Author name: Elevate PT & Fitness

Soft tissue injuries occur quite commonly in the sport of soccer. In particular, muscle injury is a common injury that can be encountered by a soccer player and lead to significant playing time loss. Muscle groups that most frequently get injured include adductors (groin), hamstrings, quadriceps, and calves. However, injury recurrence rates are highest for adductors and hamstrings. Adductor (groin) injuries prove to be the most cumbersome and “nagging” because of how often they can occur and the subsequent risk for chronicity and recurrence. Research has already shown that a history of groin injury is a risk factor for future groin injury, but in a recent research article, researchers pose the question of whether or not a previous injury to a different location plays a role in increasing risk for groin injury. In contrast to what most might believe, available hip range of motion (or lack thereof) is not a predictive factor for risk of groin injury. Instead, researchers show that a history of severe injuries in locations other than the groin increase future risk of groin injury. These “severe injuries” locations can include ankle, knee, thigh, and shoulder. You may be asking how a shoulder injury can lead to increased risk of groin injury. Fair question. It has been suggested that with an injury in one location, athletes accommodate and compensate for any deficits in their movement patterns, thus increasing stress and demand in areas other than the injured structure(s). Especially with any lower extremity injury, it would be reasonable to suggest that running pattern would be altered, potentially leading to groin injury. Especially in soccer, with the amount of cutting and change of direction, the adductor longus specifically is in high demand. Without adequate eccentric strength of this particular muscle, the risk for injury increases.   This recent research shows that soccer players with a history of more than 1 groin injury in a past season presented with severe pre-season groin symptoms in the following season. This may indicate that the previous groin injury was not fully rehabilitated. For future management of groin injuries, an emphasis on complete treatment of and recurrence prevention is essential. While there are risk factors associated with groin injury, the good news is that these risk factors are modifiable, meaning you can significantly decrease your risk for groin injury. There is current research showing that inadequate adductor strength is a modifiable risk factor for groin injury, thus suggesting that a strengthening program to specifically target adductors is appropriate and warranted. Off-season participation in the proposed adductor strengthening program a few times a week can result in significant reduction in risk of groin-related issues. The program includes 3 levels of difficulty, with exercises starting at low frequency and repetition, and gradually progressing to greater frequency and repetition. Check out the image below, which highlights the research key points and outlines the adductor strengthening program:      

Ankle sprains are one of the most common injuries that young athletes sustain while participating in sports. More specifically, in the sport of soccer, ankle sprains constitute approximately 80% of all injuries, lateral ankle sprains (inversion mechanism) being the most prevalent.1,2 Due to the high demand of running, cutting, and jumping, soccer is among the few sports with the highest percentages of ankle sprains.3 Research shows that females sustain more lateral ankle sprains compared to their counterparts.4 The peak incidence of ankle sprains occurs within the 2nd and 3rd decade of life, leaving older athletes more prone to ankle injury compared to the adolescent population. 4 Furthermore, lateral ankle sprains incur the greatest health care cost compared to medial and high ankle sprains, suggesting the need for preventative care. 4 In a study by Powers et al, hip weakness in competitive male soccer players was shown to result in poor balance and compensatory movement patterns in the ankle, leading to an increased propensity for noncontact lateral ankle sprains.5 In this research study, competitive male soccer players between the ages of 14-34 were tracked over 1 soccer season. Each participant’s hip abductor strength was assessed prior to the start of the season. At the end of the season, 25 noncontact lateral ankle sprains were reported. Based on baseline hip abductor strength, those who sustained a lateral ankle sprain had weaker hip abduction. It was suggested that decreased hip abductor strength can lead to decreased postural control and increased compensations at the ankle, which can lead to ankle sprains. Furthermore, additional research by De Ridder et al shows reduced hip extension muscle strength is an independent risk factor for lateral ankle sprains in male youth soccer players.6   Why Is This Important Information? The mere prevalence of ankle sprains among U.S. youth sports strongly suggest the need to have preventative care measures. Lateral ankle sprains incur the greatest health care cost compared to medial and high ankle sprains, further emphasizing the need to find avenues of injury prevention.4 Research is suggesting a strong correlation between hip weakness and ankle injury in soccer players. This becomes a potential solution to decreasing or preventing ankle sprains. If athletes are able to optimize hip strength, perhaps susceptibility to an ankle sprain will decrease. This correlation can be applied beyond soccer athletes; other field sports and recreational activities that may involve a significant amount and repetition of running, cutting, and jumping can potentially benefit from heeding the research data for preventative care. References: 1) Giza E, Fuller C, Junge A, et al. Mechanisms of foot and ankle injuries in soccer. Am J Sports Med 2003;31:550–4 2) Nery C, Raduan F, Baumfeld D. Foot and ankle injuries in professional soccer players: diagnosis, treatment, and expectations. Foot Ankle Clin N Am. 2016;21(2):391-403. DOI: 10.1016/j.fcl.2016.01.009 3) Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ Jr. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92(13):2279–2284 4) Shah S, Thomas AC, Noone JM, Blanchette CM, Wikstrom EA. Incidence and Cost of Ankle Sprains in United States Emergency Departments. Sports Health. 2016;8(6):547-552. doi:10.1177/1941738116659639 5) Powers, C.M., Ghoddosi, N., Straub, R.K., & Khayambashi, K. (2017). Hip Strength as a Predictor of Ankle Sprains in Male Soccer Players: A Prospective Study. Journal of athletic training, 52 11, 1048-1055. 6) De Ridder, R., Witvrouw, E.E., Dolphens, M., Roosen, P., & Ginckel, A.V. (2017). Hip Strength as an Intrinsic Risk Factor for Lateral Ankle Sprains in Youth Soccer Players: A 3-Season Prospective Study. The American journal of sports medicine, 45 2, 410-416.

