What is Soccer?
Posted Nov 11, 2017

Soccer is a competitive game – made difficult by the opponent. It is free flowing – no time outs or stoppages for coaching.   Soccer is a game of opportunities and there are many paths to the same destination.

The 5 Essential Qualities of a Soccer Player

  • Skills: technical skills in the general areas of first touch, dribbling, passing, receiving, finishing, heading, shielding, turning, tackling; being able to execute skills cleanly under pressure in a variety of situations with various body parts (strong and weaker foot).
  • Sense: tactical skills, decision-making, speed of thought/play, ability to read the game, creativity.

Note: Although creativity is often thought of as intangible or immeasurable, it is a trait that carries players to a higher level.

  • Strength: physical toughness; includes but not restricted to athletic components such as size, strength, endurance, durability, vertical leap.
  • Speed: obviously, if everything is equal and two players are compared in terms of running on the field with (technical) or without (physical) the ball at distances of 10+ yards, then naturally the faster player wins out. Quickness, agility and explosiveness are included.
  • Sportsmanship: psychological qualities — respects self, teammates, coaching staff, opponents, referees, program; includes attitude, understands team concept, accepts role(s), gives maximum effort, competitive, intensity, dependability, responsibility, training mentality on and off the field, motivated to excel, able to do what’s right not just when someone is watching; warrior.

How to be better at soccer:   Ways to Improve a Players’ Awareness of Their Surroundings:

  • Keep your head up. Avoid looking down at the ball, and consequently not observing what is around and where players are in relation to each other.
  • Look before receiving. Anticipate the next pass before you receive the ball by looking over both shoulders and thinking ahead. With younger players, equate this concept to a bird on a fence looking around.
  • Maintain an “open” body stance. Do this by turning “side on” (half turned) for greater peripheral vision and by taking an angle of support that allows you to see most (if not all) of the other players on the field.
  • Focus on the first touch. Relax as you receive the ball so you can control it quickly, and move the ball away from pressure on your first touch to create more space and time.
  • Communicate to help the receiver. Use brief phrases like “man on,” “turn” and “time” so that players on the ball know whether or not they are about to be pressured by the opponent.

By Coach Carl Weber

Values Kids Learn Through Soccer

— Appreciation for an active lifestyle
— Positive self-concept through mastering skills
— Teamwork
— Social skills
— Leadership
— Responsibility
— How to handle success and disappointment
— Fair play and sportsmanship
— Respect for others

Questions to Ask Your Child After Practice or Competition:

Don’t feel that you always have to “debrief” after the big game. It’s okay to NOT talk about the game. Below are some good questions to keep you aware of what’s going on with your child’s athletic experience without being overly competitive.

— Did you play better this week?
— What did you learn in practice?
— What do you feel you need to work on?
— Can I help you improve any skill?
— What did the coach emphasize after the game?
— Did you have fun playing today?
— Was your opponent a good sport? Were you?
— Are you getting in better shape?
— What was your favorite part of the game?
— What’s the best part of being on the team?
— What do you like most about your coach?

Concussions in Youth Soccer

Summary:  Concussions are fairly rare in soccer (less and than in 10.000 games).  Most come from direct head-on-head collisions when jumping to head the ball.  The best way to prevent this is for coaches not to encourage batteling for headers and for our referees to call fouls when he sees another player agressively charging other players in order to win the head ball. 

Concussions in Youth Soccer:
(JAMA Pediatr. 2015;Published online July 13)
• Overall, 627 concussions were sustained during 1,393,753 athlete exposures (AEs) among girls (4.50 concussions per 10,000 AEs), and 442 concussions were sustained during 1,592,238 AEs among boys (2.78 concussions per 10,000 AEs). Still, soccer remains much less dangerous than football when it comes to head injuries. American Football causes a total of more than 40% of total high school sports concussions in the U.S.
• For boys (68.8%) and girls (51.3%), contact / collision with another player was the most common concussion mechanism. Heading was the most common soccer-specific activity, responsible for 30.6% of boys’ concussions and 25.3% of girls’ concussions.
• Contact with another player was the most common mechanism of injury in heading-related concussions among boys (78.1%) and girls (61.9%). About 10% of concussions were due to soccer activities such as defending, goaltending and chasing loose balls.
• The study concludes that although banning heading from youth soccer would likely prevent 30% of concussions, reducing athlete-athlete contact across all phases of play would likely be a more effective way to prevent concussions as well as other injuries. Concerned parents and youth sports governing bodies should focus on ways to reduce dangerous player-to-player contact, where most concussions occur.

* Commentary notes that there is often pushback from soccer leagues at the notion of enforcing rules against rough play and penalizing players for it. They don't think contact can be ratcheted down. About 52% of concussions in girls and 69% in boys were because of physical contact between players -- in many cases, elbows and shoulders hitting the head.
* Parents can help ensure their kids play soccer as safely as possible by having their kids play for teams and coaches that encourage technical skills rather than physicality.
* Soccer players occasionally do wear helmets. These are usually to protect from cuts. Although there is some data that headbands can reduce the risk of concussions, but the data so far are not convincing. Even in American football, there are questions about how much helmets have reduced the risk of concussion, though they have served their purpose to reduce skull fractures. It often actually increases head-to-head contact because people are less careful.

By Carl Weber MD

Athlete in the family? Clean out the Family Medicine Cabinet!

