lead scorer of the state runner-up soccer team and is currently attending college on a full-ride athletic scholarship. More importantly, his mother describes him as a self-assured, caring person who has learned how to balance the loss of his father with enjoying life.


All patients were able to weight bear on the operated limb by the second postoperative day. At final review, 51 months (standard deviation SD , 18.2) (range, 36 to 102) from the operation, 63 patients attended 35 patients were rated excellent, 12 good, nine fair, and seven poor. Of the 16 patients in whom the procedure was not successful, eight had a pantendinopathy, 13 were runners (either middle distance or sprinters), and three were soccer players. Also, although the average interval between beginning of symptoms and operation in these patients was not significantly different from the whole group (21.6 versus 19.2 months), these patients had received more peritendinous injections (group average 1.3 average in the patients with a fair or poor result 2.7), and had been less compliant with their preoperative conservative management.

Neck pain

Neck pain is a commonly occurring complaint. Its yearly prevalence is comparable with low back pain and is about 50 in the adult population. Neck pain is the main complaint in about 3 of those who consult a physician. The yearly prevalence of cervical radicu-lopathy is 40-80 per 100000 12 . Repeated collision injuries in contact sports not resulting in fractures or spinal cord injuries are associated with neck pain and paresthesia. The symptoms are commonly recurrent, existing just for seconds during a match, and result from traction of the brachial plexus or nerve root irritation. In a large Finnish survey the neck and head accounted for 9 of all soccer injuries 13 . A heading in soccer involves hyperextension and compression of the cervical spine and may affect the vertebrae, intervertebral joints, disks, ligaments and muscles. Chronic complaints of pain and limited range of motion of the cervical spine were found in about 30 of former players from the Norwegian national soccer team...

Practical Utility

Sport science literature frequently suggests that both game intelligence and tactical creativity are important for successful athletes in different kinds of sports. In order to generate decision possibilities and seek original solutions players must be able to perceive all important information from their environments (positions of team mates and opponents, players emerging unexpectedly, etc.) and consider this information when generating an action plan. Tactical creativity is increasingly significant for complex sport games because coaches are able to collect more information about their opponents. For example, with game observation and game analysis it is possible to study the individual tactical behavior of the players (e.g., tendency to move left or right in one-on-one situations), the tactical interactions of a group of players (specific combinations in offensive play), and the general strategy of a team (e.g., fast breaking at every opportunity). As Table 1 indicates, several...


An advanced application of neural networks is the simulation of tactical behavior, creative actions, and dynamic learning in games. The current action such as tactical decisions in the game process or movement behaviors of the athletes is tested on the network, activating the corresponding neuron, which then returns information in different semantic categories such as type of activity, degree of creativity, probability of success, or probability of transition to other activities. The goal is to replace the current activity with a simulated one, which when activated in a game situation could be more creative or more successful. More specifically, the resulting simulated process could improve the team's tactical behavior. Mapped to a network, this means that neurons should have the ability to represent not only frequent but also rare actions. If such a net is calibrated with respect to success or adequacy, then the time series of a process is mapped to a trajectory, where the neurons...


A longitudinal research talent program was designed to investigate the efficacy of various training approaches in team ball sports for the development of tactical creativity. The main assumption was that the perception of many different sport game situations and the acting in these situations has a positive influence on the development of tactical creativity. A total of 135 young athletes took part in a 15-month, field-based study, where they participated in either nonspecific treatment groups (tactical training with hand, foot, and implements) a handball group (tactical training only with the hand) a soccer group (tactical training only with the foot) a field hockey group (tactical training only with implements), and a control group (no training at all). General and specific sport-oriented tactical creativity as dependent variables were measured with game-test-situations. The analysis of treatment-related effects showed that the areas in which the groups were trained (e.g., soccer,...

Deliberate Practice

The term 'deliberate practice' refers to targeted and task-centered training programs based on instructions. Studies of eminent athletes' early development indicates that deliberate environmental influences and organizational conditions benefit the generation of original thinking in sport. Trainers from different types of team sports selected the most creative and the least creative players from their teams. Creative, exceptional athletes in basketball, soccer, handball, and hockey trained significantly longer and more purposefully in their main sport before they were 14 than less creative top athletes ('deliberate practice'). In this case, specific experiences over a long time (ten plus years) are necessary for the attainment of expertise.

