Broken Bones and Bruises Rise as Youth Soccer Gets Aggressive

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It’s getting rough on the soccer field.

Mac Krause, an 11-year-old defender, recently took an elbow to the head in a championship game and crumpled to the ground. “It looked to be on purpose,” said his father, Michael Krause of Maplewood, N.J. The boy was carried off the field and out of commission for six weeks with a concussion.

Youth soccer participation has surged in the past 25 years, and so has the risk of getting hurt while playing it. A new study of children’s soccer injuries released Monday in the journal Pediatrics found soaring rates of concussions, broken bones, lacerations, torn tendons and ankle sprains since 1990.

Part of the rise can be explained by increased awareness of concussion risks and higher reporting of head injuries, a trend that is common in most youth sports. But the data show that injuries like fractures, lacerations and sprains are also on the rise. That suggests that as more kids play soccer year round and the game gets more competitive, a child’s risk for injury has also increased.

“They’re just playing a lot more than they ever did before and in some cases more intensely than they ever did before,” said Tracy Mehan, manager of translational research in the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, where the study was conducted. “All those things will contribute to the increase in injuries.”

For every 10,000 children who played soccer in 2014, 223 of them sustained an injury serious enough to be treated in a hospital emergency room. That represents a 74 percent increase from 2004, when the injury rate was 128.5 injuries per 10,000 kids. Clearly, some of that rise results from more parents taking children to hospitals to be checked for concussions. But when the researchers removed head injuries from the data, they found that injuries still increased by 60 percent, to 191 per 10,000 kids in 2014, up from 119 in 2004.

The data, from the National Electronic Injury Surveillance system and the National Sporting Goods Association, included children ages 7 to 17 who played soccer and had injuries that led to treatment at an emergency room between 1990 and 2014. The research is the first to evaluate soccer-related injury rates in such a wide age group over an extensive period of time.

The most common injuries sustained by players were strains and sprains, followed by broken bones and soft tissue injuries. The data includes only hospital emergency room visits and does not count visits to clinics, care centers and injuries treated at home, so the actual number of injuries is higher.

“Probably half of my patients are seen at an urgent care center first and the other half are seen at the emergency department before they see me,” said Dr. Daniel Green, a pediatric orthopedic surgeon at Hospital for Special Surgery in Manhattan, who said he has seen an increasing number of soccer-related injuries in children over the years, particularly anterior cruciate ligament (ACL) tears.

In 2014, more than three million players were registered in U.S. Youth Soccer — which is up nearly 90 percent from 1990 — and high school soccer participation has more than doubled in that time frame.

While there is no way to know exactly why soccer appears to be getting more dangerous, parents and coaches share anecdotal reports of children being encouraged to play more aggressively and less-experienced referees who are hesitant to call fouls and eject players from the game.

Brian Hafter, of San Bruno, Calif., who has been coaching and refereeing girls’ youth soccer leagues for eight years, said he has noticed a substantial difference in the way kids play soccer now compared with how he and his sister grew up playing it.

“There’s no question that nowadays the players are much more physical, challenging for the ball, and as a result, can put themselves and their opponents in situations that can lead to more serious injuries,” he said.

Dr. Daryl Osbahr, who is the chief medical officer of the Orlando City Soccer Club and a consultant for U.S. Soccer, confirmed that the sport is causing more injuries.

“We have younger athletes playing sports over the course of the year at a higher level, and those factors will result in increased injuries,” he said. He also noted that overuse injuries are common now because more children are specializing in one sport.

Mr. Krause, whose son took the elbow to the head, said some youth soccer teams have reputations for being more aggressive and more likely to jostle and foul, but even after complaining to officials, there’s little that can be done to curb the behavior. “When you get to a certain level of soccer, you start to see that,” he said. “I know one kid ending up breaking his leg in the tournament. It’s horrible.”

Dr. Green, the pediatric orthopedist, said his own study of injuries in New York State showed that in the past 20 years, there is a threefold increase in the rate of surgery for childhood sports injuries. One reason for the rise may be that soccer has become a more competitive sport and a path to college for talented athletes. As a result, more kids are playing on both school and club teams, as well as attending college soccer camps.

“They’re going to become more aggressive the more opportunities they have to train and play competitively,” Dr. Green said.

Liz Masterson, head women’s soccer coach at Rochester Institute of Technology in New York, has noticed the same evolution at the college level. “I definitely think the game has changed. As players are getting more competitive and they’re able to play with more force, there’s a greater risk for injury,” she said.

Athletes today may also be getting away with bending the rules, which can lead to dangerous plays, said Dawn Comstock, professor of epidemiology at the University of Colorado, Denver, has also found a rise in the rate of concussions among youth soccer players in her research.

“If you watch the World Cup game from 20 years ago versus the last World Cup, it does appear that the governing bodies of soccer have allowed the game to become more physical over time in a way that increases the risk of concussion,” she said.

“If the vast majority of athlete-to-athlete contact were restricted according to the rules of the game, we’d have less concussion as well as fewer other injuries.”