Paediatric Sports and Exercise Medicine

Playing smart soccer

A safety program of the Think First Foundation of Canada in conjunction with the Canadian Soccer Association

Soccer (football) is the most popular sport in the world.[1] It is a sport played by those of all ages, all skill levels and both genders. It has consistently been the most popular sport for children and youth in Canada since 1998, with both boys and girls aged 5 to 14 recording a 44% participation rate in 2005.[2]

The relative simplicity of the rules, accessibility to play, minimal equipment required, and relatively lower cost of involvement in soccer may explain why it is the most favoured sport for children.
Soccer is considered a relatively safe sport, but injuries do happen. Most soccer injuries affect the ankle, knee and foot.[3] Minor muscle strains and contusions are most common. However, some serious injuries can occur in soccer, including knee injuries and concussions.

One of the most serious knee injuries that can occur in soccer are ACL injuries. The ACL is an important stabilizer of the knee, helping to provide stability when cutting, pivoting, jumping, landing and changing direction. ACL injuries are rare in prepubertal and skeletally immature players but the incidence appears to be increasing, especially in female athletes. [4,5]  For teenagers, injury prevention programs such as PEP (Prevent Injury, Enhance Performance) and the FIFA 11 have been shown to reduce the incidence of this injury.[5-7] These preventative programs focus on neuromuscular training, including strengthening and flexibility exercises, plyometrics, balance and technique training, and risk awareness. 

Head injuries and concussions are also increasingly recognized in soccer. The Canadian Academy of Sports Medicine (CASM) recently published a discussion paper suggesting that soccer be regarded as a contact sport, in which players are at risk for head injuries and concussions.[8] The recommendations emphasize: the importance of safe play and respect for opponents; concussion awareness and education for coaches, parents and players; and evaluation of all concussed players by a medical doctor familiar with diagnosis and treatment of sport-related concussions.[8] The latest concussion management guidelines by the Concussion in Sport Group were published in May 2008.

Playing Smart Soccer is an injury prevention program developed by the Think First Foundation of Canada in conjunction with the Canadian Soccer Association. The program was developed to promote safe soccer for players aged 6 to 14 and is available as an education booklet in both English and French. It is written for parents, coaches, teachers, and officials. The user-friendly format includes sections on diverse injury prevention strategies including player behaviours, equipment (player and field), fitness and conditioning, technique and skill development, nutrition and hydration, environment, responsibilities of parents/coaches/referees/organizations, soccer-specific injuries and basic first aid.  Table 1 (below) shows the suggested Fair Play Code for players, coaches, parents and officials.
Soccer is the world’s most popular game and the favoured sport of Canadian children. It is a safe activity for most participants, but injuries do happen. Creating a fun and safe playing environment is important. There are many steps that players, parents, coaches, referees and health personnel can take to help reduce the risk of injury in soccer. As paediatricians, we are in a unique position to advocate for our patients and children in our communities. Together we can promote regular physical activity and safe participation in sport. The ThinkFirst Safe Soccer Program is an excellent resource to provide to patients, parents, teachers and community coaches. The complete program can be downloaded from the ThinkFirst website, along with information on concussion, as well as player, parent and coach handouts.

Further questions or information requests can be directed to either Kristin Houghton or John Philpott.

Table 1:  Fair Play Codes


  1. I will be reasonable when scheduling games and practices remembering that young players have other interests and obligations.
  2. I will teach my players to play fairly and to respect the rules, officials and their opponents.
  3. I will ensure that all players get equal instruction, support and playing time.
  4. I will not ridicule or yell at my players for making mistakes or for performing poorly. I will remember that children play to have fun and must be encouraged to have confidence in themselves.
  5. I will make sure that equipment and facilities are safe and match the players’ ages and abilities.
  6. I will remember that children need a coach they can respect. I will be generous with praise and set a good example.
  7. I will obtain proper training and continue to upgrade my coaching skills.


