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Shoe and Field Surface Risk Factors for Acute Lower Extremity Injuries Among Female Youth Soccer Players

O'Kane, John W. MD; Gray, Kristen E. MPH; Levy, Marni R. BS; Neradilek, Moni MS; Tencer, Allan F. PhD; Polissar, Nayak L. PhD; Schiff, Melissa A. MD, MPH

Clinical Journal of Sport Medicine: May 2016 - Volume 26 - Issue 3 - p 245–250
doi: 10.1097/JSM.0000000000000236
Original Research

Objective: To describe acute lower extremity injuries and evaluate extrinsic risk factors in female youth soccer.

Design: Nested case–control study.

Setting: Youth soccer clubs in Seattle, WA.

Participants: Female soccer players (n = 351) ages 11 to 15 years randomly selected from 4 soccer clubs from which 83% of their players were enrolled with complete follow-up for 92% of players.

Interventions: Injured players were interviewed regarding injury, field surface, shoe type, and position. Uninjured controls, matched on game or practice session, were also interviewed.

Main Outcome Measures: The association between risk factors and acute lower extremity injury using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI).

Results: One hundred seventy-three acute lower extremity injuries occurred involving primarily the ankle (39.3%), knee (24.9%), and thigh (11.0%). Over half (52.9%) recovered within 1 week, whereas 30.2% lasted beyond 2 weeks. During practices, those injured were approximately 3-fold (OR, 2.83; 95% CI, 1.49-5.31) more likely to play on grass than artificial turf and 2.4-fold (95% CI, 1.03-5.96) more likely to wear cleats on grass than other shoe and surface combinations. During games, injured players were 89% (95% CI, 1.03-4.17) more likely to play defender compared with forward.

Conclusions: Half of the acute lower extremity injuries affected the ankle or knee. Grass surface and wearing cleats on grass increased training injuries.

Clinical Relevance: The majority, 64%, of female youth soccer players' acute injuries involve the ankle and knee and injury prevention strategies in this age group should target these areas. When considering playing surfaces for training, communities and soccer organizations should consider the third-generation artificial turf a safe alternative to grass.

Departments of *Family Medicine; and

Orthopedics and Sports Medicine, University of Washington School of Medicine, Seattle Washington;

Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington;

§Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and

The Mountain-Whisper-Light Statistics, Seattle, Washington.

Corresponding Author: John W. O'Kane, MD, University of Washington, Box 354060, Seattle, WA 98195-4060 (

The authors report no conflicts of interest.

Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R01AR051059.

M. A. Schiff had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Received May 12, 2014

Accepted February 22, 2015

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.