Deliberate Play

Hence more intensely in many relatively unstructured (complex) team ball sports situations ('deliberate play') without guidance than less creative team players. The results suggested that unstructured play-like involvement plays a crucial role in the development of creative behavior in basketball, handball, field hockey, and soccer. At the same time, current theoretical approaches and empirical research regarding the development of creativity support this view that nonspecific experience over time, such as unstructured play, is an ideal medium for the development of divergent thinking.

Mild Head Injury

Recreation are reported by American hospitals yearly. Many more occur. A variety of reasonable guidelines have been made about when to allow an athlete to return to play.254 Most athletes recover by 10 days after the concussion. The combination of a learning disability and concussion in college football players appears to synergistically lower subsequent cognitive performance.255 Amateur soccer players are also at greater risk compared to other athletes for impaired memory and plannning performance, especially after known concussion and probably associated with frequent headers to move the soccer ball.

Osteitis Pubis

Osteitis Pubis Causes

Among athletes, primary osteitis pubis is thought to be caused by repetitive microtrauma, chronic overuse injury, and muscle imbalance. The abdominal and adductor muscles have a central point of attachment on the symphysis pubis or the pivot point, but these muscles act antagonistically to each other, predisposing the pubic symphysis to opposing forces. These forces become critical in the kicking activities associated with sports such as soccer, Australian rules football, and North American football (Fig. 44-3). When an athlete kicks, the kicking limb is hyperextended at the hip while the trunk is rotated laterally in the opposite direction. Greater than 2 mm of vertical motion is seen in cases that are associated with pubic symphysis instability. Rarely do patients require surgical treatment. There are a few case reports showing limited success after a proximal adductor release and drilling of the pubic bone in soccer players. Most of the literature regarding surgical management of...

Sesamoid Problems

Bipartite Medial Sesamoid

In the vast majority of the population, there are two small sesamoid bones under the first metatarsal head. They are incorporated into the medial and lateral heads of the flexor hallucis brevis tendons and are termed the tibial and fibular sesamoids. Sesamoid problems are more common in women, possibly due to the greater degree of dorsiflexion present normally in their first metatarsophalangeal joints and more common in the tibial sesamoid. Up to 50 of body weight may be carried by the first metatarsal head, and the sesamoids receive even more stress. The sesamoids are involved in push off and serve as an integral part of forefoot function. The sesamoid complex includes the two sesamoids, the interosseous ligament, the flexor brevis tendons, the joint articulation, and the flexor hallucis longus. Problems may range from sesamoiditis to stress fracture, acute fracture, osteonecrosis, and fragmentation. In the older population, degenerative arthritis may involve the sesamoid-metatarsal...

Scapholunate Sprains

Self Administered Hand Diagram

Figure 30-22 A, Posteroanterior radiograph of left wrist in 27-year-old soccer player who fell, landed on his left palm, and complained of pain. Note the abnormal widening of the scapholunate interval. B, Comparison view of the uninjured right wrist demonstrates the same scapholunate separation ( 3 mm) ( David Letterman sign). Patient recovered with only splint support. Figure 30-22 A, Posteroanterior radiograph of left wrist in 27-year-old soccer player who fell, landed on his left palm, and complained of pain. Note the abnormal widening of the scapholunate interval. B, Comparison view of the uninjured right wrist demonstrates the same scapholunate separation ( 3 mm) ( David Letterman sign). Patient recovered with only splint support.

Lower Face

Fractures of the mandible are common. These fractures can involve any region of the body, ramus, condyle, or joint. The direction and magnitude of the force influence the sites of the fracture and the amount and direction of bone displacement. Complicated mandible fractures may cause significant swelling and airway embarrassment. A literature review indicates the risk of mandibular fractures is highest during rugby and soccer but occurs in all contact sports. When fractures pass through dentate areas, the patients usually report malocclusion in addition to jaw pain or lip and chin numbness. Palpation of the oral and facial soft tissues often reveals mobility of bony segments. Malocclusion and eccentric movements during attempted function are typical findings for mandibular fractures. Mandibular fractures are optimally diagnosed by dental panoramic x-rays. Plane films, including right and left lateral obliques and posteroanterior or CT scanning, can also be used. Mandibular fractures...

