The Uneven Playing Field

[red card]

Long but interesting (reads like a short story) about women incurring more injuries than men in sports like soccer from NYT. But real bonus is glimpse into US girls soccer culture.

http://www.nytimes.com/2008/05/11/magazine/11Girls-t.html?em&ex=1210564800&en=6d2b8333e2cfaeae&ei=5087%0A

some highlights to note:

She had given up other sports long ago, quitting basketball and tennis by age 10. There was no time for any of that, and as she put it: “Even if you wanted to keep playing other sports, people would question you. They’d be, like, ‘Why do you want to do that?’ ”

But after her second A.C.L. operation, Janelle refused to wait that long. When her teammates were at practice, she felt a longing. What were they doing? Who was playing well? What jokes were they cracking? Just about every girl pictured in her hundreds of photographs from homecoming and other social events was a soccer teammate. She missed her sport, her friends, her life. Whenever she started to feel depressed, she said, “I would just try to rehab harder and get back earlier.”

“I once heard that the injury rate in the N.F.L. is 100 percent. It looks to me, in girls’ soccer, it’s the same thing.”

Seven women were lost that season to A.C.L. ruptures. Beutler, already immersed in A.C.L. research, was still stunned. “I thought to myself, What in the heck is going on here?” he said. Last season, the women’s team at Navy suffered three torn A.C.L.’s. “They thought that was great, a fortunate year,” he told me. “Think about that. Just three. It’s bizarre.”

Silvers directed my attention to one more player, a girl who seemed light on her feet, quick and springy. When she changed directions, she stayed in what generations of gym teachers have called “the athletic position” — knees bent, butt low to the ground. Even when walking casually during stoppages in play, she seemed more lithe than the other girls. “She moves more like a boy,” Silvers said. “Believe me, that’s a good thing.”

[terpfan68]

Thanks for the link. As the parent of a 21 year old daughter who plays high level soccer I can appreiate the frustration of the athlete and parents. My daughter will have her surgery in two days, on May 12th. The really upsetting part of her injury is that she was misdiagnosed initially and actually tried to continue playing (after some rehab and the swelling had gone down). After 6 months she finally got a MRI and then had to wait 3 months for surgery. The Canadian Medical System makes the CSA look competent.

[CoachRich]

The PEP has been around for years but yet still unknown & used in the soccer community -

http://www.aclprevent.com/pepprogram.htm

I've used it for years & seen the benefits.

Also, I do fitness questionnaire to see if players are injured or burnt out. Then a fitness program then benchmark the players for training over the season. If you don't do fitness or don't know your players have shown up injured or burnt out you have not done your job as a coach.

[terpfan68]

Thanks Coach Rich for the link.

[Richard]

quote:Originally posted by terpfan68

Thanks for the link. As the parent of a 21 year old daughter who plays high level soccer I can appreiate the frustration of the athlete and parents. My daughter will have her surgery in two days, on May 12th. The really upsetting part of her injury is that she was misdiagnosed initially and actually tried to continue playing (after some rehab and the swelling had gone down). After 6 months she finally got a MRI and then had to wait 3 months for surgery. The Canadian Medical System makes the CSA look competent.

So we should abandon the Canadian Medical System too? Misdiagnosis is a doctor making a mistake, don't blame the entire system for one doctor's misdiagnosis. Nevertheless I do sympathise with your and your daughter's agony.

[fishman]

The girls' team that I coached to two National Club Championships in three years used the PEP program faithfully; in the three years we employed it, we suffered one ACL tear, and that was from water on a gym floor. Big fan of the protocol.

[bjarne]

Great link CoachRich. Super interesting topic.

[EZmac]

Having a sister who has had 3 ACL surgeries and never been the same. I'm not surprised to see an article like this. Thanks for the link.

[terpfan68]

Gee Richard, I was being sarcastic and it wasn't just one doctor it was several and my comment was more in line with the TIME it took to get a scheduled MRI(if your not sure you run the test) and then surgery. Is it any wonder that several athletes here in Manitoba have gone to Grafton N.D. for same day surgery. You lose a year due to the injury and a year due to scheduling.

[Richard]

I'd still take the Canadian healthcare system over the American one any day. It has never let me down and neither have I had to sell my house to pay for hospital care and surgery.

[Vic]

There have been expedited $$ mri clinics in Quebec for a long time. It is the Canadian healthcare system, but the provinces have a fair amount of leeway also.

[Richard]

In BC if you don't want to wait for the public system where priority is based on true need then there are $$ MRI clinics here too. Despite what the politicians pretend we already have a de facto two tier healthcare system, one for the wealthy minority who can and will pay extra to jump the queue and another one for the rest of us, the great unwashed. I guess it is just quicker and easier for the folks in Manitoba to drive across the border to Grafton ND to enrich the Americans.

[CoachRich]

5 years using the PEP & 1 ACL injury. The PEP circuit addresses more than ACL once you get into it. Basically it stresses the mechanic difference in the way females moves on the field due to their lower body differences when compared to males & how to prehab females prior to practice & game enviroments. Also, what to do after practice & game enviroments.

At the youth level the parents were requested to view the video w/ their daughter prior to the seasons basic training. Phases for the youth were basic training, fitness build up, fitness testing & then intermediate to intense training.

Canadian medical system you can't beat it. I can speak to that from personal experience as a 41 year veteran of Crohn's Disease. Only other system that in near us is the UK sytem.

