Thanks to the US Youth Soccer Association for these great articles!

Common Injury Terms
Mark Adams, M.D.

Reprinted with permission from "The Champion Within" by Lauren Gregg. To order a copy, call 1-800-551-9721 or go to www.jtcsports.com.
A common terminology extends across the spectrum of injury. An understanding of the basic medical terms associated with sports medicine may make understanding your injury easier. The following are common injury terms.

Fracture: A fracture is a break in the continuity of a bone. Athletes and trainers should consider the diagnosis of fracture after any significant musculoskeletal trauma. This is especially important when you have local deformity, swelling, bruising or significant pain. Possible fractures should be splinted in the field and the patient transported to an appropriate medical facility for radiographs and physician evaluation.

Dislocation: A dislocation is displacement of bone from it's normal position in a joint. With a dislocation, there is loss of limb function and you are usually suddenly unable to move the joint in question. Deformity is generally visible, and swelling and point-tenderness are immediately present. An x-ray examination may be the only way to distinguish a dislocation from a fracture. On occasion, a dislocation may be reduced (put back in place) on the field.

Subluxation: Subluxation is a partial or incomplete dislocation. It's not common to have deformity since the joint has not moved completely out of position. Symptoms include joint pain and transient loss of function.

Sprain: A sprain is an injury to a joint that damages the ligaments connecting the bones together to form the joint. The deforming force creating a sprain is usually an excessive stretch or shear. Any ligament can be affected in this way, but the ankle and knee ligamentous structures are especially prone to injury. Pain, local swelling, and discoloration may be evident, and the patient may exhibit apprehension whenever the joint is examined. Looseness, or joint laxity, may result when sprains occur.

Strain: A strain is an injury to the muscle or musculotendinous unit which usually results from contraction or excessive forcible stretch. Acute muscle strain can occur within any major muscle group, yet the most commonly involved in the lower extremity is the quadriceps, adductors, hamstrings, and the Achilles complex. You may be immediately aware that the muscle has been damaged. Occasionally, it feels as if something has "popped" in the effected muscle area. The Olympic sprinter putting up with a hamstring injury is a good example of acute muscle strain. Symptoms are local pain and muscle spasm with hematoma formation and loss of muscle function. A defect in the muscle may at times be palpable.

Contusion: A contusion is a compression injury or direct blow to the soft tissues of the body. Usually, this occurs to a muscle or musculotendinous unit but may also involve a bursa, or even bone. This is a especially common in contact-type sports. A contusion creates local pain and stiffness which is increased twelve to twenty-four hours following injury. There may be localized tenderness and hematoma (bruise) formation at the site of injury.

Acute Injury: An acute injury is one that results from sudden injury with rapid onset. Most of the above injuries occur in an acute setting.

Overuse Syndrome: This is an injury that occurs from repetitive micro-trauma over a longer period of time. Constant repetitive stressing of the body day after day can lead to microscopic changes involving soft tissues or bones. This may in turn lead to constant pain during and after activity.

These common terms apply to an injury regardless of it's anatomical location. A fracture in the lower extremity may be treated much the same as a fracture in the upper extremity. Similarly, contusions, sprains, and strains have common principles of healing and treatment regardless of location.

Mark Adams was the team doctor for the 1996 U.S. Women's Olympic Team and for the 1999 U.S. Women's World Cup team.

Benefits of Stretching
Kim Stewart

Sports today have become very popular and competitive among people of all ages, even young children. A number of athletes want to learn how to bring their game to the next level. Sometimes this means breaking ineffective techniques as well as beginning new and unfamiliar habits. Sticking to something new can be difficult, especially when results may not be see immediately. But, if the athlete understands and truly believes in the benefits, then adherence by be stronger. As a coach, part of your role is to facilitate any knowledge of ways to enhance an athlete's performance, whether it may be optimizing physical or mental capabilities or preventing injuries. With this in mind, a major factor that can contribute to an athlete's success is to understand all of the values of proper stretching.

An athlete can benefit in many ways from stretching. The most common reason taught to athletes is that stretching increases flexibility, the ability to move joints through a full range of motion, thereby reducing the risk of injury. Unfortunately, the majority of athletes believe that they are invincible and that an injury will not happen to them. This attitude is reinforced when these athletes do not get injured. What many athletes and coaches do not understand is that by increasing flexibility, one's personal sprint speed, power, and strength can be optimized. For example, if a soccer player is able to move his/her leg further back during the preparatory phase of a shot, more power can be created. Another example, more useful to a broad range of sports, is increasing speed. Although an individual's sprint speed can only be altered a little bit (due to genetic constraints), one way to help optimize personal speed is to increase range of motion. It is also important to realize that a stretched muscle will encounter less resistance from contraction and tension, thereby causing less energy needed to complete a movement. When athletes learn and understands these benefits, they are usually more apt to institute a stretching program.

