WHY ARE STRESS INJURIES SO COMMON IN THE SOCCER PLAYER?*

Abstract

In recent years, the continued explosion of soccer as the most common sport has burgeoned to 200,000,000 players worldwide and 18.2 million in the USA alone. There has been the explosion of popularity with respect to the female soccer player. The history of women in soccer starts in 1921 when the European Football Association banned participation of soccer by women. In 1971, this ban was lifted, furthering participation of female athletes. In 1972, Title IX was enacted within the NCAA to attempt to equalize the number of men's and women's athletic teams in the collegiate United States environment. Subsequently, this had a dramatic effect in creating female soccer programs. In 1986, there were only 230 programs in the NCAA. By 1997, there were 696. Today, in the United States, 43% of soccer players are female. This figure is 22% worldwide. The evolution in the United States has continued to be rapid with significant developments and participants by the youth the female populations. Stress fractures still remain one of the more common problems in soccer in the 1990s. Stress fractures in amateur and professional athletes are becoming a very common entity worldwide. For example, 9 of the 24 members on the 1994 US National World Cup Soccer team were diagnosed with stress fractures. In the United States today, there is an increasing number of persons participating in sporting activities. Those competing and training including elite, recreational, youth, and female athletes. It is important to consider each of these groups separately as each has special potential problems that must be addressed. If not properly diagnosed early, these injuries can cause significant loss of time from participation or even early retirement. With greater numbers of females participating and engaging in longer hours and higher intensity, the medical professional must understand the proper diagnosis, treatment, and prevention of these injuries. Why are soccer injuries so common? Theories include the field being too hard; possible dysfunctional shoe design; training progressions or duration, intensity and frequency may be too intense; fitness levels; or, abnormalities in nutrition and endocrine variables. This article focuses on the causes and specificities of stress injuries in the soccer player including physiological, physical adaptations, medical, and orthopaedic management issues. Aristotle (384–322 BC) correctly characterized “Olympic Victors” by stating they are “those who do not squander their powers by early and overtraining.” Stress fractures have received various names when diagnosed in the tibia, including exertional posterior compartment syndrome, fatigue fractures, shin splints, anterior tibial periostitis, and medial tibial stress syndrome. What then is a stress fracture? Pentecost 27 describes an “insufficiency” fracture as that produced by normal or physiological stress applied to bone with deficient elastic resistance. In contrast, a “fatigue” (stress) fracture occurs when abnormal stress is applied to a bone with normal elastic resistance. This article serves as an overview to the general concepts on stress fractures, including history, epidemiology, and cause. The proper diagnosis, confirmatory studies, and treatment regimens are presented. Finally, the timing of the athlete's return to sports and stress fracture prevention are reviewed.