  1. I will participate because I want to, not just because my parents or coaches want me to.
  2. I will play by the rules, and in the spirit of the game.
  3. I will control my temper-fighting and “mouthing off” knowing that it can spoil activity for everybody.
  4. I will respect my opponents.
  5. I will do my best to be a true team player.
  6. I will remember that winning isn’t everything – that having fun, improving skills, making friends and doing my best are just as important.
  7. I will acknowledge all good plays/performances – those of my team and of my opponents.
  8. I will remember that coaches and officials are there to help me. I will accept their decisions and show them respect.


  1. I will not force my child to participate in sports.
  2. I will remember that my child plays sport for his or her enjoyment, not for mine.
  3. I will encourage my child to play by the rules and to resolve conflicts without resorting to hostility or violence.
  4. I will teach my child that doing one’s best is as important as winning, so that my child will never feel defeated by the outcome of a game/event.
  5. I will make my child fee like a winner every time by offering praise for competing fairly and trying hard.
  6. I will never ridicule or yell at my child for making a mistake or losing a competition.
  7. I will remember that children learn best by example. I will applaud good plays/performances by both my child’s team and their opponents.
  8. I will never question the officials’ judgment or honesty in public.
  9. 9. I will support all efforts to remove verbal and physical abuse from children’s sporting activities.
  10. 10. I will respect and show appreciation for the volunteer coaches who give their time to provide sport activities for my child.


  1. I will modify rules and regulations to match the skill level of the players.
  2. I will use common sense to ensure that the “spirit of the game” for the children is not lost by overcalling the game.
  3. Actions speak louder than words. I will ensure that both on and off the field behaviour is consistent with the principles of good sportsmanship.
  4. I will compliment both teams on their good plays whenever such praise is deserved.
  5. I will be consistent, objective and courteous in calling all infractions.
  6. I will act to promote fair play at all times.
  7. I will create a positive and constructive environment to  help the participation and enjoyment of the children.
  8. I will make a personal commitment to keep myself informed on sound officiating principles and the  principles of growth and development of children.
  9. I will enjoy the game, be friendly and try to improve my skills every game.


Executive:  Drs Laura Purcell, Children’s Hospital of Western Ontario, London, Ont. (President); Merrilee Zetaruk, Winnipeg, Man. (Vice President); John Philpott, Toronto, Ont. (Secretary); Michelle McTimoney, IWK Health Centre, Halifax, N.S. (Member at Large); David Fecteau, Trois-Rivières, Que. (Member at Large)

Principal Authors: Drs. Kristin Houghton, BC Children’s Hospital, Vancouver British Columbia, and John Philpott, Toronto Ontario (Dr. Philpott and Dr. Houghton are members of the Smart Soccer Committee of ThinkFirst Canada)

Correspondence: Dr. Kristin Houghton, Division of Rheumatology, Department of Pediatrics, UBC, Vancouver British Columbia,


1. Dvorak, J., et al., Football, or soccer, as it is called in North America, is the most popular sport worldwide. American Journal of Sports Medicine, 2000. 28(5 Suppl).
2. Ifedi, F., Sport Participation in Canada, 2005, in Culture, Tourism and the Centre for Education Statistics Research papers. 2008, Statistics Canada: Ottawa. p. 1-101.
3. Peterson, L., et al., Incidence of football injuries and complaints in different age groups and skill-level groups. American Journal of Sports Medicine, 2000. 28(5 Suppl).
4. Ireland, M.L., The female ACL: why is it more prone to injury? Orthopedic Clinics of North America, 2002. 33(4): p. 637-51.
5. Silvers, H.J., E.R. Giza, and B.R. Mandelbaum, Anterior cruciate ligament tear prevention in the female athlete. Current Sports Medicine Reports, 2005. 4(6): p. 341-3.
6. Mandelbaum, B.R., et al., Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. American Journal of Sports Medicine, 2005. 33(7): p. 1003-10.
7. Gilchrist, J., et al., A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. American Journal of Sports Medicine, 1476. 36(8): p. 1476-83.
8. Delaney, J.S. and R. Frankovich, Head injuries and concussions in soccer. Clinical Journal of Sport Medicine, 2005. 15(4): p. 216-9.

Last updated: Apr 23 2014