Youth soccer has grown tremendously in the United States over the past twenty years.
According to US Youth Soccer's Annual Registration of Players, the numbers have increased by more than 200,000.
US Youth Soccer registration has gone from 103,432 in 1974 to 3,036,43 in 2010.
The number of NCAA schools who sponsor the sport has also increased dramatically according to the National Athletic Trainer's Association (NATA).
271 NCAA schools sponsored the sport in 1988-89 and 879 sponsored the sport in 2002-2003, involving more than 19,000 participants across all three NCAA divisions.
The increasing number of participants has also contributed to the number of injuries in the sport, especially on the women's side.
In 1996, the injury rate for women's soccer peaked at just over 20 percent. It has slightly decreased since, but has been relatively steady the past six years at 15 to 18 percent.
In the men's game, neck, head and facial injuries are more common.
However, in the women's game it is more common to find injuries to lower extremities. Approximately 70 percent of all game and practice injuries affect lower extremities.
Ankle sprains, chronic knee injuries, shinsplints and stress fractures are just a few injuries that plague female athletes from the youth level to the college and professional level.
The NCAA compiles injury statistics by sport across all three divisions using the Injury Surveillance System.
According to a report, the rate of injury in women's soccer is more than three times higher in games than practices.
Research efforts have focused on knee injuries, and startling data concludes that preventative measures need be taken in order to combat the epidemic of these injuries.
Tearing of the anterior cruciate ligament (ACL) is an injury that is trending in youth sports, but particularly in women's soccer.
The ACL is small ligament that stabilizes the knee and is attached from the femur to the tibia.
Basically, it attaches one part of your knee to the other.
According to Stephanie L. Silerberg, M.D., female soccer players are two to eight times more likely to suffer the injury than men and women in any other sport.
Boston Breakers midfielder, Leslie Osborne, was asked about her bouts with injuries after a stellar college career at Santa Clara in an interview with Women's Professional Soccer (WPS) contributor Karyn Lush.
She had reconstructive surgery on her ankle and had a torn ACL repaired not long after starting to play professionally.
Osborne tore her ACL during a practice drill in 2008. Teammate Heather Mitts, who was just coming back from the same injury, was guarding her during the drill.
Osborne pivoted anticipating Mitt's movement, her body turned but her leg didn't and then...pop. That was it.
"It was the loudest noise I've ever heard," said Osborne. “It didn't even hurt...we were the only ones who heard it but we knew right away that something was wrong because of that noise, that pop."
Researchers and athletic trainers who study the injury are not only baffled at the rate women suffer the injury, but are unable to determine exactly what tears the ACL apart in cases where there is no contact.
The most difficult part for athletes is the recovery process.
An ACL doesn't merely tear, but explodes. Therefore, it will not heal without taking a donor piece (tendon, or muscle tissue) from the injured and replacing it as the ligament.
Women's national team member Ali Krieger suffered a torn ACL in a game against the Dominican Republic in January.
As shown in the video, it is clear how Krieger may have suffered some injury or damage to her knee.
The defender went in with her cleats up, made contact, and her knee buckled.
However, in Osborne's case and the majority of others, there was no contact.
Simple movements such as jumping, cutting, landing, or even shooting are motions that have caused the ligament to explode.
So how is it that year after year, season after season, and game after game, a knee can work properly with no problems and suddenly malfunction by doing something as simple as turning?
Some athletic trainers say poor coaching techniques are to blame and not enough is done to prevent the injury in the first place.
Simple things such as improper running form, poor balance, and core strength contribute to the injury.
Even the most elite players have their physical flaws masked by their advanced skill, which is why many wonder how great players end up out of the game before they are 30.
San Francisco Giants star catcher Buster Posey is a prime example.
Of course no one could have predicted that Scott Cousins would plow into him the way he did, but he was vulnerable to that injury because of how he plants his feet.
He had done it many times before, and it finally cost him.
Some say that his form needed to be corrected long before that play and the injury ultimately could have been avoided.
In an interview with San Jose Mercury News writer Tim Kawakami, team manager Bruce Bochy was asked if he had ever told Posey to try to avoid those collisions.
"...He was not completely in front of the plate. He was in a position where he could make the tag without getting hit, too. He just got himself in a tough position there because of how his leg was situated. He was down on one knee and ideally you’d like to have the foot pointed that way to have it protected a little bit."
Posey's injury was not in his knee, nor did it affect his ACL. However, his injury shows that proper playing form should be stressed to athletes at any level, in any sport, of any gender, in order to prevent injuries.
Holly Silvers, a physical therapist and the director of research at the Santa Monica Orthopaedic and Sports Medicine Research Foundation, designed an ACL injury prevention program with Santa Monica orthopedic surgeon Bert Mandelbaum.
The study was done on teams in the Coast Soccer League in Southern California in 2000.
All were between the ages of 14 and 18. The teams were given a set warm-up that consisted of stretching, strengthening, and balance exercises, called the "PEP program."
One of the main goals was to to strengthen abdominal muscles in the players which helps the body stay balanced in protective athletic positions.
Results showed that two girls suffered ACL injuries in the PEP program, while 32 girls suffered ACL injuries in groups where coaches declined to participate.
The study was done the following season and results showed a 74% reduction in ACL tears among girls doing the PEP exercises.
Wayne Nelson, DC, CCRS, is a certified Chiropractic Rehabilitation Specialist, and says that prevention is the best solution to combating the injury.
According to Nelson, reconstruction surgeries for the ACL are more complicated in adolescents and often have poor results.
Improving technique is the main idea that Nelson stresses, especially in female athletes who play the sport.
Landing softly, increase knee flexion, and maintaining proper knee alignment when jumping, running and performing cutting maneuvers are crucial.
Strength and conditioning should focus on increasing extension in the hamstring, gluteus maximus and hip, as well as abduction strength and reactivity.