Injury Prevention and Rehabilitation in Youth Football

What trends have you observed in terms of the number of injuries among youth football players, and at what age do injuries typically start to occur more frequently?

In recent years, a noticeable trend has emerged regarding the incidence of injuries among youth football players, where growth-related injuries have been observed to occur with increased frequency. This rise is largely attributed to the high training volume that academy players are exposed to on a weekly basis. The occurrence of these injuries tends to peak around the ages of 13 and 14, corresponding to the U14 and U15 age categories. This trend suggests that growth spurts during this developmental stage significantly contribute to the heightened vulnerability to such injuries.

What are the most common injuries you see in football players across different age groups (6-9, 10-14, and 15-18)?

The most prevalent injuries observed in football players across different age groups within the academy are growth-related injuries. There is a clear pattern indicating that specific injuries are more common within distinct age categories. Among the youngest players (U8-U13), the most frequently encountered conditions are Sever’s disease and Iselin’s disease, with Sever’s disease being particularly prominent. In the U14 and U15 age groups, Osgood-Schlatter disease is the most commonly reported injury. As players progress to the 15-18 age group (U17 and U19), hip apophysitis becomes the most prevalent condition, especially involving the Anterior Inferior Iliac Spine (AIIS) and pubic apophysitis.

This pattern aligns with the natural progression of the appearance and fusion of the apophysis in the foot, knee, and hip, which typically follows a distal-to-proximal sequence.

While acute injuries are generally less prevalent across all age groups in our academy, the most frequently observed acute injuries within the academy are lateral ankle sprains and avulsion fractures, with the latter being particularly common at the hip.

Can you describe your typical daily or weekly schedule when working with young football players? How do you balance your time between injury rehabilitation and injury prevention efforts?

The weekly schedule for our young football players is structured to maximize both their athletic development and overall well-being. Training sessions occur from Monday to Friday, with a competitive match on Saturday, while Sundays are reserved for rest and recovery.

Each day begins with players arriving at the facility, where they may participate in physiotherapy sessions specifically for those experiencing pain or discomfort that needs to be checked before training. We educate all players on the importance of informing the physiotherapists early if they feel any discomfort. This proactive approach allows us to manage potential injuries as soon as possible, preventing them from worsening and potentially requiring the player to be pulled out of training.

Following this, all players participate in a "Performance Prep" session led by the physical coach, which serves as both a warm-up and a strength training session in preparation for the training on the pitch. During on-pitch training, any players recovering from injuries engage in a rehabilitation session with a physiotherapist, either in the gym or on the pitch, depending on the nature and stage of their injury. After the training session, players proceed to a structured gym workout with the physical coach before having lunch.

The day concludes with academic commitments, emphasizing the importance of balancing sports with education. This comprehensive schedule not only promotes physical development and injury prevention but also fosters a holistic approach to player well-being, preparing them for both athletic and personal success.

How closely do you work with the strength and conditioning coach? Where do your responsibilities in athlete rehabilitation and injury prevention overlap, and where do they differ?

The Performance Department team, which includes the physiotherapist, physical coach, and mental coach, collaborates closely to ensure that players receive comprehensive support from all aspects of their development. The physical coach is responsible for overseeing all on-pitch activities with the team, as well as managing strength training sessions in the gym. My role, as the physiotherapist, focuses on managing all players who are currently injured or experiencing issues that require specific attention. This collaborative approach allows for a seamless integration of rehabilitation and injury prevention strategies, ensuring that players are holistically supported in their athletic development and recovery processes.

As an injured player progresses closer to reintegration into team training, the physical coach and I work collaboratively to design a tailored return-to-training plan. This ensures that we meet the specific load requirements for the individual player, taking into account their position-specific demands and physical readiness. Through this coordinated effort, we aim to facilitate a smooth and effective transition back to full participation in team activities, while minimizing the risk of re-injury.

How important is injury prevention among young football players? What specific strategies or best practices do you implement to reduce injury risk in this age group?

Injury prevention is fundamental to ensuring the long-term success and development of young football players. Our primary objective is to maintain player availability and keep as many athletes on the pitch as possible. Achieving this goal requires a collaborative effort, where players are fully engaged and understand the critical role that injury prevention plays in their overall performance and well-being.

