Injuries reported in male youth soccer players most commonly occur in the lower extremities, and include a high proportion of ligament sprains at the ankle and knee with a lower proportion of overuse injuries. There is currently a paucity of available literature that examines age- and sex-specific injury risk factors for such injuries within youth soccer players. Epidemiological data have reported movements that lead to non-contact ligament injury include running, twisting and turning, over-reaching and landing. Altered neuromuscular control during these actions has been suggested as a key mechanism in females and adult populations; however, data available in male soccer players is sparse. The focus of this article is to review the available literature and elucidate prevalent risk factors pertaining to male youth soccer players which may contribute to their relative risk of injury.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Adrim TA, Cheng TL. Overview of injuries in the young athlete. Sports Med. 2003;33:75–81.
Alentorn-Geli E, Mendiguchı´a J, Samuelsson K, et al. Prevention of anterior cruciate ligament injuries in sports—part I: systematic review of risk factors in male athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22:3–15.
Atkins SJ, Hesketh C, Sinclair JK. The presence of bilateral imbalance of the lower limbs in elite youth soccer players of different ages. J Strength Cond Res. 2015 (in press).
Barber-Westin SD, Galloway M, Noyes FR, et al. Assessment of lower limb neuromuscular control in prepubescent athletes. Am J Sports Med. 2005;33:1853–60.
Barber-Westin D, Noyes FR, Galloway M. Jump-land characteristics and muscle strength development in young athletes. A gender comparison of 1140 athletes 9 to 17 years. Am J Sports Med. 2006;34:375–84.
Beard DJ, Kyberd PJ, Fergusson CM, et al. Proprioception after rupture of the anterior cruciate ligament. An objective indication of the need for surgery? J Bone Joint Surg. 1993;75:311–5.
Besier TF, Lloyd DG, Ackland TR, et al. Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sport Exerc. 2001;33:1176–81.
Beynnon B, Howe JG, Pope MH, et al. The measurement of ACL strain in-vitro. Int Orthop. 1992;16:1–12.
Beynnon BD, Fleming BC. Anterior cruciate ligament strain in-vivo: a review of previous work. J Biomech. 1998;31:519–25.
Brophy R, Silvers H, Gonzales T, et al. Gender influences: the role of leg dominance in ACL injury among soccer players. Br J Sports Med. 2010;44:694–7.
Cloke D, Spencer S, Hodson A, et al. The epidemiology of ankle injuries occurring in English Football Association academies. Br J Sports Med. 2009;43:1119–25.
Croce RV, Russell PJ, Swartz EE, et al. Knee muscular response strategies differ by developmental level but not gender during jump landing. Electromyogr Clin Neurophysiol. 2004;44:339–48.
Crosier JL, Crelaard JM. Hamstring muscle tear with recurrent complaints: an isokinetic profile. Isokinet Exerc Sci. 2000;8:175–80.
Daneshjoo A, Rahnama N, Mokhtar AH, et al. Bilateral and unilateral asymmetries of isokinetic strength and flexibility in male young professional soccer players. J Hum Kinet. 2013;36:45–53.
Daniel DM, Stone ML, Dobson BE, et al. Fate of the ACL-injured patient: a prospective outcome study. Am J Sports Med. 1994;22:632–44.
De Ste Croix MBA. Advances in paediatric strength assessment: changing our perspective on strength development. J Sports Sci Med. 2007;6:292–304.
Draganich LF, Vahey JW. An in-vitro study of ACL strain induced by quadriceps and hamstring forces. J Orthop Res. 1990;8:57–63.
Faigenbaum AD, Farrell A, Fabiano M, et al. Effects of integrative neuromuscular training on fitness performance in children. Pediatr Exerc Sci. 2011;23:573–84.
Ford KR, Shapiro R, Myer GD, et al. Longitudinal sex differences during landing in knee abduction in young athletes. Med Sci Sports Exerc. 2010;42:1923–31.
Guskiewicz KM, Perrin DH, Gansneder B. Effect of mild head injury on postural stability in athletes. J Athl Train. 1996;31:300–6.
Hewett TE, Paterno MV, Myer GD. Strategies for enhancing proprioception and neuromuscular control of the knee. Clin Orthop. 2002;402:76–94.
Hewett TE, Myer GD, Ford KR. Decrease in neuromuscular control about the knee with maturation in female athletes. J Bone Joint Surg Am. 2004;86:1601–8.
Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33:492–501.
Hewett TE, Ford KR, Myer GD, et al. Effect of puberty and gender on landing force and jump height. Med Sci Sports Exerc. 2005;37:S66.