BY PERRI KLASS, M.D, NY Times Everyone knows that getting a baby to sleep through the night can be a big challenge for parents. But sleep problems are common among preschool and school-age children, too. As we ask children to function in school, academically and socially, fatigue can affect their achievement and behavior. Australian research on sleep problems in children has included work aimed at the “school transition” year in which children adjust to a school schedule. In a study of 4,460 children, 22.6 percent had sleep problems, according to their parents, at that transition age of 6 to 7 years. “We were surprised, we thought it was all baby sleep” that was the problem, said Dr. Harriet Hiscock, a pediatrician who is a senior research fellow at the Murdoch Childrens Research Institute at the Royal Children’s Hospital in Melbourne who was one of the authors of the study. Those results led to a randomized controlled trial of a brief intervention for children in their first year of school. A group of 108 parents who felt their children had sleep problems was divided into two groups. One group got a consultation at school, with a program of strategies tailored to the child’s sleep issues, and a follow-up phone consultation; the other group got no special intervention and served as controls. Parents in the intervention group were counseled about a range of possible measures to improve sleep, from consistent bedtimes and bedtime routines to relaxation strategies for anxiety that might be contributing to insomnia. The children in the intervention group resolved their varying sleep problems more quickly, though sleep problems got better over time in both groups. The interventions also produced positive effects on the child’s psychosocial function and parents’ mental health. The most common sleep issues for children around the age of school entry, Dr. Hiscock said, definitely include limit-setting issues — that is, some of them need their parents to make the rules and routines clear. But there are also children with what sleep specialists call “sleep onset association disorder,” in which a child has become habituated to falling asleep only in a certain context, requiring the presence of a parent, or needing to have the TV on, to cite two common examples. Very anxious children are also often problem sleepers. And then there are children beset by nightmares, night terrors and early morning waking. Screen use is a major issue in childhood sleep, and more generally in childhood these days. The first recommendation is always to get the screens out of the bedroom, the same recommendation made for improving adolescent sleep, and for adults in the current best-selling book by Ariana Huffington. All of us, old and young, are vulnerable here, but it’s a good place for parents to draw the line for their children, even when they can’t quite manage it for themselves. Reut Gruber, a psychologist who is an associate professor in the department of psychiatry at McGill University, where she is director of the Attention Behavior and Sleep Lab, said that there is a close association between sleep and a wide range of cognitive functions, including attention, executive function and memory. When children go to school, “they need to pay attention and plan and follow instructions, all of which fall under executive function, which is very much affected by sleep,” she said. Many parts of the brain work less well when children are tired. “The prefrontal cortex is very sensitive to sleep deprivation, and it is key to the brain mechanisms which underlie executive function and some of the attentional processes,” she said. “The amygdala is affected by sleep deprivation and is essential for emotional processes.” These different but connected brain pathways led her to be interested in the way that sleep affects many different aspects of academic performance. In an experimental study of a small group of 7- to 11-year-olds who did not have sleep, behavior or academic problems, the children were asked to change their sleep patterns, so that they were sleeping an hour less per night, or an hour more. After five days with less sleep, she said, there was measurable deterioration in alertness and emotional regulation, and after five days with more sleep, there were gains in these areas. For the past several years, Dr. Gruber and her colleagues have worked with a school board in Montreal to develop a school-based sleep promotion program that was piloted in three elementary schools; results were published in May in the journal Sleep Medicine. The intervention involved a six-week sleep curriculum for the children, to teach them about healthy sleep habits, and materials designed to involve parents, teachers, and school principals, who were asked to consider the sleep ramifications of school schedules, extracurricular activities and homework demands. The children in the intervention group extended their sleep by an average of 18.2 minutes a night, and also reduced the length of time it took them to fall asleep by 2.3 minutes. These relatively modest changes correlated with improved report card grades in English and math; the control group children’s sleep duration did not change, and their grades did not improve. The goal of the intervention was to help families make sleep a priority. “How do you make changes in your priorities, find the way as a family, as a school, as an individual, to reshuffle things, no matter how much homework, no matter how many aunts and uncles coming for a visit, that bedtime will still be respected?” Dr. Gruber asked. “We all agree in principle, but how do we actually incorporate it into daily life?” The American Academy of Pediatrics recently endorsed the 2016 guidelines issued by the American Academy of Sleep Medicine, that 3- to 5-year-olds need 10 to 13 hours of sleep per day (including naps), while 6- to 12-year-olds need nine to 12 hours for optimal health and well-being. Dr. Gruber advised that a child should wake up naturally, without requiring energetic parental encouragement. If after nine or 10 hours of sleep, a child still seems very tired, parents might wonder about