One of our key strategies in injury prevention is education. We emphasize the importance of adequate sleep and proper nutrition, as these two factors significantly impact injury prevention and recovery. Players are educated on the need to obtain 8-10 hours of sleep each night to support optimal physical recovery. In terms of nutrition, they receive guidance on their energy expenditure due to high training volumes and other daily activities. To meet these demands, players are advised to consume approximately 3,000-3,500 kcal per day. Additionally, Vitamin D supplementation is recommended for all players to mitigate the risk of growth-related injuries, such as apophyseal injuries. Wellness questionnaires are utilized as a tool to gather insights into various aspects of a player's well-being, helping us monitor their physical and mental status effectively.

Strength training also serves as a cornerstone of our injury prevention program, particularly for players from U15 to U19. This structured approach helps build physical resilience, enhances muscle strength, and reduces injury susceptibility.

Beyond evidence-based practices, we prioritize daily communication with players. These regular check-ins provide valuable insights into their physical and mental state, enabling us to identify any emerging issues early and adjust their training or rehabilitation plans accordingly. This holistic approach ensures that players are supported not only physically, but also mentally.

What are the first steps you take when an injury occurs? Do you still follow the RICE (Rest, Ice, Compression, Elevation) method, or are there other approaches you prefer?

When addressing injuries, our approach varies depending on the type and severity of the condition. For growth-related injuries, we implement a strategy focused on load monitoring. Players are generally allowed to remain on the pitch, albeit with specific restrictions aimed at minimizing pain levels. For instance, players suffering from pubic apophysitis may participate in warm-up and possession drills but should be excluded from longer sprints and finishing exercises, while they are experiencing pain. It is crucial to keep players engaged in football training as much as possible while managing their growth-related concerns.

In the case of acute injuries, we primarily adhere to the “PEACE & LOVE” protocol, which emphasizes the importance of "Education" alongside "Load" management. We believe that effectively navigating the acute phase of an injury can significantly influence the duration of the recovery process. This proactive approach aims to optimize healing and facilitate a quicker return to full participation in training and competition. Throughout this process, we maintain consistent communication with players, parents, and coaches to ensure that everyone understands the rehabilitation strategy and expectations. This collaborative approach helps align all parties, facilitating a cohesive and supportive environment for the player’s recovery.

What are the dangers of returning to football too soon after an injury, and how do you manage the pressure from coaches or players to expedite the recovery process?

Returning to football prematurely after an injury poses a serious risk of re-injury and can lead to even longer periods of absence from the sport. The impact extends beyond physical setbacks, potentially undermining the player’s confidence and overall development. To mitigate these risks, we prioritize comprehensive education for both players and coaches at F.C. København, ensuring they understand the long-term implications of rushing back into training or competition.

Through ongoing communication and detailed explanations of each rehabilitation plan, we foster a strong sense of trust and collaboration between all parties. Coaches are kept fully informed about the status of each injured player and the rationale behind every phase of their recovery. This alignment allows coaches to support the player’s gradual return without placing undue pressure or compromising their health.

Our goal is always to get the injured player back to the pitch as quickly as possible but in the safest way possible.

Do you think many youth football clubs lack adequate physiotherapy support? If so, what changes do you believe should be made to improve access to proper physiotherapy services?

Many youth football clubs face significant challenges in providing adequate physiotherapy support. A considerable number of physiotherapists may lack comprehensive knowledge of the unique physiological and developmental needs of young athletes, particularly in comparison to adult athletes. The types of injuries encountered by youth players often differ markedly from those experienced by adults, primarily due to the growth and developmental changes that young athletes undergo. These changes have a profound impact on injury patterns and recovery processes, making it essential to have physiotherapists with specialized expertise in youth sports medicine.

It is inevitable that children and youth athletes will encounter injuries at some point in their football careers. Therefore, it is crucial that they receive the highest quality of care to facilitate their safe return to football. Clubs that prioritize robust physiotherapy services will see more players remaining on the pitch, improving daily, and progressing towards becoming the athletes they aspire to be in the future.

No youth athlete should have to abandon the sport they love due to an injury; with the right support and treatment, all injuries can be effectively managed and resolved.