Choosing a test

There are a number of laboratory tests which evaluate various aspects of performance (Fig. 2.2.2) and are commonly used. These include determination of maximum aerobic power (maximum oxygen uptake) to evaluate the athlete's ability to take up and utilize oxygen as described in Chapter 1.1. A Wingate test consists of 30 s of maximal cycle exercise aiming at determining the maximum anaerobic power and ability to maintain a high power output. Strength measurements in which strength or power of an isolated muscle group is measured during either isometric, concentric or eccentric contractions are other laboratory tests often used. Such tests provide general information about the capacity of an athlete and may separate different performance levels of athletes within a sport. For example, for soccer players the Fig. 2.2.7 Maximum knee extensor torque (Nm) under isokinetic loading at a velocity of i8o s for Danish top-class soccer players in various positions. Means+SE are given. *...

Pain following TBI

While there are no pain receptors in the brain itself (i.e., the white matter, the ependymal linings of the ventricles, and the choroid plexus are not pain sensitive and much of the cortex, pia, and arachnoid matter can be electrically stimulated, burned, or cut without pain), certain parts of the dura at the base of the brain and the dural arteries are sensitive to pain (Bonica & Loeser, 2001). Secondary vascular lesions of the brain, particularly of the thalamus, may be a source of central pain (Bonica & Loeser, 2001). The hypothalamus and the limbic structures have an important role in the motivational, emotional, and affective components of the pain experience and these structures are quite commonly implicated in damage arising as a consequence of TBI. Migraine can also be triggered by head trauma often in the context of sporting activities including heading the ball in soccer (Bennett, Fuenning, Sullivan, & Weber, 1980).

Ankle Sprains

Positive Talar Tilt Test Ankle

Lateral ankle sprains are the most common form of ankle sprains and are caused by excessively inverting the ankle. This injury occurs in sports involving jumping (e.g., basketball, volleyball) when an athlete lands incorrectly and in sports involving abrupt direction changes (e.g., football, soccer). These ankle sprains involve partial or complete tears of the (ATFL, CFL, and or PTFL, which are listed from most to least often injured. Damage to the medial ligamentous structures (i.e., deltoid ligament) occurs less commonly and is the result of an eversion injury. Associated fractures, such as a Maisonneuve fracture (proximal fibula fracture), and tibiofibular syndesmosis injuries should be ruled out.

Social interactions

Torstensen (1996) and Vikne (1996) looked at back pain in top Norwegian athletes, and compared them with chronic low back pain patients in the general population (Table 13.2). About 10 of all athletic injuries involve the spine, and 25-40 of these are serious problems such as fractures or spondylolysis. But chronic disability due to a simple back strain is rare in athletes. Even among elite soccer players who get frequent musculoskeletal injuries, early retirement because of back pain is almost unknown.


As to the effects of creatine on actual strength and sports performance, the supplement has had mixed results at best. Some authors have demonstrated improvement in short-duration events like repeated sprints,75 although this has not been reproduced in other trials.76 Other investigators have shown improvement in specific soccer drills,77 but again this has not held for studies with athletes from other sports such as rugby or softball.78,79 Kilduff et al80 noted that subjects with the largest increases in body mass had the greatest increases in strength, suggesting that there are some athletes who are responders to creatine while others are not.

Shoulder Instability

Breast Tumor Jpg

The rate of noncontact ACL injuries in high-risk sports such as soccer and basketball is greater in female than in male ath-letes.35-37 The young appear to be most at risk, with the vast majority of ACL injuries occurring in those 15 to 45 years of age.38 In one study, the average age of those who sustained an ACL injury was 26 years.39 Neither risk factors nor the mechanism of injury is well defined for ACL noncontact injuries. Proposed risk factors include shoe-surface interactions and other environmental concerns anatomic factors such as hip varus, knee valgus, foot pronation, femoral notch size, and size of the ACL hormonal factors (levels of estrogen, progesterone, relaxin, and others) and neuromuscular factors such as upright posture, landing a jump and cutting on a straight knee, leg dominance, and poor hamstring strength relative to quadriceps strength (quadriceps dominance).40,41 Soccer T 300 3 seasons C 300 Basketball, volleyball, soccer Soccer Soccer T 121 1 season F C 100...

Low back pain

The lifetime, i-year and point prevalence of low back pain in the adult general population is reduced in persons who are physically active for at least 3 h week 23 . Back pain is more common in the general population than in former elite athletes 24 . Weight-lifting is associated with degeneration of the entire spine, and soccer with degeneration in the lower lumbar region. The prevalence of back pain and degeneration is low in runners. The incidence of chronic low back pain varied from 50 to 85 in a Swedish epidemiologic study including soccer and tennis players, wrestlers and gymnasts 25 . In 36-55 of the athletes, the radi-ologic examination was interpreted as abnormal. Low back pain is reported to interfere with sports activity at least once a year in about 30-40 of elite swimmers and more than 60 of elite cross-country skiers. The complaints in cross-country skiing are more related to the double-poling and diagonal stride techniques than to skating techniques 26 .