• All of us have the potential risk for drug abuse....risk does vary based on genetic vulnerability.....Reinforcing effects of the drugs.....Curiosity, need for novelty seeking.....General rebelliousness etc.

• The risk of substance use disorders are common. The lifetime prevalence of these syndromes, including alcoholism, is >20% for men and ~15% for women, with young and middle-aged persons most heavily affected.

• Over 70% of abusers get their meds from a friend or relative. 

• ‘Pharming’ is a term used for the abuse of prescription and over-the-counter drugs in teens.

   A study indicates that adolescent males who participate in sports may have greater access to opioid medication, which puts them at greater risk to misuse these controlled substances (J Adol Health. 2014;54:333-340).....had higher odds of being prescribed an opioid medication (i.e., medical use) during the past year (adjusted odds ratio [AOR], 1.86), higher odds of past-year medical misuse of opioid medication as a result of taking too much (AOR, 10.5), and higher odds of past-year medical misuse of opioid medication to get high (AOR, 4.01) compared with males who did not participate in organized sports during the study period. Among females, no association was found between participation in organized sports and medical use, medical misuse, and non-medical use of opioid medication.

Although most studies find that sports participation is negatively associated with cigarette use and illicit drug use, there is consistent support that athletes are more likely to drink alcohol and engage in problem drinking. Despite the positive benefits that adolescents gain from participation in sports, sports participation may actually put some adolescents at risk for substance use because of increased access to different types of substances, the stress associated with athletic participation and maintaining a competent athletic identity, or exposure to a set of normative behaviors that can facilitate the use of different types of substances (e.g., using performance-enhancing drugs to be the best).

 This study found that male adolescents who participated in organized sports had higher odds of past-year medical use and medical misuse (i.e., used too much) of opioid medications on at least one occasion compared with male non-participants.

 Although medical prescription opioid use is not necessarily problematic, having unsupervised access to these medications can put adolescents at risk of illegally distributing or illegally using these controlled substances. Because adolescents who participate in interscholastic sports may have greater access to opioid medications, greater awareness should be instilled in parents and coaches to monitor, store, and dispose of these medications properly.

• Kids who report sipping alcohol are more likely to report more drinking by the ninth grade, according to a study (J Studies Alcohol Drugs 2015;online March 30). Beginning in middle school when the students were age 11. At that point, almost 30% of kids said they had tried sipping alcohol, most often provided by their parents at a party or special occasion. Alcohol used as part of a religious service was excluded. By the time the students entered high school in ninth grade, about 25% of the early sippers said they had had a full alcoholic drink, compared to less than 6% of the other kids. Nine percent of the sipping group had gotten drunk or binge drank, compared to about 2% of other kids, the authors reported. "We have found in other analyses of this sample that sippers receive fewer messages disapproving of adolescent alcohol use and they have a greater perception of alcohol's availability."  Some parents who do not drink at all may be recovering alcoholics, and their children are at an increased risk of developing alcohol dependence as adults, Jackson said. Kids who sip alcohol at an early age tend to have more problems with delinquency and poor school achievement, and may be living in households where alcohol is consumed more frequently or heavily, she said. "The bottom line is that how youth view alcohol will affect the choices they make." D'Amico told Reuters Health by email. There are exceptions such as religious occasions, so it's important to make sure that children know when drinking alcohol is acceptable and when it is not, she said.

By C Weber MD

Why is Soccer so Great?

The world's most popular team sport. In the United States soccer is the third most popular team sport among children ages 12 to 18 years, and ranks second in participation among children ages 6 to 11. Fortunately, soccer has a relatively low injury rate compared with other contact sports.

• Soccer actually requires a decent amount of intelligence, communication and hard work....the key ingredients that make one succesful in life. It's fast-paced and with 22 people on the field, there are a lot of things happening at once.

• Unlike American football where you get to stop and set everything up again after each play, and most people only have to do one thing well, in soccer you need to think much more quickly. You need to be offensive and defensive no matter which position you play and the clock doesn't stop. 

•  It's excellent for teaching children about teamwork, coordination and sportsmanship. Unlike games like basketball where the sport focuses on individuals, soccer requires the entire team to work cohesively and it focuses on good technique just as much as highest score. It's probably one of the best sports for any child to learn.

Strength and Balance Exercises....in. Stretching....out.

Strength training and balance exercises are more likely to help prevent sports injuries than stretching according to an analysis of data from 25 trials with more than 26,000 participants......including soccer, basketball and handball players and army recruits (Br J Sports Med 2013;online October 7). 

• Overall, researchers analyzed close to 3,500 injuries.
• The data "do not support the use of stretching for injury prevention purposes, neither before or after exercise," the study team wrote.
• Balancing exercises meant to improve joint stability lead to a 45% lower risk of injury among people in the exercise group.
• Strength training exercises to build muscle led to a 68% drop in injuries in four studies. Those benefits seemed to apply to both overuse injuries (33% reduction) and more acute sprains and tears.
• For some athletes, improving technique might be the most important injury prevention tool.  "Technique is really important. Very basic techniques, like landing."  (proprioception training)
• Not overdoing it is an important way for recreational athletes like runners to avoid injuries, Dr. Yu added.

