Carl Shearer was a player with the Vancouver Whitecaps of the NASL. I had the privilege of coaching him. After the NASL folded Carl used his considerable intelligence and determination to graduate as a physician – Dr. Carl Shearer. Carl has put his knowledge from on the soccer field and off it to become one of the leading experts in the world regarding soccer-related injuries. Dr. Carl commented in one of our earlier articles about the controversial topic of heading and injuries associated with that exciting skill (Click here for the link). In our World of Soccer newsletters Marc Rizzardo, another internationally-recognized injury expert, has been doing a series of articles about injuries. Marc and Carl know each other well and have worked together with the Canadian National Team program. Just recently Marc covered the importance of the proper warm up exercises. I was quite surprised when he said that ideally Warm-Ups should last at least 20 minutes. Now Dr. Carl reveals some really cutting-edge information out of Sweden about warming up and avoiding injuries.

Injuries in youth soccer
We can we decrease the carnage – getting the word out
by Carl Shearer

There can be no doubt that competitive team sports bring many benefits to its participants. However, injury risks are very real. There is not much doubt that there is an epidemic of youth sport injuries. In my professional life I see on a first hand basis the carnage that organized sports can bring. I have seen players whose careers are ended due to injury; I have seen teams that have been decimated by severe injury. I have seen many players who are looking at a bleak musculoskeletal future as a result of injury. I currently coach my 11 year old daughter’s soccer team and, while I love the fact that these young girls are enjoying the beauty of the game that their predecessors (from my era) were, discriminately, unable to partake in, I do fear that they may be walking through the door of injury and future disability.

Wouldn’t it be fabulous if we could prevent some of these injuries?

Over the years much lip service has been paid to the topic of injury prevention in sports. However, until fairly recently we have lacked a credible injury prevention program – as a result most injury prevention is perhaps better assigned to the realm of mythology. The work of the Oslo Sport Trauma Research Center is changing this. The Norwegians, in combination with FIFA (the international governing body for soccer) have developed an injury prevention warm-up for adolescent female soccer players that has been proven in a very high level study (published in the British Medical Journal in December 2008) to really work. In fact the results have been quite astounding. This injury prevention program is a structured warm-up called the 11+. This program has been shown in 15- and 16-year old female soccer players to significantly decrease overall injuries, acute injuries, severe injuries, and even overuse injuries. It also decreased knee injuries although this decrease in knee injuries was, just barely, not statistically significant (a complicated concept to explain in such a short article).

Suffice to say it was still an important finding. The bottom line was that this structured warm up was proven (with the highest scientific standards) to dramatically decrease injuries. The evidence is overwhelming that this warm-up program should be and probably, will become the standard required for coaching adolescent female soccer players. It does represent the best evidence we have for preventing the carnage. While this program has only been proven to work in adolescent females (males were not studied), I believe that it should, at least for now, be extrapolated to other age groups, males and other similar sports. For example, rugby, football, and basketball would probably be wise to consider the introduction of this structured warm up into their training sessions. This is a very exciting development in sports medicine. However, it is not free of problems.

For example:

• This warm up represents a paradigm shift in soccer warm-ups: This takes us away from warming up with the ball to running, strength and balance training exercises.
• The program takes 20 minutes to perform. This is a relatively large amount of time, particularly when you only have a one hour practice time allotted – as is the case at my Maple Ridge soccer club.
• I do believe that this time problem can be overcome by creatively using space and by changing the practice schedules. It does, however, represent a bureaucratic challenge for the soccer clubs. Although future research may allow us to reduce the time required in the warm-up, at present it is probably unwise to cut back on the program for sake of time. It must be remembered that it is the entire warm-up that has been proven to work, not part of it.
• The program requires a reasonably large effort on the part of the coach. Understanding the drills and teaching proper technique is thought to be critical to the program’s success. The players also have to focus on what they are doing or the program will not yield maximal benefits.

The program can be downloaded (free) from FIFA’s website at: Click here The FIFA website has descriptions of the drills and videos that demonstrate the proper technique. If you are coaching an adolescent youth soccer team you should seriously consider implementing this program. If you have a child on a youth soccer team, you should consider asking the coach about implementing this program. It may mean a lot for the athletic future and, more importantly, the future musculoskeletal health of your child.

Carl Shearer MD.  Dr. Shearer is a former professional soccer player with the Vancouver Whitecaps; he is a consulting sport medicine physician, team physician with the Canadian Soccer Association, and head of the Section of Sport and Exercise Medicine for the BCMA. He has no vested interest in this program other than hoping to see less kids and teams devastated by injury.