Hand and wrist injuries are common in all sports. They are more common in children than adults 7 . A study from the Cleveland Clinic showed that 14.8 of all athletic participants under the age of 16 years sustained upper extremity injuries. Of these 16 involved the hand and 9 involved the wrist 8 . Of 113 injuries of the hand and wrist 97 occurred in football, six in soccer, three in wrestling, three in baseball, two in basketball, one in ice hockey and one in rugby. They reported 96 fractures, 35 sprains and four dislocations. Metacarpal fractures accounted for 38 of the 96 fractures. There were 12 distal radius fractures and 11 scaphoid fractures. They reported 12 thumb injuries including 12 ulnar collateral ligament tears 8 .


In relation to the key question that we have addressed of all emotions, we must ask what might be the functions of sadness and what are its adaptive features The fact that we have to ask this question with a hint of surprise reflects something of the bad press that sadness receives in our culture. In many cultures sadness is not considered to be inherently negative, because sadness, or states akin to sadness, are more valued (e.g., Kleinman & Good, 1985 Lutz, 1985) for example, a state of sad reflectiveness may be considered a step along the road to salvation in many Asian societies. These schematic-level goals are therefore both culturally inspired and culturally maintained and may be shared goals between the self and significant others. As Barr-Zisowitz (2000) emphasises, the variation across cultures in the approach to sadness reflects a culture's view of the perceived lack of self-mastery, and the perceived demands that may thereby be placed on others in the social network as a...

Avulsion Injuries

AS IS avulsion fractures are caused by sudden contraction of the sartorius muscle when the hip is extended and the knee flexed. This injury is common in sports requiring jumping and in sprinters after forceful hip extension. AIIS avulsion injuries are caused by strong rectus femoris contractions and occur after forceful kicking in sports such as soccer.

Langs network theory

One of Lang's most influential innovations was to suggest that emotions such as fear or anxiety are not single coherent emotional states, but that they are expressed in the three systems of verbal report, behaviour, and physiology. Furthermore, these three systems are only partially synchronised with each other, so that it is possible for an individual to show an emotion-like reaction in one or two of these systems, but not in the remainder. For example, an individual waiting for a job interview might claim to feel relaxed (verbal report) while sweating profusely and pacing up and down or a soccer manager might look perfectly calm and relaxed to the camera while experiencing utter panic at his team's dreadful performance.

Turf Toe Injuries

Originally described as occurring on artificial turf surfaces, turf toe injuries involve a primarily hyperdorsiflexion force to the first metatarsal phalangeal joint.14 Varus and valgus forces may also play a role and may increase the likelihood of late instability. These injuries occur in football, soccer, dance, and other sports that involve great toe dorsiflexion activity. The injury involves primarily the plantar plate the sesamoid complex and the collateral ligaments are injured depending on the severity and direction of the forces involved.


Turf Toe Syndrome

Treatment of metatarsalgia is initially conservative. As previously described, heel cord and hamstring stretching may be quite helpful. Shoe modification is essential. A simple felt pad that sticks to the liner of the shoe may be enough, or a more complex custom orthosis may be indicated (Fig. 71-6). Metatarsal bars are not useful in the athletic population. It is important to examine the athlete's training shoe. In cyclists and soccer players, the shoe may be too small or too stiff, contributing to the problem. These patients should be encouraged to choose wider shoes with better padding in the forefoot and deeper toe boxes. In addition, patients should be instructed to

Bony Impingement

Most patients with anterior bony impingement in the ankle will present with anterior ankle pain and loss of dorsiflexion. Soccer players seem to be particularly prone to this problem due to the repetitive trauma to the anterior capsule. Dancers and runners develop anterior bony impingement because of repetitive dorsi-flexion. The pain and loss of motion may worsen slowly over time, but presentation to a physician is often precipitated by an acute injury.1 The diagnosis can be confirmed with anteroposterior and lateral views of the ankle. Dorsiflexion stress radiographs can also be obtained to confirm contact between anterior osteophytes on the tibia and talus.2 The features that should be carefully evaluated on plain radiographs include the


Tumors are not uncommon in the groin area, and we have seen several cases in which the pain was first experienced in the groin area in connection with a soccer game or similar sports activity. The pain was often considered to be caused by strain in the groin muscles and tendons. After a couple of months, the patients are often referred to surgical or orthopedic departments because of persistent pain or tumor-suspicious findings on X-ray. Osteosarcomas, chondrosarcomas, malignant schwannomas and other tumors have been diagnosed often at a late stage, due to both patient's and doctor's delay. Persistent pain or an unexplained 'mass' in the groin region should be carefully investigated to exclude a tumor, and a radiology examination should always be included at an early stage in patients with diffuse groin pain. Ultrasound, MR imaging or CT scan will secure the diagnosis.


