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November 23, 2010
Injury management: The return-to-play decision

One of the toughest decisions in youth soccer is determining when a player who has suffered an injury is ready to return to action. Dr. Dev K. Mishra, who has served as team doctor at the professional, national team, college and high school level, is the founder of SidelineSportsDoc.com. We asked Dr. Mishra for advice on making the return-to-play decision.

Interview by Mike Woitalla (from Soccer America's Youth Soccer Insider)

SOCCER AMERICA: What’s the most important thing to keep in mind when determining if a player is fit to return to action?
DR. DEV MISHRA:
The emphasis on the sideline has to always be directed toward athlete or child safety. The emphasis is always on erring on the side of caution.

SA: Because a premature return can lead to a more serious injury?
DR. MISHRA:
Yes. In my clinical practice over the last 15 years I see one or two kids each week with a significant injury that started out as some kind of minor injury. For whatever reason they kept playing and that minor injury turned into something more significant.

Sometimes it was because they were put back in the game too soon. Sometimes it was because they failed to report it to the coach.

If you think a kid’s not really ready, it’s better to sit them – maybe lose them for a few days – rather than to let them get back in before they’re ready and lose them for weeks or months.

SA: What’s the optimal approach to take in making a decision?
DR. MISHRA:
What I’d love to see is that the real decisions on return to play – if it’s a significant injury – is not in the hands of the coach, it has to be in the hands of a trainer or physician – someone who’s really trained and qualified to make that decision.

But there are settings where someone who is professionally qualified isn’t there to make a remove-from-play or return-to-play decision. In that case, it’s really going to come down to the coach. It has to be the coach who has the knowledge to be able to intervene.

SA: What if a young player insists she or he is ready to play?
DR. MISHRA:
This is where the decision becomes really tough. You really need to be their advocate -- to be their voice.

As the kids gets older, they’re going to have better reasoning abilities. They’re also going to have other motivations to stay in the game – and perhaps not tell you stuff. That’s when you really have to have some judgment and the decision can be very difficult.

SA: We hear about pros playing with injuries all the time …
DR. MISHRA:
That’s a totally different setting. Those are not minors. They can undergo treatment with informed consent. It’s completely different for a kid.

With kids, you have to make the tough decision for their own good. What if you’re at an away tournament? What if it’s your star player? What if you have to play a man-down? You still always want to err on the side of safety.

SA: Are there any rules of thumb, such as looking for a limp?
DR. MISHRA:
In soccer, we’re mostly talking about lower extremities – hip, knee, ankle, foot.

The safest thing to do is confirm that the kid is really pain free. If you’re deciding on return-to-play, it’s really a black-and-white approach.

If the kid is pain-free, no swelling, normal ability to jog, cut, sprint and jump with normal strength – they can return to play. That’s basically saying if a kid gets back to “normal” – they can play.

But there are subtleties that make it complicated, which is why it is always advised to consult a medical professional when there is any doubt.

(Dev K. Mishra, the founder of SidelineSportsDoc.com, is an orthopedic surgeon in private practice, Burlingame, Calif. He is a member of the team physician pool with the U.S. Soccer Federation and has served as team physician at the University of California, Berkeley.)


(Mike Woitalla, the executive editor of Soccer America, coaches youth soccer for Rockridge SC in Oakland, Calif. His youth soccer articles are archived at YouthSoccerFun.com.)

November 18, 2010
A season ends; reflections begin

Today is soccer practice day, but it isn't because the season ended last weekend.

So I'm not checking which balls need to be pumped up, if the first-aid kit is in order, or if the pinnies and goalkeeper gloves are back in the coach's bag. (Which reminds me, are you ever supposed to wash those pinnies?)

By Mike Woitalla (from Soccer America Magazine's Youth Soccer Insider)



Instead come the reflections of the last season. Did I coach well? What could or should I have done differently?

I never forgot the player cards, so that’s a plus.

The best memories are those moments when the youngsters showed signs that they’re mastering the ball and being creative – and the smiles and the laughs.

For sure, there are few things nicer than watching the kids score and celebrate goals. But a goal we didn’t score may last longer in my memory than shots that hit the net, because I still chuckle when I replay the incident my mind:

The opponent’s 11-year-old goalkeeper made a spectacular diving save. The rebound rolled invitingly toward our center forward. But she, instead of pouncing, was applauding the save as the keeper got to her feet and recovered it.

Another season of coaching and observing many other youth games did give me the impression that youth coaching is getting better year-by-year. One still hears far too much sideline shouting, including the very troublesome “Get rid of it!” and “Kick it out of bounds!” But more adults with soccer knowledge and an appreciation of children’s stages of development seem to be involved in the sport.

What I fear keeps getting worse is the invasive role of tournaments, because they are so profitable, on youth soccer.

League games are doubled up on weekends to make room for tournaments, which have teams playing three to four games in two days. Teams can end up with six to eight games over a 16-day period. Who believes this is healthy?

Three games in one weekend is already excessive, but four borders on the atrocious. Is the fourth game necessary so the trophies can be divvied out? If trophies are so important to someone, why not decide the winners with three-game round-robins? So what if there are two champions in the same age group.

Speaking of tournaments, one had a point system that awarded 6 points for a win, 3 for a tie, and shutouts earned 1 bonus point. In the case of a scoreless tie, each team got an extra point. Rewarding defensive, anemic soccer at the early ages is not what the sport needs.

If coaches of youngsters aren’t emphasizing attacking and scoring it’s no wonder the nation lacks players with a nose for the goal at the higher levels.

(In what I hope must be a rare example of misguided coaching is the U-6 coach whose policy is to sub out the scorer after each goal. Let’s hope that if we’ve got a potential Lionel Messi he’s not in that squad.)

A big thanks to the referees and their assistants, whose mistakes, when we really assess them, still generally even out between the two opponents.

In 14 games at the U-12 level, I counted four officiating errors that just maybe could have impacted the final result: three on offside calls, and a ball rolling past the goal line without the officials seeing that. (An especially tough call because the goal line paint had disintegrated during the day's earlier games).

So these refs’ error rate was comparable to the 2010 World Cup officials’.

I do have a pet peeve: Why are so many refs obsessed with calling foul throw-ins? If both feet are on the ground and the ball is tossed with both hands, from behind and over the head, it’s a fair throw. It doesn’t matter if the player twists his body, how the ball spins, or where it goes.

Still, next season I’ll make sure my players throw the ball in the robot-like fashion expected of the most finicky refs. And I’ll keep thinking about how to be better coach – how to help the players improve and how to inspire them to play with the ball when it’s not practice or game time.

The challenges of youth coaches are many. For me, one of the greatest is getting 11-year-old girls to stop chatting. Each practice or game seems like a reunion of dear friends who haven’t spoken in years. So eager are they to catch up that they struggle listening to even the most concise words from the coach.

Before one game, shortly before kickoff, I gathered the players, had them read my cap so they would focus on me, pleaded with them to stop chatting -- which they did! -- and proceeded to read off the lineup.

But one player kept raising her hand and trying to interrupt me. I said sternly I needed her to listen and to save her question for when I’m done.

Yet she blurted out, while pointing at my lineup sheet, “You’ve got me in there twice!” And there was her name, at forward and in midfield.

Sometimes it’s a good thing when players don’t obey their coaches.



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