By Dev K. Mishra, M.D., Soccer America, February 26, 2009
The unfortunate reality of soccer as a contact sport is that injuries happen. Most of these are relatively minor things that get better with some rest and rehabilitation, but some injuries will be more severe and will require assistance from a number of professionals to get you back in the game.
What follows below is a basic outline of how different individuals are involved in returning a player to competition after a significant injury, and the different phases in the recovery process.
For the purposes of this article, let's assume we are dealing with an injured high-school athlete, at a school that has an athletic trainer on staff.
The Injury Event
One of the most important things to do at the time of injury is to not get up and attempt to keep on playing. I can't tell you how many times I've heard an athlete tell me that they attempted to continue playing after the initial injury, only to get a second injury making the original injury far worse.
If you suspect you're hurt, notify your coach or trainer and get evaluated. You're not helping yourself or your team by trying to play while injured. The trainer's job on the sidelines is to look out for your safety. The trainer is highly skilled in determining whether an injury is mild with potential return to play that day, moderate requiring some rest and rehab, or more severe requiring a doctor to evaluate you. If a trainer is not available, go back to the old standard RICE- Rest, Ice, Compression (ace wrap), Elevation.
Full Evaluation, Establishing the Diagnosis and Treatment Plan
Your school may have a doctor in charge of caring for the athletes at the school, otherwise known as a "team physician." If you've had a significant injury, your trainer will communicate with the physician and arrange for the physician to evaluate you, usually in their office. If you don't have an established team physician, it's important for you to be seen by someone skilled in dealing with athletic injuries.
Two organizations with members specifically trained in treating athletes are the American Orthopedic Society for Sports Medicine (www.sportsmed.org
), and the American College of Sports Medicine (www.acsm.org
). The links can take you to a "find a doctor" section, where you can then find a specialist in your local area.
The doctor will listen to your description of the injury. Often, I can zero in on the probable diagnosis just by listening to the athlete tell me how it happened. The doctor will then examine the injured area, which provides even more information. Finally, "imaging studies" such as x-rays or an MRI scan might be ordered to confirm the diagnosis.
Putting all of this information together, the doctor will come up with an individualized treatment plan. The plan can include rehabilitation, equipment modification, bracing, casts, and sometimes surgery. The doctor should clearly communicate with the player, family, other healthcare providers, trainer, and sometimes coaches. There are a number of laws protecting patient privacy that we need to observe, but clear communication with the injured athlete and family are always required.
Dealing with Psychological Issues
There's never a good time to be injured. With soccer, we are dealing with an almost year-round sport, even in cold winter climates. So, no matter when in the "season" the injury occurs, something in your training or competitive schedule will be missed. My advice to athletes I'm treating is to try and "let it go," and understand that an injury occurred, understand that treatment will almost always get you successfully back to play, and understand that it will take some time to get back.
It's normal to be upset, especially if the injury will involve treatment with surgery and extensive rehabilitation. Most athletes will get over their initial feelings and get on with the task of getting healed. Some athletes, however, have significant difficulties coping psychologically with an injury. If you are feeling overwhelmed by the injury, or just having a hard time dealing with it, be certain to let your treating doctor know as help is available for that too.
Treating the Injury
The treatment phase involves the healing of the injured part. For an ankle sprain, this may involve a brace and crutches. For a broken foot of ankle there may be a cast placed on the leg. For a torn ACL in the knee, surgery is usually needed. This phase of treatment is directed by the doctor, and will take days to weeks depending on the type of injury.
Rehabilitating the Injury
Once the treatment for the injury has started, the next phase of recovery begins. This will often involve referral to a qualified physical therapist. The physical therapist is highly trained in techniques to restore function of the injured part, develop a plan for sport-specific training, suggest continued equipment modification such as bracing, and continue communication with the player, family, physician, and trainer. For many injuries, we've learned over the years that early involvement by a physical therapist speeds up return to play.
Conditioning the Injured Athlete for Return to Play
Let's say you've had a significant ankle sprain. You were treated in a brace for 2-4 weeks, and then you started getting some movement skills back for another 2-4 weeks. Now we're up to 4-8 weeks from the time of your injury, and you know what you haven't been doing- practicing or playing soccer. Getting yourself match fit will take a few more weeks (or even months, if you've been out a long time). In this phase we will usually rely on the trainer to start sport specific conditioning drills designed to safely return you to play.
Putting it All Together -- How Long Until You Can Play Again?
I've broken the process into "phases" above, but the reality is that there's a lot of overlap between the phases. For example, treatment and rehabilitation will be going on at the same time and will overlap, and rehabilitation and conditioning will also overlap. Each situation can vary quite a bit with the specifics of your injury, but here are some very rough guides based on my practice.
"Moderate" or Grade 2 ankle sprain
: Brace 2 weeks
Rehab and conditioning 2 weeks
Full return to training 5 weeks after injury
Foot fracture treated in a cast or boot
Cast or boot 4 weeks
Rehabilitation and conditioning 3-4 weeks
Possible return to training 9 weeks after injury
ACL tear treated with surgery
Surgery takes place 3-4 weeks after the initial injury
Rehab begins immediately after surgery, continues through 4 months
Sport specific conditioning months 5-8
Full return to training at 9 months
(Dev K. Mishra is an orthopedic surgeon in private practice, Burlingame, California. He is a Team Physician at the University of California, Berkeley, and member of the team physician pool with the U.S. Soccer Federation.)