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Bill Klaproth (Host): Soccer is one of the most popular sports in the world for kids and adults alike, but because of the nature of the game, soccer players must be aware of the risks for injury. And here to talk with us about injury prevention and the science involved in modern soccer, is Dr. Mathew Pombo, Director of The Emory Soccer Medicine Program. 

Dr. Pombo thanks for your time. So, what are the most common soccer injuries the Emory team treats?

Matthew Pombo, MD (Guest):  We see a lot of soccer injuries coming through the clinic and one of the unique things we decided to do is create a program to help manage these. 

The most common things we see, I mean are by far ankle sprains, overuse injuries in today’s youth soccer world; these kids are training more than they ever had, so we are really seeing a lot of hamstring strains, a lot of hip flexor strains. We will see some growth plate issues from growth plates such as traction overuse injuries of the heel as well as up on the iliac crest of the pelvis, low back pain also is an overuse common injury in soccer. So, it’s a lot of overuse things. The devastating injuries such as ACL tears and things are out there and that’s what we hear more about. But really the most common injuries that we see with soccer are ankle sprains and overuse injuries from just over training. 

Bill:  So, when it comes to those overuse injuries, and low back pain and hip flexor strains and ankle sprains; how does your team come together to treat soccer players at all levels, ages and abilities?

Dr. Pombo:  We have athletic trainers, we have physical therapists, we have primary care sports physicians, we have got a team of surgeons. We also have a few PhDs on the program to help lead our research endeavors and so, it’s really a multidisciplinary approach where we not only are identifying athletes that are injured on the field with athletic trainers; we are now getting them through a streamlined team to the appropriate physician. If they need surgery; to the surgeon. We have physical therapists that are involved in rehab and then in terms of return to play; which is one of the big things we have identified in soccer. 

The number one time a kid or a soccer player is at risk to get injured is when they are coming back from a prior injury. So, we are really working with athletic trainers on how to build up their soccer volume and get them back on the field safely. So, it’s really comprehensive care from really start to finish when you are talking about a youth athlete or a youth soccer player in particular. 

Bill:  Well I think it’s really important to note that the Emory Soccer Medicine Program is the only multidisciplinary program for treatment and services in the state. So, when it comes to that treatment, can you tell us about the latest cutting-edge techniques that you use at Emory to treat your patients?

Dr. Pombo:  Yeah, I think it really goes into the before and after and when I say the before and after, I think when a kid is injured, most of the time we call the doctor and we go see the doctor. Well, where we are unique is we really want to work before the injury. We want to work on educating parents and we want to continue to educate coaches and basically all these youth soccer academies that the way to keep a kid out of the office is really with the work that you do beforehand. A lot of load tracking, how much practice these kids are doing, how sore are they, what age they are. We are really starting to learn about that the easiest way to keep a kid out of the office is to do injury prevention and education beforehand. So, like I said, most of the injuries are overuse injuries and ankle sprains. So, I think a lot of education in the community is one of the unique cutting-edge ways that we are doing things differently is rather than just treating them when they come to the office; we are trying to get out to them, so they don’t ever have to get here. 

Now, one of the other areas is the after which is once a kid is injured; as I mentioned earlier, they are at high risk for reinjury as they try to ramp back up their volume. And traditionally, we have always said heh you are cleared to go play and kids will go out and play. But we are learning with things like ankles sprains that they have an almost a 45% reinjury risk within the first three weeks of getting back to play. So, by tracking data and really learning about soccer players and when and how their injuries occur; we are really able to translate that data into how to get kids back playing safely once they have been injured. So, it’s really more of a before and after than it is during the injury we are talking about in terms of more unique ways to approach the soccer player. 

Bill:  So, that before and after, very important. Let’s stick with the before a little bit. I know at Emory comprehensive care of the soccer athlete begins at the preperformance level which includes a preparticipation physicals, performance enhancement, injury prevention, you were mentioning educational programs, research. Can you tell us a little bit more about that preperformance level care?

