1. Youth Soccer Anthony Beutler, MD Major, USAF, MC Chief, Injury Prevention Research Laboratory Uniformed Services University, Bethesda MD *

2. Youth Soccer Anthony Beutler, MD Major, USAF, MC Chief, Injury Prevention Research Laboratory Uniformed Services University, Bethesda MD

3. Youth Soccer Anthony Beutler, MD Major, USAF, MC Department of Family Medicine, USU

4. Overview The Spectrum of Soccer Injuries Are Soccer Injuries a Problem? What We “Know” About Injury Prevention What’s Next in Injury Prevention Encourage You to Stay-Tuned & Stay Involved

5. Your Chance to be Sports Doc

6. How About This One?

7. Overview The Spectrum of Soccer Injuries Are Soccer Injuries a Problem? What We “Know” About Injury Prevention What’s Next in Injury Prevention

8. Fast Facts About: Youth Sports Injuries Account for 42% of medically attended injuries in children More than transportation-related accidents 3.7 million ER visits 7 million doctor visits 20% of children miss at least 1 school day per year due to sports related injury

9. Greatest risk in High School and College Higher % risk in girls Higher # of injuries in boys Common & Severe: ACL (Anterior Cruciate Ligament) Tear

10. Surgery 6 to 36 month rehabilitation 77% sports disability within 5 years 44% disability with daily living in 5 years Bad News Gets Worse: Long-term Effects of ACL Tear

11. Surgery 6 to 36 month rehabilitation 77% sports disability within 5 years 44% disability with daily living in 5 years Bad News Gets Worse: Long-term Effects of ACL Tear Arthritis Risk: No Surgery: >90% in 20 years “Good” Surgery: >90% in 20 years

12. Overview The Spectrum of Soccer Injuries Are Soccer Injuries a Problem? What We “Know” About Injury Prevention What’s Next in Injury Prevention

13. Rules? Braces? Fields/Cleats? Changing You! Looking at the Man in the Mirror: What to Change?

14. Human Movement Change: What we “Know” about Injury Prevention Mandelbaum - 2005 80% decrease in ACL Injury 14-18 yo female soccer players 30 minute exercise program before pract/game Non-randomized

15. Human Movement Change: What we “Know” about Injury Prevention Mandelbaum - 2005 80% decrease in ACL Injury Myklebust - 2003 Decreased ACL injury in “elite” handball athletes

16. Human Movement Change: What we “Know” about Injury Prevention Mandelbaum - 2005 80% decrease in ACL Injury Myklebust - 2003 Decreased ACL injury in “elite” handball athletes Olsen - 2005 50% decrease leg injuries (?ACL) 14-18 yo male & female handball players 20 minute program before practice & game

17. Human Movement Change: What we “Know” about Injury Prevention Mandelbaum - 2005 80% decrease in ACL Injury Myklebust - 2003 Decreased ACL injury in “elite” handball athletes Olsen - 2005 50% decrease leg injuries (?ACL) 14-18 yo male & female handball players 20 minute program before practice & game Pfieffer - 2006 No Change in Injury Female High School Soccer, Basketball, and Volleyball Athletes

18. Landing/moving “stiff” Decreased trunk, hip, and knee flexion Large ground reaction forces Excessive frontal plane motion Knee valgus Tibial rotation Multifactorial Human Movement Change: Risk Factors for ACL Injury

19. Overview The Spectrum of Soccer Injuries Are Soccer Injuries a Problem? What We “Know” About Injury Prevention What’s Next in Injury Prevention

20. Future of Injury Prevention: What’s Going on Now? 20 Teams from North Carolina - TUSA Triangle United Soccer, Chapel Hill 20 Teams from Maryland - MSI & NCSL

21. Movement Assessment Jump Landing Two Legged Squats One Legged Squats Preseason

22. Exercise “Warm-Up” Program Tailored Program Generalized Program Placebo (Mouthguard) Program In-season Injury Monitoring

23. Post-Season Assessment Improvement overall score Improvement individual deficits Not just injury prevention - but injury screening Postseason

24. Pre-Season Future of Injury Prevention: Why Injury Screening? Post-Season

25. Post-Season scores are better than Pre- Season scores Gains mostly retained between Spring & Fall seasons Future of Injury Prevention: What Have We Learned?

26. Post-Season scores are better than Pre- Season scores Gains mostly retained between Spring & Fall seasons What Would We Still Like to Know? Does tailored program prevent more injuries? What biomechanics are associated with fewer ACL injuries? How often, how long, how long between?

27. Can We Prevent All Injuries?

28. Overview The Spectrum of Soccer Injuries Are Soccer Injuries a Problem? What We “Know” About Injury Prevention What’s Next in Injury Prevention Encourage You to Stay-Tuned & Stay Involved

29. Questions? Youth Soccer Injury Prevention Anthony Beutler, MD abeutler@usuhs.mil Chief, Injury Prevention Research Lab Uniformed Services University In collaboration with: Darin Padua, Ph.D, ATC Associate Director Sports Medicine Research Laboratory Steve Marshall, Ph.D Associate Professor Injury Prevention Research Center Lindsay DiStefano, MA, ATC Doctoral Student Sports Medicine Research Laboratory Michelle Boling, MS, ATC Doctoral Student Sports Medicine Research Laboratory University of North Carolina, Chapel Hill