COMMENT: Although the researchers said "it's not clear which specific exercises have the best chance of warding off ankle sprains, ligament tears and other injuries", I suggest plyometric training as it combines strengthening and balance and can be performed without any specialized equipment. Pliometric exercise translates into “more length” as loaded or explosive eccentric muscle actions are used.
Examples:  Jump and reach.  Box jumps. Single-leg hops. Squat jumps. Alternate-leg bounding. Double leg hops. Barrier jumps. Ski downs (side to side jumps, like doing moguls...can be done jumping over a soccer ball).  See above diagram. C. Weber MD

Soccer Headgear:

Soccer has more than 265 million players around the world and is the only contact sport with purposeful use of the head for controlling and advancing the ball. Headgear is marketed for reducing head acceleration and risk of concussion, but the evidence is still out.

• A study that examined head kinematics during soccer heading found that head acceleration was greater in women than in men when wearing the soccer headgear (J Athl Train 2008;43:578–584).....the authors state that "Clinically, athletic trainers should be cautious when advising athletes or parents about the potential effects of the headgear".
-- The participants performed 4 soccer headers under 3 headgear conditions (control, Head Blast Soccer Band, and Full90 Select Performance Headguard).
-- Head acceleration in women was 32% and 44% greater than in men when wearing the Head Blast (21.5 g versus 16.3 g) and Full90 Select (21.8 g versus 15.2 g), respectively (P < .05). Compared with men, women exhibited 10% greater head accelerations (20.2 g versus 18.2 g) during the control condition (P = .164). These difference may be due to differences in head mass and neck muscle strength. Based on the Newton Second Law of Motion (F = ma), less head mass and neck strength should result in greater head accelerations upon force application.

Think about American Football…..the helmets don’t necessarily protect from concussion as they do not affect acceleration / deceleration injuries….the brain is floating in CSF, it if gets jerked it can slam into one side or the other of the skull (coup and contracoup injury).   A helmet does protect you from contusions and lacerations, thus a great idea for goalies.  Additionally it hurts (stings) less when heading a ball….unfortunately the mass effect is not necessarily significantly reduced.
• Head contact in soccer has the potential to cause acute traumatic brain injury including concussion or, potentially, a pattern of chronic brain injury (Curr Sports Med Rep. 2011;10(6):324-9)...."Headgear has not been shown to be effective in reducing ball impact but may be helpful in reducing the force of non-ball-related impacts to the head".....There are concerns that universal use of headgear may cause more aggressive heading and head challenges, leading to increased risk of injury.

• About 4%–20% of all injuries in soccer are “head injuries,” under which term they include concussions, nasal fractures, injuries of the eye, lacerations, and contusions (J Athletic Training. 2001;36(3):328–333).

• According to a study of concussions in soccer players, 67.7% of reported concussions were due to player contact, while 18.3% were associated with contacting the ball and 13.4% with contacting the playing surface (J Athletic Training. 2007;42:278–285)....Less than 1% were associated with contacting the goal.

• A study found that application of headgear was linked to a decrease in the peak force of impact from a soccer ball traveling at 56.4 kph (35 mph). This force was approximately 112.5% lower (nearly 400 N), as compared to the unprotected force platform (J Athletic Training. 2003;38(3):220–224).

• Currently available headgear for soccer heading shows little ability to attenuate impact during simulated soccer heading (Ac Emer Med. 2008;published online: 28 JUN. DOI: 10.1197/aemj.10.1.85).
-- A soccer ball was propelled at the headform at three different speeds known to occur in soccer play: 9, 12, and 15 m/sec (20, 26, and 34 mph). The main outcome was the peak acceleration of the headform associated with these impacts with and without protective headgear. There was no significant difference in the measured accelerations at the center of gravity with or without headgear (p = 0.50). However, the interaction term of headbands, pressure, and speed was significant at F = 5.51 and p = 0.00001. Using contrasts within conditions, some headbands were found to cause a decrease in peak acceleration at the highest speed and pressure, suggesting the headbands may play a role in decreasing impact for more forceful blows.

Go Grass!

Let's be thankful for the new Haller fields brought to us by Sequim Family Advocates and that will our low rainfall we can play on grass fields all year around in Sequim.  Here is another reason.....less injuries than with artificial turf.

• College football players suffer knee injuries about 40% more often when playing on an artificial surface compared to when they're playing on grass (Am J Sports Med 2012;online April 5).....turf provides a more consistent playing field, and is expected to deliver better performance, but it has not been considered any less safe than grass.....ACL injuries were 10 times more common during games than during practices, and close to five times as common during scrimmages than during regular practice.

--Athletes were also 1.39 times as likely to be injured when playing on modern artificial turf as they were when playing on grass.

--The newer types of artificial playing fields are called infill surfaces. They have a layer of synthetic grass over a field of rubberized pellets called fill.

--"What the problem is, we think, is the shoe-surface interface." Players are able to get a better grip on turf than on grass -- perhaps too good a grip. So if you are in the wrong position, because your leg doesn't give way as it does on grass, it can distribute that force to your knee and cause an injury.  The answer might be found with working with shoe makers to try to design footwear that can mimic the grip that players get on grass....to change the molding patterns on the shoe to decrease friction.


Early versions of synthetic turf that appeared in the late 1960s and 1970s were sometimes little more than a layer of thick, carpet-like material laid over concrete, he said. In today's U.S. artificial surface market, more than 30 companies compete with proprietary mixes of what the industry calls "infill systems," which can include rubber, silica sand and polyethylene fibers.

Montreal-based FieldTurf, which funded 40% of the current study, relies on a blend of silica sand and cryogenically ground rubber for its fields.

Estimates vary, but artificial field turf surfaces can last up to 10 years, with initial installment costs ranging from $800,000 to $1 million and annual maintenance fees of about $2,500.