Not only is teaching the benefits of stretching important, but also knowing the best time to stretch is key. A number of people believe that stretching before practice is all that is necessary for an athlete. First of all, the muscles should be warm before stretching occurs. A coach should have the athletes break a sweat, usually doing a sport specific activity, and then do the stretching. To save some practice time, coaches might announce what will happen during the practice that day and/or review previous practices or competitions. One key mistake often made is over-stretching before practice. You want your athletes to have good range of motion for practice, but this is not the time to try to gain flexibility. The best time for that is after practice or own their own. Doing a cool down jog and stretch after training allows athletes to stretch again when are warm and helps reduce next day muscle soreness. It also gives the team time together and provides some relaxation prior to leaving practice. Individuals who need additional stretching to further increase flexibility can be advised to do stretching at home. It does not have to take up too much time because it can be done while doings other things, like watching TV. You should remind the athletes that they still must utilize proper stretching techniques, even at home. Even though children do not place as much demand on their body as older athletes, learning the value and the habit of stretching at an early age may aid in their success later on in their career.

Article contributed by Coaching Youth Sports, an online newsletter presenting information about learning and performing sport skills.

Eating to Play
Dr. Don Kirkendall

A letter was sent to the editors requesting information about eating around game times. With the new season nearly upon us, it is probably a good time to review some topics associated with nutrition and sports performance.

This has been one of the most intensely researched topics in the sports performance literature and there have been many advances from the "Saturday morning steaks" that dads might remember from their high school football days.

Research can be grouped into four categories regarding the timing of eating: training days prior to competition, day of competition, during competition and after competition. In brief, carbohydrates are the best choice so choose foods that give the most carbohydrate per serving.

Days Prior To Competition
This was the first real focus of study that lead to the "glycogen loading" concept. Without going into a lot of scientific history, the typical routine now is to gradually reduce training volume and intensity while increasing the fraction of the total diet that is carbohydrates. This will help the muscles load up extra glycogen (the main fuel for muscles) for the game.

In soccer, this is not a common practice unfortunately. Most research shows that the muscle glycogen levels of (male) soccer players are no better than the spectators in the stands - not good.
Studies on soccer players have shown that those with the most pre-game muscle glycogen run the farthest at the fastest speeds during a game. As such, it is surprising to see that glycogen loading schemes have not been as universally adopted in soccer as they have in traditional endurance sports like running, cycling, cross-country skiing and triathalons.

Five to six grams of carbohydrate per kilogram of body weight over a 24 hours period is the typical suggestion so read those labels on food packaging. Remember, 1 pound of body weight/2.2 = kilograms of body weight.
Day of Competition

There is probably no more area full of misleading information than eating the day of competition - the proverbial pre-game meal. Most pre-game meals are eaten in the 3-4 hours prior to competition. But realize that the food eaten will have little to do with the energy expended in the game. That comes from what was eaten in the 2-3 days prior to the game.

Most players eat what they like so they won?t still feel full come game time. Remember that the more calories (i.e. fat and protein) in a meal, the slower the food leaves the stomach. Carbohydrates are always the best choice as fruits, cereals, juices, pancakes/waffles etc. over sausage, eggs, steak, or many choices on the breakfast menu at a fast food restaurant.

Food in general, and carbohydrates in particular, should be avoided in the last hour before play. Carbohydrates stimulate an insulin response which lowers blood sugar and also stimulates the production of serotonin, a chemical in the brain that reduces arousal (makes you listless and sleepy).

Both are obviously counterproductive to competition. If something must be eaten, choose low glycemic index foods as they cause less of an insulin response.

Immediately prior to competition (in the minutes before kickoff), carbohydrates can be taken in. The excitement of the game will counteract the insulin response and the fresh carbohydrates give the muscles an extra source of fuel. The type of carbohydrates is important. Foods should be of a moderate or high glycemic index (see table).
Carbohydrate supplement drinks work great. "Clear" candies (jelly beans, "Gummy" candy, Skittles etc. you get the idea) are another choice. .

Eating During Competition
During the game, carbohydrate supplement drinks given before the game and at halftime have been shown to increase running volume and intensity in the second half in soccer players. This is important to consider because goals become more frequent later in the game as players get tired.

If you have more energy than your opponents, you are more likely to have an advantage over the opposition and hopefully, score more later in the game. As you can see from the table below, the ubiquitous orange slices at halftime are pretty low on the priority as a carbohydrate source.

