From the Guidelines
For a patient who continued to play soccer to the point of incapacitation, immediate rest, medical evaluation, and a period of rehabilitation focusing on nutrition and physical therapy are recommended. The patient should follow a comprehensive approach to manage their condition, including the RICE protocol: Rest (complete cessation of activity), Ice (apply cold packs to injured areas for 15-20 minutes every 2-3 hours), Compression (use elastic bandages if swelling is present), and Elevation (keep injured limbs elevated when possible) 1.
Key Considerations
- Pain management can include acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) if not contraindicated.
- The patient should seek professional medical assessment to rule out serious injuries such as fractures, ligament tears, or concussion.
- Depending on the specific injury, physical therapy may be necessary for rehabilitation, focusing on exercises that improve strength, flexibility, and range of motion.
- A gradual return-to-play protocol should be implemented only after symptoms resolve and medical clearance is obtained, emphasizing the importance of not returning to play while symptomatic 1.
Nutrition and Rehabilitation
- Alterations in energy requirements during rehabilitation should be monitored, aiming for a balanced diet that supports recovery without excessive caloric intake 1.
- Dietary protein intake is crucial, with recommendations suggesting at least 1.6 g/kg body mass per day, distributed throughout the day, including before sleep, to help attenuate muscle loss and support recovery 1.
- Emerging data indicate potential roles for specific nutritional compounds in retaining/restoring muscle tissue during rehabilitation, such as omega-3 fatty acids, β-hydroxy-β-methylbutyrate, and ursolic acid, although more research is needed to confirm their efficacy 1.
Safe Return to Sports
- The recovery course is longer for younger athletes, and a more conservative approach to return to play is warranted 1.
- Education about sport-related injuries and concussions is integral to improving awareness, recognition, and management, with the mantra "when in doubt, sit them out" guiding decision-making for return to play 1.
- Proper diagnosis, treatment, and a medically supervised stepwise return-to-play process will help prevent chronic issues and ensure a safe return to sports.
From the Research
Treatment Recommendations
The patient who continued to play soccer to the point of incapacitation likely suffered from various musculoskeletal injuries, including contusions, acute and chronic musculotendinous strains, and ligamentous injuries to the knee and ankle 2.
Common Injuries in Soccer
- Contusions
- Acute and chronic musculotendinous strains
- Ligamentous injuries to the knee and ankle
- Groin pain
- Facial trauma
- Mild brain injury (concussion)
- Heat-related injury
Treatment Approach
Most injuries are minor and respond to analgesics, therapy modalities, and exercise therapy 2. However, for more severe injuries, individualized treatment should be provided, taking into account the specific needs of the high-demand patient 3.
Prevention of Future Injuries
An injury prevention program is essential to prevent future injuries, and this program should involve the player, trainer, responsible physician, and physical therapists 3. Additionally, identifying and addressing risk factors such as joint instability, muscle tightness, inadequate rehabilitation, or lack of training can help prevent injuries 4.
Risk Factors for Injuries
- Joint instability
- Muscle tightness
- Inadequate rehabilitation
- Lack of training
- Previous traumatic events
- Physical and biological characteristics of the player
- Life style habits such as smoking, alcohol, and diet
Importance of Proper Rehabilitation
Inadequate rehabilitation can lead to moderate or major injuries, highlighting the importance of proper rehabilitation and prevention strategies 4, 5.