Youth Soccer Injuries: ACL, Concussions and What Parents Can Control

The two soccer injuries worth planning for are ACL tears, which hit girls about twice as often as boys, and concussions. A structured warm-up like FIFA 11+ cut injuries by about 30% in pooled trials, and in Illinois school sports a player with a suspected concussion has to come out right away and can't return without written medical clearance. Add sensible heading limits, a day or two off each week and real sleep, and you've covered most of what a parent can control.

This guide is general information, not medical advice. If your kid gets hurt, or has pain that keeps coming back, see a doctor or an athletic trainer.

Key takeaways

• A meta-analysis of randomized trials found the FIFA 11+ warm-up reduced injuries in soccer players by about 30%.
• Female soccer players tear their ACL at about 2.2 times the rate of male players, according to a 2019 British Journal of Sports Medicine meta-analysis.
• Under Illinois law (105 ILCS 5/22-80), a student athlete suspected of a concussion must be removed immediately, and a coach may not authorize a return to play or return to learn.
• The CDC's return-to-sport plan has six steps, and each step typically takes at least 24 hours.
• U.S. Soccer's 2015 rules ban heading for players 10 and under and limit heading in practice for ages 11 to 13 in its youth national teams and academies.

What actually prevents soccer injuries?

The best-supported prevention tool is a structured neuromuscular warm-up, and FIFA 11+ is the one with the most research behind it. A systematic review of FIFA 11+ pooled randomized trials and found injuries dropped by 30% (relative risk 0.70) among players who did it. The studies covered players older than 13, boys and girls.

FIFA 11+ isn't a jog and a few stretches. It's a set routine of exercises done in order, and the trial results come from teams that actually did it on a schedule. A team that skips it half the time shouldn't expect the same benefit.

Ask your kid's coach two things: do you use FIFA 11+ or something like it, and how many times a week? If the answer is "we warm up," ask what that means.

Why do girls tear their ACL more often?

Female soccer players have a higher ACL injury rate than male players, by a wide margin. A 2019 meta-analysis in the British Journal of Sports Medicine found an incidence rate ratio of 2.2: about 2.0 ACL injuries per 10,000 athlete exposures for women and girls versus 0.9 for men and boys. An "athlete exposure" is one player taking part in one practice or game.

Those are small numbers per session. Over years of practices, games and tournaments, though, they add up.

If you have a daughter who plays, that's the strongest reason to care about the warm-up. For a plan built around your kid, including how she lands and changes direction, talk to a physical therapist or athletic trainer.

What does Illinois law say about concussions?

Illinois has a concussion law for school sports: the Youth Sports Concussion Safety Act, 105 ILCS 5/22-80. It covers interscholastic athletics at public, private and charter schools, and it's specific.

• Immediate removal. If a coach, official, athletic trainer, parent, the player or certain others believe a concussion may have happened, the student must be removed from practice or competition right away.
• Medical clearance. The player can't return until a physician, athletic trainer, physician assistant or advanced practice registered nurse evaluates them and gives a written statement clearing them.
• No coach clearance. The statute says plainly that a coach "may not authorize a student's return to play or return to learn."
• Return to learn first. Schools must have a return-to-learn protocol, and the student has to complete it before going back to play.
• Training and paperwork. Coaches and game officials need at least 2 hours of IHSA-approved concussion training, repeated at least every 2 years. Each school year, students and a parent must sign a concussion information form before the student can play.

The IHSA puts this into practice through its Sports Medicine Acknowledgement & Consent Form, which says an athlete can't return to activity after a suspected concussion without medical clearance, however mild it seems, and must complete the school's return-to-play protocol.

What about club soccer?

The Illinois statute is written for interscholastic athletics, meaning school teams. Club, park district and travel soccer aren't named in it. Ask your club what its concussion protocol is, who decides when a player returns, and whether the coaches have had training. Then hold the club to the school standard anyway. A concussion is the same injury whether it happens on a Friday at school or a Saturday at a tournament.