Eating After The Game
The game uses muscle glycogen (carbohydrate) so it must be replaced. Research has shown that muscle is the most receptive for carbohydrate replacement in the first two hours after exhaustive exercise. Therefore, it is important to eat some moderate to high glycemic index foods in the first two hours after a game.
From the table, you see there are quite a variety of options for food, most of which require a little planning and typically do not come in a bag or a tray from a fast food restaurant. With games at 12 noon and 4 pm, it is necessary to get some carbohydrates back into the muscles quickly.

Remember, fast foods are high in fat and protein and can remain in the stomach at the start of the next game (depending on when it was eaten and how much was eaten) and doesn't return much in the way of carbohydrates to the muscles, therefore should be avoided.

A nutritionist gave me a good suggestion: make up bags of Chex Mix with some pretzel sticks added (forget the oil and baking requirement) and let the players eat this after the game. Clear candy is also good as are raisins, cakes, pies, bagels.

Ideally, eat 50-75 grams of carbohydrate every two hours until you reach the total based on your weight (5-6 grams/kg body weight).

But don't get the idea that all the carbohydrate can be replenished in a couple of hours. Under the best of conditions, it can take 20 hours to fully replenish muscle glycogen from muscles that have been completely depleted.

Eating for sports performance requires a bit of planning and clock watching, but can lead to improvements in performance. When done properly, the players will notice they have more energy late in games as well as when they have multiple games with minimal recovery between games.

For more information, try:
http://www.olympic-usa.org/inside/ - USOC website for nutrition information including some sample menus.
http://www.mendosa.com/gi.htm - a complete discussion of the glycemic index.
http://www.mendosa.com/gilists.htm - for a long list of foods with their glycemic index. These last two sites are written for diabetics, but contain much useful information.
Glycemic Index Table
High Glycemic Foods
Syrups (e.g. maple, corn, cane); Honey; Bagel, white bread, jams, jellies; Potato; Most cereals; Raisins, banana, watermelon, pineapple; Carrots, cooked; White rice; Maltodextrin; Jelly beans, Skittles, pretzels, most candy bars
Moderate Glycemic Foods
Whole grain bread; Spaghetti; Corn; Oatmeal; Oranges, grapes
Low Glycemic Foods
Yogurt; Peanuts; Beans, peas; Apple, peach, pear; Milk and milk products.

This sports science article comes from the Sports Medicine Section at the Duke University Medical Center and UNC Hospitals. The authors are members of the US Soccer Sports Medicine Committee including from UNC Dr. William E. Garrett, Jr (US National Teams Physician and Committee Chairman), and John Lohnes. From Duke are Dr. Don Kirkendall (exercise physiologist) and Patty Marchak (athletic trainer for 1996 US Women's Olympic Team).

Common Sports Injury - Muscle Soreness

Muscle Soreness

Muscle soreness is a common sports injury. Caused by working too hard for too long, muscle soreness is not only painful; it can also cause restricted range of motion. Muscle aches can strike during the latter stages of exercise, immediately after exercise, or 12 to 48 hours after exercise. No matter when the aches hit, there are steps you can take to ease the pain. Better yet, there are ways to prevent muscle aches all together.

Remedies for muscle soreness:
1. Ice - Ice your muscles to reduce inflammation. A bag of ice wrapped in a towel or a bag of frozen peas makes a great cold compress. Apply the ice no more than 20 minutes per hour.
2. Acetaminophen - The pain reliever found in Tylenol works well on muscle aches. Ask your doctor about taking an over the counter medication or giving it to your child and follow the directions on the package carefully.
3. Fluids - Replenishing lost fluids is important, and electrolyte/carbohydrate drinks like Gatorade are good picks for the cooler. When digested, the carbohydrates found in these drinks are converted into glycogen, which acts as a fuel for muscles.
4. Vitamin C - Eating an orange after a game or practice may reduce day after pain. When your muscles are overused during exercise, they produce agents (free radicals) that can damage tissue. Antioxidants like vitamin C may absorb these agents before they cause any problems.
5. Massage - Massaging aching muscles promotes circulation and increases production of serotonin, a compound produced in the brain that has a pain-killing effect. Never massage joints! That can cause further damage.
6. Warm bath - For temporary relief, a warm bath will have a soothing effect as it relaxes the muscles and promotes circulation.

To avoid muscle aches and pains all together, be sure to know your limits - don't overdo it! Focus on proper conditioning. And always stretch before physical exertion. Don't stretch too far or too quickly - and never bounce or stretch to the point of pain. Improper stretching can cause injuries; be sure to only stretch to the point of a comfortable pull and hold stretches for about 20 seconds, repeating the stretch about five times.