Dr. Pombo:  Yeah, so, soccer is one of those sports that preseason we can certainly do some things and a lot of that is more of how to build up volume, making sure the kids are in shape. One of the highest risks of injury particularly in an ACL in soccer, is fatigue. So, kids that have time away, kids that have been offseason, kids that are coming back into season; we really want to make sure that the soccer community understands that those are high risk times and so, preperformance level testing such as baselining an athlete on how they move, how they jump, there’s beep tests, there’s yo-yo tests, there’s lots of things that we use with US soccer and at the International level that we are trying to educate coaches that we can begin to baseline performance and movements so that we know when these kids are out of shape and when they are not. A lot of times we’ll track heartrates, we’ll track accelerations and distances travelled in practice through GPS monitoring. It’s harder to do that at the youth level; but that’s kind of what we do in US soccer and at the professional rank that we consult with. So, we are trying to bring some of that information down to the youth athletes so that it is a little bit more what I would call objective meaning there is science behind it. Instead of just letting coaches go do their thing and make kids run hills and make people – make these young athletes do certain things that we traditionally have done in soccer. There is a lot of science behind the soccer player and the challenge has been bringing it from the clouds which is the professional world down to the youth world which is really where it’s needed. So preperformance levels of training and performance are – it’s kind of this abstract way of thought but we are trying to put science behind it. 

Bill:  And Dr. Pombo let’s stay with science right now. Earlier, you were mentioning return to play. Can you tell us about the science and research you are doing to find the most effective ways to get soccer athletes back on the field, better, faster, safer and stronger after an injury?

Dr. Pombo:  Yeah, so one of the keys to science is data and so one of the unique things that we have which is a – here at Emory in our soccer program is a injury tracking research project that basically – if you are a parent out there with a youth soccer player, we are trying to encourage all of them to enroll into our injury tracking program and what that is, is it’s a research study where once to twice a year parents will get an email from Emory that just asks has your young soccer player been injured and if it’s no, then you are done. If it’s yes, we will kind of branch off into trying to locate what injury it was and how severe so that we can track youth soccer in the Atlanta, actually in Georgia actually. We want to know what our athletes are seeing here especially as more soccer clubs are building turf fields and going from grass to turf and our training loads change as they get older. We are introducing more and more soccer days into the younger kid and we don’t really understand what that’s going to do from an injury perspective. So, if parents out there want to go to Emory Sports Medicine and you will find the link for soccer medicine. There’s a link on the website to enroll into the injury surveillance study. It’s a pretty unique study that has kind of garnered a little bit of prestige across the country and other programs that are trying to model similar youth injury tracking studies. 

So, that’s one of our mainstays. We are also doing some smaller studies in terms of hip range of motion and risk of hip injuries. We have some suspicions that the hip and the pelvis can be very important, which we have known in soccer players, but how range of motion and data translate to things that maybe we can identify to reduce risk if we can target certain deficits. 

We have a bunch of ACL studies going on in terms of the quadriceps tendon which has been a big part of the ACL here at Emory. This has been an institution that has really brought a lot of data over the last ten years on the quadriceps tendon as the very reliable and valid ACL reconstruction graft. I have been using it a lot in soccer and it has really become the ACL graft of choice for me. So, I think there’s a lot of ways that Emory Soccer Medicine and Sports Medicine in general, are contributing to high level athletes across the world. We are also kind of a leader in education of other physicians as well. So, that’s some of the science and research that we have going on and I think it’s important that as the academic center, we are the only academic center here in Atlanta so it leads us to bring a little bit more credibility to what we do with the ability to track and research everything that we do here at Emory Soccer Medicine. 

Bill:  Well, it’s fascinating how you are using this data for science and research and Dr. Pombo, thank you so much for your time today. For more information on the Emory Soccer Medicine Program please visit emoryhealthcare.org/soccer, that’s emoryhealthcare.org/soccer. You’re listening to Advancing Your Health with Emory Healthcare