[terpfan68]

Question: Would Christine Sinclair had to wait for an MRI and surgery? And oh yeah, lets assume the injury happended in a pick-up game in the park and not while playing or practising for Canada? Don't tell me we don't have a two tiered system. (our provincial government shut down the private clinic that was offering MRI) I would have liked to just be able to buy insurance for my daughters.)

[Richard]

You probably could negotiate an arrangement with an insurance company to pay for out of province medicare but the best insurance is prevention. If you are afraid of injury and the possible consequences, don't participate in activities where there is a high risk of injury.

[Richard]

"Question: Would Christine Sinclair had to wait for an MRI and surgery?"

Probably not but then again there are only about 25 players across Canada in her situation. And preferential treatment for the privileged elite is nothing new, has always been there. Does Stephen Harper have to wait in line at his local hospital ER if he is sick or injured? Of course not. The world was ever thus and always will be, get used to it.

[terpfan68]

Richard's statement:

If you are afraid of injury and the possible consequences, don't participate in activities where there is a high risk of injury.

This is a bit condescending -- a bit of blame the victim. I don't have any problem with the risk of injury. What I do have problems with is the TIME for treatment. If you Richard(and your family)have been lucky enough to escape the problem, well lets just hope (to misquote Dickens) "Your eyes aren't opened by experience."

[Richard]

The time/cost for treatment must be taken into consideration when evaluating risk. I don't participate in skydiving, not because I don't find it appealing, but because I won't expose my dependents to the risk or negate my life insurance.

As a multiple heart attack survivor as a result of unfortunate genetics with a wife who is a cancer victim, we both owe our lives to the wonderful and prompt care provided by the Canadian healthcare system. When you really need it, you get it.

There is no condescension here at all, I speak from hard, personal experience too. Neither do I intend to minimise the pain and suffering of your daughter. Reality bites sometimes and we must suffer the consequences of our own actions.

[Vic]

1) The PEP warmup and cooldown is a pretty much a standard high end soccer training and match warmup. I spent time with three different

U15-U18 teams last week, and they all began their warmups with something 80-90% similar.

2) It's great information to share, and 5 years and one ACL injury is great, but it can be a little misleading. I don't know what group(s) you are with, but in young children ACL injuries are nowhere near as common as a few years after puberty. ACL injuries are also much more common in: (a) higher levels of play where athletes are pushing their bodies beyond their boundaries, and ( lower levels of play where players are not warming up properly if at all.

Professional athletes suffer cruciate ligament damage with regularity, and they are match prepared by the finest staff on the planet. It happens sometimes. Simple quirks in your bodies movement (especially during fatigure), another players movement (i.e. a tackle or sudden force in your change of direction, contact in the air causing improper landing), low grade playing surfaces (the famous 80's "astroturf"), etc.

There is no magic solution. But for older girls and women this warmup and others similar are absolute minimum requirements for the game of soccer. And especially those carrying more weight than their muscles have been developed for, those without a smooth and balanced gait and turn, those who have been inactive for more than 48 hours, and older players with less elasticity.

Terpfan I echo your feeling on availability and equity of services. And at the same time I echo Richard's comments on our system versus others in the world. It's the reality we live in, but that doesn't mean we aren't living in the dark ages in the world of healthcare.

Decades ago I know when you lived in Quebec you paid 3% of your income to the provincial healthcare system. And it didn't matter if you made $15,000 a year or $15,000,000 - you paid 3%. Kind of an interesting approach.

Sorry to hear about you guy's and your loved ones. I have dodged the bullet this far but have been surrounded by it since I was a child, and as Richard has let on, and I'm sure Rich's wife can attest to, serious illnesses not only affect us all, they define us.

Keep on ticking...

[Richard]

We are all too ready to criticise and complain about our universal central payer healthcare system and it certainly has its faults but there are few if any countries anywhere with significantly better systems overall, despite what the survey pundits may say from time to time. I have seen it from both sides, I have three doctors and one dentist in the family plus three nurses.

[CoachRich]

Vic -

1)Great to hear more teams are using PEP like warm ups as it was specifically designed for females w/ the USA Soccer WNT in mind. One can do many variaton of it. My smallest grid area is 20 x 20 yds when warm up space is limited

IMO, any coach, that doesn't warm a team up shouldn't be coaching as it's part of injury prevention & training.

Overall things have gotten better but I think it's time to let the forgieners who have certification get in the system quicker.

2) I started w/ U13's who are now U18's who even though I haven't coached them for 2 years still do the program on their own as they've seen the benefits of the PEP & fitness program.

I'm into year 3 of the Women's Program I started at the club & the women do it as well. Ages are U18 to 23. The player who did her ACL was 21.

One of the hardest things I've found as players get older is to get them to warm up as many have never been shown. Like you said Vic it's the age when warming up makes the most difference.

Non contact injuries for me are more relative to the players level of fitness & training. But even then a crappy clay based field up dips in it is an easy way to herniate a back.

Richard -

I agree.

I would say one of the key things I've learnt w/ 41 years of Crohn's Disease is to educate yourself & learn so when it's time for being sick you know what to do. Same for when it's time for surgery.

I'm the 1st to support the medical system here as I've seen it change from over 3 months in the hospital to 8 days now. At the sametime,

Sadly, I've not been happy w/ the unionization of nurses as my last visit for surgery, the young nurses were too busy countdowning the time to coffee break when the senior nurses did their duty.