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The Soccer Docs

Some say that soccer is a universal language, popular on a scale from local to global and a sport that unites us across the world. From kids to adults, through practice and sweat, victory and defeat, we can’t seem to get enough soccer.

At OrthoCarolina Pineville, Dr. Scott Burbank, Dr. William Graham, physician assistant Andy Hylton and athletic trainer Mike McGowan stay ahead of their goals as much as possible. They work hard to not only be the best medical providers to the patients they see in clinic, but to be a mainstay in the Charlotte soccer community as well. Dr. Burbank serves as head team physician for the Charlotte Independence, Dr. Graham as associate team physician for the Independence, Andy as provider for the Charlotte Eagles Soccer Club (also a former professional soccer player nationally and internationally) and Mike as athletic trainer to the Independence. All additionally provide medical services for Charlotte Soccer Academy. With approximately 5,000 families with active players, CSA is one of only two clubs in North and South Carolina that offers every level of play in youth soccer and is the largest competitive youth soccer organization in North Carolina.

With busy but exciting schedules, the soccer medical squad has to be quick on their feet. We asked Dr. Graham a few questions about how he, Dr. Burbank, Andy and Mike manage to stay on the ball for teams from beginner to premier level:  

Do you tend to see more injuries in-season or offseason? What are some of the most common injuries you see? 

Dr. Graham: Definitely in-season as the intensity level inevitably picks up. The single most common injury that occurs in soccer is a simple ankle sprain, though anyone close to the game, particularly the women’s game, will associate soccer with ACL tears.

You treat soccer players of all ages and expertise levels. Are there any common threads that bind those patients?

Dr. Graham: Yes and No. The non-contact ACL tear is ever-present, affecting both males and females, all age groups, and all levels of competition. But there are definitely injury patterns that we see with different age groups and different levels of competition. The younger females are most susceptible to the non-contact ACL. The more competitive males who have been playing for a long time can get hip and groin problems such as FAI and Athletic Pubalgia. And many of the professionals will show up in the office with a Footballer’s Ankle. Concussions and head injuries don't discriminate. The push for educating players, parents, and coaches regarding concussions, as well as for early diagnosis and preseason neuro-cognitive baseline testing has been just as significant in Soccer Sports Medicine as with other sports aver the last several years.

Over the summer you provided medical care at the CONCACAF Gold Cup in Charlotte. What were you responsible for there?

(CONCACAF is the official organization of the Confederation of North, Central American and Caribbean Association Football, and the Gold Cup is a tournament played in off-years of the World Cup. 2015 was only the second time the event had been hosted in Charlotte.)  Dr. Graham: I served as venue medical director for the Gold Cup which involved organizing resources for the teams and prepping emergency protocols. We were working with a brand new concussion protocol as well, or step-by-step process you follow when a player is injured. Dr. Burbank, Andy and I were on hand throughout to provide medical services as needed.

When you’re on the field providing medical care for any soccer group, what are you typically doing?

Dr. Graham: We respond to acute injuries the same way we would for any other sport, assessing injured athletes with the ATCs and triaging injuries that need acute care preventing the athlete from continuing to compete that night, or patching them up quickly if it is safe for them to keep playing. The biggest focus of sideline medicine affecting the soccer sports medicine community is navigating the running clock and the team playing down a man while sideline assessments are done. Soccer is traditionally a flowing sport with a running clock that has minimal formal stoppages in play. There can be a stoppage in play for a water break if certain temperature and humidity metrics are met; this was first instituted at the World Cup in Brazil as a step towards combat heat related illnesses. We have recently seen a similar change at some levels where a formal stoppage in play can be called now to allow for assessment of a player with a head injury. My mentor, Bert Mandelbaum, sits on the MLS and FIFA Medical Committees and he has been pushing very hard for these concussion protocols to be put in place. I think that is a change that we need to see at all levels of competition.

Tell us about your work with the U.S. Soccer Development Academy and the Youth National Teams

(The Academy in part works to identify and develop elite soccer players, as well as provide resources and support to the clubs that support those players.)  Dr. Graham: I have been fortunate enough to cover several youth national team camps as well as Development Academy Finals over the last several years, and I was honored to serve as the team physician for the U17 Mens’ Team when they traveled to Izmir, Turkey this past January and finished 2nd in the Aegean Cup. Locally we have been able to help out with the Academy’s U-13/14 age group regional showcase event which takes place in North Carolina in each year. I love this game. It’s a privilege to have the opportunity to care for soccer players at all levels.

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