Keep both your legs strong!

Pro soccer players are much more likely to suffer ankle sprains when one foot is stronger than the other (Am J Sports Med, 2012;online May 14).....When a player cuts or lands from a jump, it's important to have symmetrical activation of the two sets of ankle muscles to help the joints absorb the impact and prevent damage.

- But there is still an important message from the new study, even for amateur athletes. "This study does suggest that if soccer players want to lower their risk of suffering ankle sprains, then they should strengthen their ankle musculature evenly, so that they have a good balance between both legs."

- "This take-home message can apply to just about all athletes and non-athletes," he added. "Proper balance between the lower extremities is very important."

- Earlier studies have shown that both lace-up ankle braces and balance training on a wobble board can help stave off injuries to the joint.

- "I tell people to go ahead and balance on one leg, then the other for two to three minutes," said Dr. McGuine, who led those studies, adding that two to three times a week is a good start.

- They also found that heavy players were more prone to sprains, which makes sense given the extra force their ankles have to absorb when they land or cut.

- Apart from keeping a healthy weight, Dr. McGuine told Reuters Health that it's important for athletes to learn how to land properly, too. "Don't land stiff legged," he said. "We want a soft foot strike."


  Even mild dehydration may affect our moods and ability to concentrate during exercise according to a study on male and female athletes (J Nutrition 2012;online January 16).

• You are often already dehydrated once you become thirsty, but subtle cues like a headache and/or fatigue can be your body’s way of telling you to drink more water.   Thirst can’t be relied upon until 5% dehydration. Mild dehydration is a common causal factor in heat-related illnesses (heat stroke, heat exchaustion etc).

• Knowing the signs of dehydration can also keep you out of the danger zone. Another sign is dark urine. Your urine should be a light yellow color.

• The best way to avoid becoming dehydrated is to drink an adequate amount of water.  Consume moderate quantities of water before, during and after soccer games and practices in order to avoid mild dehydration.  

How much water do we need? Women need about 91 ounces (2.7 liters) of water a day on average from all dietary sources.  Men need 125 ounces (3.7 liters).  ~80% of water intake comes from water and beverages, and 20% is derived from food.  Food, and other drinks all contribute, so it is impossible to say how many glasses of plain water someone should drink. The usually rule fpr adults is to drink 6 to 8 glasses of water a day.  Those who are very physically active or who live in hot climates may need to drink more water. I reccomend you avoid strictly avoid calorie-dense sugared sodas for hydration.

• Studies of professional soccer players have shown that a well-hydrated player’s performance can be up to 25% better than those that are poorly hydrated. These studies showed that dehydration may lead to decreased speed, passing, shooting and dribbling skills, as well as a decrease in the ability to focus. During a game in warm weather, a player can lose as much as 3 to 4 pounds of fluid. It has been shown that a loss of just 1% of body weight can lead to decreased performance.  Greater than 2% loss of the body weight in hot weather can be a safety issue, leading to issues such as heat exhaustion.
During training, a player should drink 8 to 10 ounces every 20 minutes. During a game, a player should drink 20 ounces at halftime. Weigh yourself before and after training or a game, and you’ll discover that you may have lost some weight, which is mainly attributed to fluid loss. For every pound of weight loss, drink 22 ounces of water. This last tip is especially important for tournaments where you will play more than one game in a day.

Carl Weber MD

Performance Fuel

 Eating the right foods at the right times can help you train/compete at your best. Eating "right" today will also improve your long-term health and future well-being. 

How to Achieve this: Always have at least three kinds of wholesome foods at each meal and at least two kinds of wholesome foods for each snack.  Aim for at least 90% of the calories from quality foods and, if desired, the remaining 10% from sweets and treats.

Water or Sports Drinks?
Water is an adequate fluid replacer during sports sessions that last less than 60 minutes, particularly if you have fueled-up with a pre-exercise snack. Sports drinks are helpful during training sessions and games that last longer than 60 to 90 minutes or on multiple game days; they replace both water and some carbohydrates.

Fueling Before Practices and Games

• If you have always abstained from eating within the hour or two before you play just because you think you should exercise with an empty stomach, think again. Pre-soccer food actually contributes to greater stamina and endurance.

Try 100 to 300 calories of a light snack (e.g. crackers, banana, toast). You might be pleasantly surprised by the benefits—more energy, better concentration and focus, greater stamina, and better ability to keep up with the opponent at the end of the game.

The general "rule of thumb" before a hard practice or game is to allow:
• 3-4 hours for a large meal to digest
• 2-3 hours for a smaller meal
• 1-2 hours for a blended or liquid meal
• less than an hour for a small snack, as tolerated

Pre-soccer carbohydrates fuel the muscles:

• The snack you eat even within the hour before you play can get digested into glucose and burned for energy. If you have trouble with solid foods (i.e., banana, bagel) before you play, you might want to experiment with liquids, such as a fruit smoothie, low-fat yogurt, or a canned liquid meal such as Boost. In general, carbohydrate-based snacks are digested more easily than fatty foods. Low-fat foods and meals tend to digest easily and settle well.

Engineered Sports Foods?: Commercial energy bars do not contain any magic ingredients that will enhance performance more than, for example, a granola bar, bagel, or fig cookies and water.

• Fueling with a pre-workout energy bar and sports drink is an expensive way ($2 to $3) to energize your workout. You could less expensively consume 300 calories of banana+yogurt+water ($1) or pretzels+raisins+water (50¢).