How long does a concussion take to recover from?

There's no fixed number of days, and anyone who promises one is guessing. The CDC HEADS UP return-to-sport plan has six steps:

Step	What it looks like
1	Back to regular daily activities
2	Light aerobic activity
3	Moderate activity
4	Heavy, non-contact activity
5	Practice and full contact
6	Competition

According to the CDC, each step typically takes at least 24 hours, and a player moves on only if no new symptoms show up at the current step. If symptoms come back, the player rests and restarts at the previous step. In the best case that's most of a week, and often it's longer.

School comes into it too. In Illinois schools, the return-to-learn protocol has to be finished before return to play, so expect your kid to ease back into class before practice.

The most common mistake is letting a kid "shake it off" after a knock to the head and go back in. If you aren't sure, keep them out. Being wrong costs one game. Being wrong the other way is a lot more expensive.

When can kids start heading the ball?

U.S. Soccer's 2015 concussion rules ban heading for players 10 and under and limit heading in practice for players 11 to 13. As CBS News reported, those rules apply to U.S. Soccer's youth national teams and academies. Other leagues and clubs set their own policies, so ask yours what it does.

For a younger kid, the simple version is no heading in games or training. Between 11 and 13, heading in practice should be limited, with the focus on technique rather than repetition. Our guide to soccer at ages 9 to 12 covers what training at that age should look like more broadly.

Rest days and sleep: the boring stuff that works

Overuse injuries make up a big share of youth sports injuries, and rest is the easiest fix. In its 2016 report on sports specialization, the American Academy of Pediatrics said overuse injuries account for 46% to 50% of all athletic injuries and advised young athletes to take one to two days off per week from competition and sport-specific training, according to Healio's summary. The same report recommended playing more than one sport at least until puberty. We go deeper on that in our guide to early specialization vs. multi-sport.

Count the whole week. Club practice, high school practice, futsal, private training and weekend games all land on the same legs. Five sessions from three different coaches can add up to more than any one of them knows about.

Sleep is the other half. A consensus statement from the American Academy of Sleep Medicine, endorsed by the AAP, recommends 9 to 12 hours per 24 hours for ages 6 to 12 and 8 to 10 hours for teens 13 to 18. In one small study of 112 adolescent athletes, those averaging under 8 hours of sleep a night were 1.7 times as likely to report an injury as those sleeping 8 hours or more. It was a small survey, so don't read too much into the exact number, but it points the same direction as the guidelines.

Late practices, long tournament drives and a phone in the bedroom all cut into sleep. Some of that's unavoidable. Some of it you can control.

Pain that keeps coming back is a signal too. Heel pain, knee pain below the kneecap, or a sore spot that flares every practice in a growing kid should get looked at by a doctor rather than played through. Our guide to ages 13 to 14 and puberty covers how growth spurts change things.

What this means for your family

• Ask your kid's coach whether the team does FIFA 11+ or a similar neuromuscular warm-up, and how often.
• If you have a daughter, treat ACL prevention as part of training, not an extra. Ask a physical therapist or athletic trainer about landing, cutting and strength work.
• Learn the rule: if you suspect a concussion, the player comes out and stays out until a qualified medical professional clears them in writing.
• Ask your club, not just the school, for its written concussion protocol.
• Expect concussion recovery to take close to a week at minimum through the CDC steps, and often longer, with return to school first.
• Follow heading limits: none at 10 and under, limited practice heading from 11 to 13.
• Build in one or two days off from soccer each week, and count every team and trainer in your kid's weekly load.
• Protect sleep: 9 to 12 hours for ages 6 to 12, 8 to 10 hours for teens.
• For any injury, or pain that won't go away, see a doctor or athletic trainer. Don't try to diagnose it from the sideline.

Keep it simple

Most of this is unglamorous. A warm-up done properly, a kid who sleeps, a day off that's actually off, and a parent willing to say "sit out" after a head knock. Very little of it costs money, and nearly all of it is in your hands.