Hewett T, Johnson D. ACL prevention programs: fact or fiction? Orthopedics. 2010;33:36–9.
Hewett TE, Myer GD. The mechanistic connection between the trunk, knee, and anterior cruciate ligament injury. Exerc Sport Sci Rev. 2011;39:161–6.
Hewit J, Cronin J, Hume P. Multidirectional leg asymmetry assessment in sport. Strength Cond J. 2012;34:82–6.
Holcomb WR, Rublet MD, Lee HJ, et al. Effect of hamstring-emphasized resistance training on hamstring: quadriceps strength ratios. J Strength Cond Res. 2007;21:41–7.
Iga J, George K, Lees A, et al. Cross-sectional investigation of indices of isokinetic leg strength in youth soccer players and untrained individuals. Scand J Med Sci Sports. 2009;19:714–9.
Imai A, Kaneoka K, Okubo Y, et al. Effects of two types of trunk exercises on balance and athletic performance in youth soccer players. Int J Sports Phys Ther. 2014;9:47–57.
Imprezzilini F, Bizzini M, Dvorak J, et al. Physiological and performance responses to the FIFA 11+ (part 2): a randomised control trial on the training effects. J Sport Sci. 2013;31:1491–502.
Ireland ML. The female ACL: why is it more prone to injury? Orthop Clin North Am. 2002;33:637–51.
Krosshaug T, Nakamae A, Boden BP, et al. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med. 2007;35:359–67.
Lee TQ, Anzel SH, Bennett KA, et al. The influence of fixed rotational deformities of the femur on the patellofemoral contact pressures in human cadaver knees. Clin Orthop. 1994;302:69–74.
Le Gall F, Carling C, Reilly T, et al. Incidence of injuries in elite French youth soccer players; a 10-season study. Am J Sports Med. 2006;34:928–38.
Leetun D, Ireland M, Wilson J, et al. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sport Exerc. 2004;36:926–34.
Li G, Rudy TW, Allen C, et al. Effect of combined axial compressive and anterior tibial loads on in situ forces in the anterior cruciate ligament: a porcine study. J Orthop Res. 1998;16:122–7.
Lloyd RS, Oliver JL, Hughes MG, et al. Age-related differences in the neural regulation of stretch–shortening cycle activities in male youths during maximal and sub-maximal hopping. J Electromyogr Kinesiol. 2012;22:37–43.
Lloyd RS, Oliver JL, Faigenbaum AD, et al. Chronological age vs. biological maturation: implications for exercise programming in youth. J Strength Cond Res. 2014;28:1454–64.
Malliou P, Gioftsidou A, Pafis G, et al. Proprioceptive training (balance exercises) reduces lower extremity injuries in young soccer players. J Back Musculoskelet Rehabil. 2004;17:101–4.
Maulder P, Cronin J. Horizontal and vertical jump assessment: reliability, asymmetry, discriminative and predictive ability. Phys Ther Sport. 2005;6:74–82.
McGuine TA, Greene JJ, Best T, et al. Balance as a predictor of ankle injuries in high school basketball players. Clin J Sports Med. 2000;10:239–44.
McGuineTA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34:1103–11.
Meylan C, McMaster T, Cronin J, et al. Single-leg lateral, horizontal, and vertical jump assessment: reliability, interrelationships, and ability to predict sprint and change-of-direction performance. J Strength Cond Res. 2009;23:1140–7.
Michaud PA, Renaud A, Narring F. Sports activities related to injuries? A survey among 9–19 year olds in Switzerland. Inj Prev. 2001;7:41–5.
Mickle KJ, Munro BJ, Steele JR. Gender and age affect balance performance in primary school-aged children. J Sci Med Sport. 2011;14:243–8.
Moore O, Cloke DJ, Avery PJ, et al. English Premiership Academy knee injuries: lessons from a 5 year study. J Sports Sci. 2011;29:1535–44.
Myer GD, Ford KR, Hewett TE. Rationale and clinical techniques for ACL injury prevention among female athletes. J Athl Train. 2004;39:352–64.
Myer GD, Ford KR, Palumbo JP, et al. Neuromuscular training improves performance and lower extremity biomechanics in female athletes. J Strength Cond Res. 2005;19:51–60.
Myer GD, Ford KR, McLean SG, et al. The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. Am J Sports Med. 2006;34:445–55.
Myer GD, Brent JL, Ford KR, et al. Real-time assessment and neuromuscular training feedback techniques to prevent ACL injury in female athletes. Strength Cond J. 2011;33:21–35.
