Coach-run soccer rehab curbs re-injury rates

NEW YORK (Reuters Health) - A rehabilitation program controlled by team coaches can help prevent injured amateur soccer players from being hurt again, Swedish researchers report.

The program cut the likelihood that injured players would experience a re-injury during the same season by 66 percent, Dr. Martin Hagglund and colleagues at Linkoping University found.

Athletes who have been injured are at particularly high risk of re-injury, with a 15 percent to 30 percent re-injury rate among elite soccer players and a 33 percent rate for amateurs, the researchers note in the American Journal of Sports Medicine.

However, they point out, amateur athletes get "very poor or even nonexistent" medical support. For this reason, the researchers developed a simple, inexpensive rehabilitation program that amateur coaches could implement with little medical supervision.

The program included a 10-step rehab plan that athletes began once they were able to walk without pain or limping, as well as criteria for when athletes could return to the field. In order to return to competitive play, athletes had to be able to participate fully in team training without experiencing swelling or pain at their injury site; the number of training sessions required depended on how severely they had been injured.

To investigate the program's effectiveness, the researchers randomly assigned 24 amateur soccer teams to the rehab strategy or a comparison "control" group. Ten teams including 241 players completed the study.

Ninety players were injured in the intervention group, 14 percent of whom were re-injured during the season; among 79 injured athletes in the control group, 29 percent experienced re-injuries.

The Overall risk for re-injury was 66 percent lower in the intervention group, while the risk of lower extremity re-injury was reduced by 75 percent, the researchers calculate.

Just three re-injuries occurred during the first week of play in the intervention group, compared to 21 re-injuries in the control group. "Avoiding early recurrences due to premature return to play probably was an important component of the intervention," Hagglund and colleagues write.

"Since medical availability at amateur level soccer is low, our rehabilitation program was designed to assist team coaches to assess progress through functional rehabilitation and to help guide return to play decisions," they add. "Based on these findings, we recommend its use in grassroots and lower levels of soccer."

SOURCE: The American Journal of Sports Medicine, September 2007.