Pre-soccer beverages provide fluids to fully hydrate your body. By drinking diluted juice or sports drinks before you exercise, you can optimize your fluid intake, as well as boost your carbohydrate and energy intake. The best pre-exercise fluid choices include water, sports drinks, diluted juices, hot chocolate.

Professional women soccer players may burn 1,000 calories a game, and men, 1,500.
For the older player:
• 5 to 6.5 miles covered per game (2.5 for goalkeepers)
• 1,000 activity changes per game, meaning a change of speed or direction every 6 seconds
• Games are typically played at 75% of a person’s physical limits
• Rest pauses happen for about 3 seconds every 2 minutes

Avoid Insufficient Sleep Syndrome: This occurs when one regularly fails to get enough sleep at night. The result is sleep deprivation.  It is voluntary, but unintentional. The normal amount of sleep we need varies from 6-9 hours (average ~7.5 hr).  One normally is unaware that they need more sleep than they are getting. Presents with concentration and attention problems, low energy level, reduced alertness, distractibility, irritability and fatigue. Lower self-reported sleep quality is associated with reduced quality of life (Sleep 2009;32:1049-1057)......"Those subjects who reported having difficulty initiating and maintaining sleep... and those who reported being excessively sleepy during the day had lower quality of life than subjects who did not report having these symptoms."

By Carl Weber MD

**Ref:  (The Clinical Medicine Consult, www.clinicalmedconsult.com) (Food Guide for Soccer by Gloria Averbuch & Nancy Clark. © 2010 by Meyer & Meyer Sport (UK) Ltd.)

Sports-Related Product Advertisements Usually Are Unsubstantiated:
Posted Dec 3, 2012

Claims for enhanced performance generally were unreferenced or misleading according to a systematic assessment of 235 magazine ads for sports-related products (BMJ Open 2012;2:e001702

Many advertisements for sports-related products (e.g., sports drinks, oral supplements, footwear, clothing) contain claims of enhanced performance or recovery.

Investigators assessed the extent and nature of these claims in ads that were published in 92 different magazines in March 2012.

The magazines contained 235 ads for sports-related products. Fifty-four different product ads (23%) made 113 enhanced performance or recovery claims. Of these claims, only three were supported by references in the ads.

Websites for products making enhanced performance or recovery claims were reviewed. Overall, 431 performance or recovery claims were found for 104 different products. Of these claims, only 141 were supported by references on the websites. (More than half of websites that made claims did not provide any references.) Of the 141 cited references (plus 5 that were provided upon manufacturer contact), about half could not be appraised critically (e.g., didn't exist; a review, not original research; animal study), and most of the remainder (82%) potentially were biased (e.g., nonrandomized studies).

Only three (4%) cited studies were judged to be of high quality.

Comment: The results of this evaluation are not surprising, but they are sobering: Most claims of enhanced performance or recovery in advertisements of sports-related products are not supported by references. And even when they are, the evidence rarely is high quality.

Is Stretching Before Games and Practices Important?

The simple answer:  No. 

However in athletes with prior injuries there is likely benefit to prevent re-injury.  See below for "warm ups".


Most injuries occur during muscle contractions within the normal range of joint motion, which raises doubts about how increasing range of motion could lower the risk of injury. 

If you’re like most of us, you were taught the importance of warm-up exercises back in grade school, and you’ve likely continued with pretty much the same routine ever since. Science, however, has moved on. Researchers now believe that some of the more entrenched elements of many athletes’ warm-up regimens are not only a waste of time but actually bad for you.

Most fitness experts now agree that static stretching before exercise is not just counter-productive, but potentially harmful. Traditional stretches, like when people bend over to touch their toes or stretch their legs on a fence, often cause the muscles to tighten rather than relax — exactly the opposite of what is needed for physical activity. It is like extending a rubber band to its limit. When people stretch to the maximum, they are more likely to pull a muscle.



• Stretches that work several muscle groups at once are great for upper-body warm-ups before a workout according to a review of 31 past studies (Br J Sports Med 2015;published February 18 online).....Higher load dynamic warm-ups are "the best bet" in most situations. For the upper body, these include pushups, dumbbell back flys, and resisted lateral raises.

Dynamic stretches focus on getting the blood flowing and increasing range of motion by using multiple muscle groups simultaneously. Unlike static stretches, which generally involve holding a single pose for a minute or two, dynamic stretches use a series of controlled movements.

Low-intensity stretching had little effect on performance, which agrees with previous research on upper body warm-ups, McCrary said.

"Flexibility increases are generally unrelated to any type of performance improvements," he noted.

Heating and cooling during a warm-up also does little to improve performance, the study found. While applying heat to specific muscles before strenuous activity may minimize the loss of flexibility in the days following the workout, this practice didn't show other benefits.


"Warm-up exercises may reduce injury by improving performance for serious athletes". "But recreational athletes and weekend warriors are at a lower physical fitness level, especially in aerobic capacity, and they may fatigue by warm-up exercise and reduce performance."

"Short-term, high intensity exercises need vigorous warm-up," Takizawa said. "But long-term endurance exercises do not."

It's impossible to say for sure how intense dynamic stretching or other warm-ups might affect the risk for injuries, McCrary said.

"We haven't really zeroed in on what kinds of warm-ups best prevent injuries," he said.