Myer GD, Faigenbaum AD, Chu DA, et al. Integrative training for children and adolescents: techniques and practices for reducing sports-related injuries and enhancing athletic performance. Phys Sportsmed. 2011;39:74–84.
Myer GD, Faigenbaum AD, Ford KR, et al. When to initiate integrative neuromuscular training to reduce sports-related injuries in youth? Curr Sports Med Rep. 2011;10:155–66.
Nesser TW, Huxel KC, Tincher JL, et al. The relationship between core stability and performance in Division I football players. J Strength Cond Res. 2008;22:1750–4.
Noyes FR, Barber-Westin SD, Fleckenstein C, et al. The drop-jump screening test: difference in lower limb control by gender and effect of neuromuscular training in female athletes. Am J Sports Med. 2005;33:197–207.
Opar D, Timmins R, Dear N, et al. The role of neuromuscular inhibition in hamstring strain injury recurrence. J Electromyogr Kinesiol. 2013;23:523–30.
Padua D, Arnold B, Perrin D, et al. Fatigue, vertical leg stiffness and stiffness control strategies in males and females. J Athl Train. 2006;41:294–304.
Padua DA, Marshall SW, Boling MC, et al. The landing error scoring system (LESS) is a valid and reliable clinical assessment tool of jump-landing biomechanics. Am J Sports Med. 2009;37:1996–2002.
Philippaerts RM, Vaeyens R, Janssens M, et al. The relationship between peak height velocity and physical performance in youth soccer players. J Sports Sci. 2006;24:221–30.
Plisky PJ, Rauh MJ, Kaminski TW, et al. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36:911–9.
Powell JW, Barber-Foss KD. Sex related injury patterns among selected high school sports. Am J Sports Med. 2000;28:385–91.
Price RJ, Hawkins RD, Hulse MA, et al. The Football Association and medical research programme: an audit of injuries in academy youth football. Br J Sports Med. 2004;38:466–71.
Quatman CE, Ford KR, Myer GD, et al. Maturation leads to gender differences in landing force and vertical jump performance: a longitudinal study. Am J Sports Med. 2005;34:1–8.
Ross S, Guskiwicz K. Assessment tools for identifying functional limitations associated with functional ankle instability. J Athl Train. 2008;43:44–50.
Rumpf M, Cronin J. Injury incidence, body site, and severity in soccer players aged 6–18 years: implications for injury prevention. Strength Cond J. 2012;34:20–31.
Russell PJ, Croce RV, Swart EE, et al. Knee muscle activation during landings: developmental and gender comparisons. Med Sci Sports Exerc. 2007;39:159–69.
Simonsen EB, Magnusson SP, Bencke J, et al. Can the hamstring muscles protect the anterior cruciate ligament during a side-cutting maneuver? Scand J Med Sci Sports. 2000;10:78–84.
Small K, McNaughton L, Greig M, et al. The effects of multidirectional soccer-specific fatigue on markers of hamstring injury risk. J Sci Med Sport. 2010;13:120–6.
Tursz A, Crost M. Sports related injuries in children: a study of their characteristics, frequency and severity with comparison to other accidental injuries. Am J Sports Med. 1986;14:294–9.
Van der Sluis A, Elferink-Gemser MT, Coelho-e-Sliva MJ, et al. Sports injuries aligned to peak height velocity in talented pubertal soccer players. Int J Sports Med. 2014;35:351–5.
Volpi P, Pozzoni R, Galli M. The major traumas in youth football. Knee Surg Sports Traumatol Arthrosc. 2003;11:399–402.
Zazulak BT, Hewett TE, Reeves NB, et al. The effects of core proprioception on knee injury: a prospective biomechanical epidemiological study. Am J Sports Med. 2007;35:368–73.
Zebis MK, Andersen LL, Bencke J, et al. Identification of athletes at future risk of ACL ruptures by neuromuscular screening. Am J Sports Med. 2009;37:1967–73.
No sources of funding were used to assist in the preparation of this article. One author (Gregory Myer) would like to acknowledge funding support from National Institutes of Health Grants R21-AR065068.
Conflicts of interest
Paul Read, Jon Oliver, Mark de Ste Croix, Gregory Myer and Rhodri Lloyd declare that they have no conflicts of interest relevant to the content of this review.
About this article
Cite this article
Read, P.J., Oliver, J.L., De Ste Croix, M.B.A. et al. Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players. Sports Med 46, 1059–1066 (2016). https://doi.org/10.1007/s40279-016-0479-z
- Anterior Cruciate Ligament
- Anterior Cruciate Ligament Injury
- Medial Collateral Ligament
- Soccer Player
- Injury Risk