Injury Management

The following information is for coaches in dealing with minor injuries only. Injuries that are more severe, with significant loss of mobility and function or resulting in moderate to severe pain should always be seen by their family physician. Coaches can utilize first aid techniques and initial protection and management, but additional care may be required by an MD. Minor injuries that do not respond to rest, ice and other simple measures require evaluation by an MD.

While soccer is a sport with few serious injuries, there is hardly a game or practice without some minor injuries. In many cases, with some quick attention, a player may return to the game without a problem. There are, however, moderate injuries that will require treatment at the field, and result in a player missing game or practice time. This section will deal mostly with sprains, strains and contusions. Skin injuries like cuts and abrasions will be dealt with in the section on blood and body fluids. This posting will present some ideas on how to manage those minor and moderate injuries. The information here is not meant to replace actual medical treatment, it is more in the nature of first aid management at the field.

First Aid Kit: All coaches should carry a first aid kit to practices and games. For an idea of what to include in a first aid kit go to the National Center For Sports Safety website. Another essential item for coaches to carry is ICE with plastic bags and a wrap to secure it. As a coach myself, I know how much a coach must bring to games…..a bag of soccer balls, equipment bag, personal gear, chair, the list goes on. So my suggestion is have the assistant coach or a designated parent always bring a small cooler of ice to games. Some tournaments may provide athletic trainers and ice is available, but most regular games and all practices, none of that is available.

PRICE: As a coach and a physical therapist, I have usually followed the acronym PRICE when dealing with new acute injuries. P=Protection; R=Rest; I=Ice; C=Compression; E=Elevation. Depending on the body part and type of injury, not all of these will apply in every case, but it is a good way to start. Let’s break it down one step at a time. See US Youth Soccer Guidelines.

Protection: The idea here is to protect the injured part. If it is a sprain (wrist, ankle, knee, etc) some form of protection is necessary to prevent additional injury. Protection can be accomplished in various ways depending on the body part to be protected. A supportive wrap for an ankle or wrist, crutches for an unknown leg injury, splint for a suspected fracture of the wrist, a sling for an arm, or simply a clean gauze dressing to cover a cut or abrasion. It all qualifies as “protection”. The goal here is to prevent additional injury.

Rest: In many cases, injuries will require “rest” that is being removed from activity while the injury heals, or receives additional assessment. For example if an ankle is sprained in a game, and the player is unable to run, jump and perform skills required for the game, then a period of “rest” is required as part of the healing and recovery process. A concussion would require “rest” per medical direction. Rest qualifies as time away from activity to permit recovery.

Ice: Ice is the body’s friend when dealing with soft tissue injuries like sprains, strains and contusions. When the body sustains an injury to the soft tissue, capillaries are damaged, tissues are stretched or torn, and the the body releases fluids (blood, tissue fluid) into the injured area as the initial response. In many cases the body overreacts and significant swelling and bleeding occur. Excessive swelling can actually delay the recovery and slow the healing process. The goal here is to minimize the swelling, and reduce the pain that follows injury. Cooling of the tissues slows the body’s reaction to the injury. Normally Ice is applied to the area with a thin layer of protection to prevent skin from freezing, for a time period of 10-20 minutes every 2 hours or so. It can be secured with elastic wraps or rolls of thin cellophane wrap. The are many forms of ice or cold applications. I always believed that crushed ice is best, as it conforms well to the body part, is easy to apply. Frozen “blue gel” packs from the freezer at home are very cold, and hold sub zero temperatures longer, creating a greater risk for freezing the skin. Be aware also that Ice directly from your freezer is much colder than ice from your cooler at the field. Some guidelines to follow when applying ice:

1. Time of application can range from 10-15 minutes for thin tissues (ankles), to 20-25 minutes for thicker tissues (quadriceps, hams). Can be applied every 2 hours.
2. Use a thin layer of protection between the ice and the skin. Do not overprotect the skin with a thick dry towel, as this insulates the cold too much from the area and no benefit is achieved. A thin damp towel is best.
3. Inspect the skin before and after icing.
4. Extra protection may be used of bony prominences….areas where bones are just under the skin.
5. Special caution should be taken with chemical cold packs from the freezer.
6. Ice can be effective for several days after the initial injury, not just the old “24 hrs” that we used to believe.
7. Know your player’s sensitivity to ice or cold, as some may be overly sensitive.
8. Make a note of the time of ice application to be sure you do not exceed recommended duration.

My favorite reference for using ICE (Cryotherapy) is “Cryotherapy in Sport Injury Management” by Kenneth L. Knight.

Compression: Another way to reduce swelling is to apply some form of compression to the injured part. This applies primarily to sprains and strains of the extremities. Remember, reducing swelling means a quicker return to activity. Elastic wraps are normally the most effective way to achieve this compression. The sooner the compression is applied, the more effective it will be. I have seen ankle sprains literally swell up as I watched them. Caution needs to be given to avoid excessive compression which might compromise normal blood flow.

Elevation: This goes hand in hand with compression, and also applies to the extremities. When a newly sprained ankle is left in a dependent (hanging down) position, the pressure in the circulation is greater and fluids leak out into the tissues quickly. Elevation, reduces this outward flow of fluids, and permits fluids to drain back into the primary circulation of the leg and into the body core.

Use All Your Tools: It should be noted that using just one strategy will not accomplish the desired results. For example, just elevating a sprained ankle will have minimal effectiveness. Whereas, if the ankle is iced, compressed and elevated, the combined effect will but much more significant and beneficial.