• Tendon injuries are common in sports, research finds that stretching doesn't help and might even raise the risk of injury for some (J Sci Med Sport 2015;online March 31). "Stretching is often viewed as an empirically accepted method to prevent sports injuries, including tendinopathy," write the authors......"However, there is no scientific evidence that confirms this." There was no evidence that stretching was beneficial but some that it might increase the risk of injury in people who already had problems with their knees or the patellar tendon. This was also true for so-called eccentric training, a method of doing muscle contractions. Many stretching exercises target specific muscles but the living body doesn't work like that. Movement involves synergies among groups of muscles. 


• Stretching for about 5-10 minutes per session showed no significant effect on either muscle soreness or injury (Effects of stretching before and after exercising on muscle soreness and risk of injury: Systematic review. BMJ 2002;325:468-70)…..”the average subject would need to stretch 23 years to prevent one injury”. 

• Stretching reduces the muscles force and power by 2-5%, but other reports indicate that it may increase the running speed by 2-5% (Phys Sports Med 2005;33:22-26). 

• No protective effect was seen for stretching and warm-up programs, as assessed in three trials (Prevention of sports injuries: Systematic review of randomized controlled trials. Arch Intern Med 2007;167:1585-92).

• Stretching before or after exercise won't spare either elite athletes or weekend warriors from muscle soreness one to three days later according to a review of 10 studies (Cochrane Database of Systematic Reviews 2007, Issue 4. DOI: 10.1002/14651858.CD004577.pub2)....."Some evidence suggests that once muscle soreness has developed stretching may provide a transient relief of soreness….The current review does not provide any evidence of an effect or otherwise of stretching on risk of injury, performance, or well-being." In many studies, the major predictor of joint injury was previous injury and joint laxity, not necessarily inadequate flexibility.

• The data on stretching and muscle soreness indicate that, on average, individuals will observe a reduction in soreness of less than 2 mm on a 100-mm scale (5%) during the 72 hours after exercise and thus stretching protocols used in these studies do not meaningfully reduce lower extremity injury risk of army recruits undergoing military training (J Athl Train. 2005 Jul-Sep; 40(3): 218–220).

• A comprehensive search of literature on stretching for injury prevention screened 361 articles concluded that no convincing evidence existed to continue routine pre-exercise stretching (The impact of stretching on sports injury risk: a systematic review of the literature. Med. Sci. in Sports Exerc.36(3):371–378).


Warming up is important

Warming up and stretching are two totally different things.  To do a warm-up means literally to warm up your muscles, which means doing a slower, gentler version of the activity. You can make stretching part of your warm-up.

Including neuromuscular training in youth soccer warm ups reduces injury rates and could save $2.7 million Canadian dollars (US$2.1 million) in healthcare costs over one season in Alberta, Canada, according to a RCT on 744 youth soccer players ages 13 to 17 years (Br J Sports Med. 2016;Published Online First 31 March)(http://bit.ly/1NsDy9d). Neuromuscular training targets strength, agility and balance more than a standard warm up routine. Half of the players were led through a 15-minute warm up before play, including five minutes of aerobic and dynamic stretching components and 10 minutes of neuromuscular training consisting of eccentric strength, agility and jumping exercises. They were also directed to do 15 minutes of balance training at home using a wobble board.
Players in the comparison group had a "standard of practice" 15-minute warm up before play, including on aerobic components, static and dynamic stretching and a home program that only involved stretching. Players in the neuromuscular warm up group had 38% fewer injuries during the season than those in the comparison group.
The researchers estimated direct cost savings related to these injuries, including visits to healthcare professionals, treatments, surgeries, X-rays, supplies and equipment used by injured players. They added direct costs to the healthcare system to out-of-pocket medical costs incurred by players and their families, which may include physiotherapy, splits, braces, crutches and chiropractic visits.

The researchers estimated that for 58,100 Alberta youth soccer players during one indoor season, there are about 12,000 injuries. Almost 5,000 injuries could be avoided and $2 million in healthcare costs saved with the neuromuscular training program,.

"I perceive savings of 689 Canadian dollars for every 1000 participation hours as very noteworthy, especially considering that the only intervention was a more effective 15 minute warm-up."

The right warm-up should do two things: loosen muscles and tendons to increase the range of motion of various joints, and literally warm up the body. When you’re at rest, there’s less blood flow to muscles and tendons, and they stiffen. You need to make tissues and tendons compliant before beginning exercise.  A well-designed warm-up starts by increasing body heat and blood flow. Warm muscles and dilated blood vessels pull oxygen from the bloodstream more efficiently and use stored muscle fuel more effectively. They also withstand loads better.

To raise the body’s temperature, a warm-up must begin with aerobic activity, usually light jogging. Overly vigorous aerobic warm-up simply makes you tired. Most experts advise starting your warm-up jog at about 40 percent of your maximum heart rate (a very easy pace) and progressing to about 60 percent. The aerobic warm-up should take only 5 minutes (note: sprinters require longer warm-ups, because the loads exerted on their muscles are so extreme).  

For soccer, instead light jog, you could incorporate a gentle half field overlap (weave) passing drill.....such that each player does this 3 or 4 times.

By Carl Weber MD

Hamstrings Injury

Hamstring strains are the most common injury among soccer players:

The injuries typically happen when players are sprinting and the hamstrings extend to prevent the knee from overstretching. That tension while the muscle is extending is known as eccentric contraction. 