Cates that it may be possible to reduce the incidence rate of ACL injuries in soccer 83 , but the results of this single study has to be verified further. The prevention of ACL injuries in female players is particularly important, since females have a higher incidence of this injury, get injured earlier in life and, in addition, have a greater risk of knee OA even when injuries are excluded. The increased popularity of female soccer, not least at high-school level, shows a clear path towards a problematic situation some years ahead. Knee injuries occurring at 18 years of age, with radiographic OA in the early thirties and onset of symptoms perhaps a few years later or even before, may result in patients requiring OA surgery in their early forties. A study of injury risk factors in female soccer revealed that neither physical capacity, functional performance, nor muscle strength correlated to injuries 84 . In that study increased joint laxity was the only significant risk factor.

Crash measures

Athlete-related crash measures mainly focus on the physical preparation of athletes to allow them to withstand the forces involved when a collision or a fall occurs. Athlete-related crash measures could involve, for example, a general strength training program or falling techniques. Environmental crash measures include safety nets to avoid falling alpine skiers from flying into the crowd or soft mats protecting gymnasts who fail a dismount or fall down from apparatus. There are many examples of equipment-related crash measures in sports, possibly because they are the most obvious to consider, or because there is a potential sales profit involved. Equipment-related measures include release bindings for alpine skiing, helmets for various sports, taping and braces for ankles and other joints, shin guards for soccer players, eye guards for squash and racquetball, and visors for ice hockey.

Case story 651

The patient is a 32-year-old semiprofessional soccer goalkeeper. He has previously been treated for a complicated fracture of the distal phalanx of the right thumb and minor finger injuries, had resected an exostosis of the lateral region of the right distal femur and glenoid labral lesions in both shoulders, and has had surgical treatment of both Achilles tendons because of tendinopathy. During his i4-year-long soccer career he has been manipulated i -2 times yearly because of slight to moderate low back pain, but never missed a soccer game until January 1999. He was periodically moderately impaired by pain, but his impairment did not make him disabled and did not interfere with his participation in soccer games at an outstanding level. In 1997 he had a CT scan which showed a central protrusion at the L5-Si level not affecting the Si nerve roots. Considering the activity patterns of a goalkeeper struggling for the ball in various positions, he had an excellent performance level and...

Avulsion fractures

There are three typical locations for avulsion fractures of the pelvis (i) anterior superior iliac spine (ASIS) (ii) anterior inferior iliac spine (AIIS) and (iii) ischial tuberosity. Avulsions from the ASIS typically occur from a strong contraction of the sartorius muscle during jumping in sports such as basketball. AIIS avulsions occur in kicking sports such as soccer, resulting from a violent contraction of the rectus femoris muscle. Avulsions of the ischial tuberosity occur from hamstring contractions and are most frequently seen in running and hurdling sports. For avulsion fractures of the ASIS and AIIS, most authors recommend non-operative treatment. This includes symptomatic activity restriction until the fracture heals. Although there are no large series in the literature, it does not appear that operative fixation results in either earlier return to activity or better return of strength than non-operative treatment.


(McShane et al., 2006 Housner et al., 2009). The most common form of autologous growth factor therapy is platelet-rich plasma (PRP) and is increasingly used to treat tendi-nosis. Although a relatively novel option for sports-related injuries, PRP has been used in other medical conditions for two decades. The use of PRP migrated to orthopedic procedures, where it has been used effectively to augment bone and soft tissue healing in the operating room, especially in poorly healing fractures and those at high risk for nonunion. Most recently PRP has been used in the outpatient setting for a variety of sports-related soft tissue injuries, including the treatment of chronic tendinopathies, as well as moderate to severe acute ligament, muscle, and tendon injuries. Autologous growth factor therapy in the treatment of chronic tendinosis can initiate a stalled or failed healing response, leading to a healthier and less symptomatic tendon. In the management of chronic lateral epicondylosis...

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