Pro and amateur soccer players who regularly did a particular strengthening exercise were less likely to get sidelined with a hamstring injury, according to a study from Denmark (Am J Sports Med 2011;online August 8th)......based on usual hamstring injury rates, only 13 players would have to regularly undergo the strengthening exercises to prevent one injury

Teams did those exercises up to three times a week during the 10-week break between seasons, then once a week once matches were underway. 

The authors state that "One of the best things about the exercise, is that "you can do this efficiently, with the whole team, on the pitch, without any additional equipment except maybe a towel or some additional knee padding. Every soccer team in the world should be doing it."

See below for example.


Hamstring Injury Prevention

The "Nordic" Hamstring Curl:

The exercises only take about 5 minutes, and can be done without any extra equipment.

To do the exercises, players pair up, with one athlete on his knees and the other holding the back of the first player's legs and ankles to the ground.

The kneeling player slowly leans forward while holding his/her weight back with his hamstrings, until reaching a push-up position, then pushes himself back up once he/she hits the ground.

I reccomend doing one strengthening session a week.  Start with 5 reps for each partner. 

Add one rep weekly until at 10 reps per session to minimize muscle soreness.

By Carl Weber MD

Soccer Ball Heading and Injury to the Brain?

Heading the ball in soccer is an integral part of the game, but it might also be a cause of brain injury, according to research presented here at the Radiological Society of North America 97th Scientific Assembly and Annual Meeting.

 In a study of amateur soccer players, those who fielded the ball more frequently with their head had brain abnormalities similar to those seen in patients with traumatic brain injury. They also had evidence of impaired cognition, said Michael Lipton, MD, PhD, associate director of the Gruss Magnetic Resonance Research Center at the Albert Einstein College of Medicine in New York City.

 Heading the ball during a game is common, but it is even more common during practice sessions. "Players do these drills where they literally beat the ball back and forth between a coach throwing it at a player, or 2 players using their heads. They'll do this 30, 40, or more times at a shot. People who are playing pretty intensely, who spend at least 3 days a week in some pretty intense soccer play, can report an excess of 5000 heads a year," Dr. Lipton told Medscape Medical News.

 Dr. Lipton and his team used diffusion tensor imaging to detect changes in brain white matter, as indicated by fractional anisotropy, in 32 amateur soccer players. They also estimated how often each player headed the ball on an annual basis, and then ranked the players according to heading frequency.

 The average age of the players was 31 years, and all had played soccer since childhood.

 "Lower fractional anisotropy is an indication of derangement of brain structure at a microscopic level," Dr. Lipton explained. "In normal white matter, the diffusion or movement of water molecules is highly organized and collinear, but in the presence of any kind of injury, some of the structure that essentially shepherds those water molecules all in the same direction is lost, and the movement of water molecules becomes more random."

 This derangement is seen in traumatic brain injury and is associated with cognitive impairment in patients with traumatic brain injury, he added.

 The investigators compared the brain images of the players who had a heading frequency of 1320 per year or more with players who had a heading frequency of less than 1320 per year.

 They found that greater heading frequency was associated with low fractional anisotropy. Players with higher heading frequency had significantly lower fractional anisotropy in 5 brain regions in the frontal lobe and in the temporo occipital region, compared with those with lower heading frequency.

 "These 5 regions are responsible for attention, memory, executive functioning, and higher-order visual functions," Dr. Lipton said.

 The study also found that there was a threshold for the amount of heading required to cause these types of changes. When that threshold level was surpassed, white matter injury became detectable.

 "Our analysis showed that approximately 1000 to 5000 heads per year was the threshold. Once players went past that, we observed a significant decline in their fractional anisotropy in the 5 identified brain regions," Dr. Lipton explained.

 "The implication is that there is likely to be some safe range within which you can play soccer and head the ball and not have a bad effect from it. We don't know exactly where that threshold lies. More research needs to be done. Until then, caution is always a good thing, and that is generally what I tell people," he said.

 The investigators also administered a battery of neuropsychologic tests, and found that those with the highest heading frequency had significantly poorer performance on tests of delayed verbal memory (P < .01) and visual motor function (P < .03), compared with those with lower heading frequency.

 Dr. Lipton pointed out that this study looked at the effects of soccer heading in adults, but that children are likely to be even more affected.

 "There are a lot of reasons to be concerned that this effect would be magnified in children," he said. "It would be very hard to attribute the ill effects of heading directly to that activity, because the types of problems that people will have as a result of the kind of injury we are talking about are very nonspecific. It would be very hard to know whether poor performance in school is due to heading. Research needs to be done to define what these effects are and to determine a safe threshold for heading."

 Dr. Lipton added that he has no illusions that people will stop playing soccer.

 "That's just not going to happen, but...we can definitely identify safe parameters within which the game can be played. I hope our study raises awareness. The solution doesn't have to be proscriptive, it just has to identify safe parameters within which we can play safely."

 Commenting on this study for Medscape Medical News, Max Wintermark, MD, chief of neuroradiology at the University of Virginia in Charlottesville, said: "These data are interesting, and the fact that neurocognitive findings support the imaging findings reinforces the validity of the study. However, the study sample is small, and these findings need to be confirmed in a larger study."

 Dr. Wintermark said that he would be curious to know if there is a repair mechanism at work when the players stop playing soccer for a while.

 "Perhaps the effect of heading is not cumulative because of some repair occurring between headings, and lessening or preventing injury might be a matter of not doing too much heading repeatedly in a certain period of time. All of this needs to be studied further before recommendations can be made."

 He added that the finding that heading in soccer could cause such brain abnormalities is not surprising.

 "When you are a soccer player, you have a lot of these headings, and you accumulate them little by little.... It is not a surprise to realize that this could affect you," said Dr. Wintermark, who confessed that he played a lot of soccer as a kid in Europe.

 Dr. Lipton and Dr. Wintermark have disclosed no relevant financial relationships.

 Source:  Radiological Society of North America (RSNA) 97th Scientific Assembly and Annual Meeting: Abstract SSK 12-04. Presented November 29, 2011.



 When I have my teams practice headers, I try and limit to 12 offensive headers plus 12 defensive headers per practice session and at close range....they may get a few more during the scrimmage/play sessions.

Can you really see reason for try and head a goalie's high and deep punt when trapping is usually suffices?  I know the pro’s do it, but look at the pain of their face despite the subsequent rebound being barely better than a 50/50 ball!
I specifically coach the kids not to head a goalie punt!   I recommend limiting heading in practices to direct short (flick) passes (when the ball bounces high) and of course scoring opportunities on crosses (or defending against such).  The player in the zona rosa and black hole, where most of the crosses occur will only be partially deflecting (altering the direction) of the ball.  However the clean-up (far post) will likely take the full force as he/she needs to reverse the balls direction.

 Force = mass x velocity. The mass of current (waterproof) soccer balls is constant (older balls used to pick up more water weight).You will see the greatest force transfer coming from higher, longer airtime balls such as drop kicks and defensive clears that are taken directly with the head trying to reverse the direction of the ball.  There is less energy transfer with most goal scoring headers as they are usually glancing blows / partial deflections.

By Carl Weber MD


Sports Related Injuries: Good news. Soccer is low on the list.

According to the CDC, for all ages, basketball, football and bicycling accounted for the greatest number of emergency visits for all causes in 2006, with 603,239 and 524,692, respectively (MMWR 2007;56(29):733-37)....follwed by playground activities and riding all-terrain vehicles....About 5.1% of all emergency visits related to sports or recreation. Males account for about 70.5% of such visits. For both males and females, the highest rates occurred among those ages 10 to 14 years, followed by ages 15 to 19. Football and wrestling carried the highest risk of severe injury to high school athletes, according to a review of sports-injury data (Am J Sports Med 2009; DOI: 10.1177/0363546509333015).....the only high school sports with severe-injury rates that exceeded the national average of 0.39 incidents per 1,000 athletic exposures. Girls' basketball came in third, exceeding the severe-injury risk of boys' basketball (0.34 versus 0.24 ) per 1,000 exposures......Almost 60% of severe injuries resulted in disqualification from a sport for at least a year (0.3% of the injuries permanently disqualified)......Knees were most often associated with severe injury (29% of the total), followed by ankles (12.3%), and shoulders (10.9%). Fractures accounted for the largest share of diagnoses (36%), followed by complete ligament sprains (15.3%), and incomplete ligament sprains (14.3%).


A comprehensive analysis of female biomechanics during early pubertal growth spurts can predict which athletes are most likely to experience anterior cruciate ligament (ACL) tears in the future (American College of Sports Medicine (ACSM) 57th Annual Meeting: Abstract 1125/2. Presented June 3, 2010).....girls have significantly more valgus (knock-kneed) movement when they land from a 30 cm jump than men; this discrepancy is greatest when girls are at the peak of their growth spurt....."Before puberty, the incidence of ACL tears is equal in boys and girls. However, beginning at age 12, ACL tears become 10 times more common in women than in men......"Neuromuscular training programs can lower the risk of ACL injury in female athletes to that of men....."preventive exercises should be focused on selective upregulation of the medial hamstring as the essence of preventive neuromuscular training."


                                              Traumatic brain injuries (TBIs):

We are all signing waivers for this now due to our lawmakers in Olympia, WA. But the risk is fairly low among soccer players. TBIs from participation in sports and recreation activities have received increased public awareness, with many states and the federal government considering or implementing laws directing the response to suspected brain injury.  Let's here it for more beaurocracy!

Activities with the highest rates of traumatic brain injuries (TBIs) among people under age 20 were horseback riding (15.3% of all horseback riding injuries), ice skating (11.4%), golf (11.0%, included those sustained from riding in golf carts), all-terrain vehicle riding (10.6%), and tobogganing or sledding (10.2%)(Morbidity and Mortality Weekly Report (MMWR) 2011:60(Oct);1337-1342).

Approximately 71.0% of all sports and recreation--related TBI ED visits were among males; 70.5% were among persons aged 10--19 years. An estimated 2.5% of children and adolescents with sports and recreation--related injuries are hospitalized or transferred to other facilities.

The 5 most common activities associated with emergency department visits for nonfatal traumatic brain injuries related to sports or recreation activities: (MMWR. 2011:60(Oct);1337-1342)

For males <19yo: from the playground (7.8%), bicycling (16.5%), football (19.9%), baseball (6.5%) and basketball (7.6%).
For females <19yo: from the playground (14.2%), bicycling (11.8%), horseback riding (5.7%), basketball (9.2%) and soccer (9.5%).

To minimize TBI in sports and recreation activities: practicing skills, strength and conditioning, and sportsmanship, and using protective equipment (e.g., bicycle helmets). Secondary strategies include knowing the signs and symptoms of TBI, responding to suspected TBI appropriately, and permitting return to activity only after evaluation and clearance by an experienced health-care provider.