Thank you in advance for your participation in Emory Sports Medicine's youth soccer injury surveillance study! Your participation is crucial in developing injury prevention strategies to make soccer safer and more enjoyable for athletes in the Atlanta area and beyond.
This is a research study examining common soccer injuries in youth soccer athletes and the risk factors associated with those injuries.
The responses you provide will be used for research purposes only and your child's date of birth is requested so age-specific injury data can be analyzed.
We will ask that you complete this initial survey, and every three months we will contact you for an update to see if any injuries have occurred in the interim.
The survey should take no more than five minutes to complete unless your child has a more complicated injury history, in which case the survey should take no more than 10 minutes to complete. In the absence of injury, follow-up surveys will take less than 30 seconds to complete.
Your child may benefit from the development of injury prevention protocols in the future that are developed based on the outcome of this study.
The only risk is a breach of confidentiality and the study team will make every effort to reduce that risk by keeping your information in a secure electronic database.
There is no penalty for not participating in this study, and you are free to withdraw participation in the survey at any time.
If you have any questions, feel free to contact Emory Sports Medicine at soccermedicine@emoryhealthcare.org or by emailing the principal investigator, Dr. Lee Kneer, at lee.kneer@emory.edu.
Thank you again for your participation and for your contribution to the health of our athletes.
I agree to participate in Emory Sports Medicine's youth soccer injury surveillance study.
* must provide value
Yes
No
Please enter your child's date of birth using the MMDDYYYY format.
* must provide value
Today M-D-Y For instance, if your child was born February 21st, 2004, please enter 02212004
Please list your child's first and last initials.
This information is used only to prevent duplication of survey responses.
Please list your preferred email address.
This information will only be used for the purposes of this study.
Is your child female or male?
* must provide value
Female Male
For how many years has your child participated in organized soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
"Organized soccer" refers to participation in a league of teams limited by age, each with a defined roster playing against those teams in games officiated by a neutral party.
What is your child's primary position?
* must provide value
Forward Midfielder Defender Goalkeeper
What is your child's dominant leg?
* must provide value
Left Right
If your child is ambidextrous, please refer to the leg with which they would take a penalty kick.
On days when they play organized soccer, approximately how many hours per day does your child practice/play soccer
* must provide value
1 2 3 4 5 6 7 8 9 10
Organized soccer includes games and practices. It does not include recreational play.
For how many days of the week does your child play organized soccer, including practices and games?
* must provide value
1 2 3 4 5 6 7
For how many months of the year does your child play organized soccer?
* must provide value
1 2 3 4 5 6 7 8 9 10 11 12
Approximately how many soccer matches does your child participate in annually?
* must provide value
Please enter a number between 1-365
Does your child travel out of state to participate in soccer matches or tournaments more than once a year?
* must provide value
Yes
No
Does your child play soccer recreationally?
* must provide value
Yes No
Recreational soccer includes any soccer activities not overseen by a coach or officiated by a referee. It does not include any organized soccer training activities.
Approximately how many hours per week does your child play soccer recreationally?
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 or more
Does your child play any other sports competitively besides soccer?
Yes
No
At what age (in years) did your child stop playing sports other than soccer?
* must provide value
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
My child never played another sport competitively
What other sport(s) does your child play competitively? (Check all that apply)
* must provide value
What other sport(s) does your child participate in besides soccer?
* must provide value
Please list all that apply not checked on the previous question.
How many months of the year does your child take off from organized sports?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12
This includes refraining from any practice, training, or competition and refers to all sports.
Has your child ever experienced an injury that:
- Occurred as a result of participation in an organized soccer practice or contest, AND
- Resulted in one day or more missed time from soccer participation, AND
- Necessitated medical care?
* must provide value
Yes
No
This includes practices and games. This does not include recreational play or semi-structured play such as in gym class.
Approximately how many times since your child started playing organized soccer have they sustained an injury while playing soccer that
- Caused them to miss time playing soccer, AND
- Necessitated medical care?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 More than 10
What type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
We would now like to ask you a series of questions regarding the soccer-related injuries sustained by your child. We will start with the FIRST (as in the oldest) injury your child sustained that resulted in at least one day of missed soccer participation and which necessitated medical care.
Regarding this FIRST injury, what type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
We will now move on with the SECOND (as in the second-oldest) injury your child sustained that resulted in at least one day of missed soccer participation and which necessitated medical care.
Regarding this SECOND injury, what type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
If this injury was a recurrence of a previous injury, please select the same injury
We will now move on to the THIRD (as in the third-oldest) injury your child sustained that resulted in at least one day of missed soccer participation and which necessitated medical care.
Regarding this THIRD injury, what type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
If this injury was a recurrence of a previous injury, please select the same injury
We will now move on to the FOURTH (as in the fourth-oldest) injury your child sustained that resulted in at least one day of missed soccer participation and which necessitated medical care.
Regarding this FOURTH injury, what type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
If this injury was a recurrence of a previous injury, please select the same injury
We will now move on to the FIFTH (as in the fifth-oldest) injury your child sustained that resulted in at least one day of missed soccer participation and which necessitated medical care.
Regarding this FIFTH injury, what type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
If this injury was a recurrence of a previous injury, please select the same injury
We will now move on to the SIXTH (as in the sixth-oldest) injury your child sustained that resulted in at least one day of missed soccer participation and which necessitated medical care.
Regarding this SIXTH injury, what type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
If this injury was a recurrence of a previous injury, please select the same injury
We will now move on to the SEVENTH (as in the seventh-oldest) injury your child sustained that resulted in at least one day of missed soccer participation and which necessitated medical care.
Regarding this SEVENTH injury, what type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
If this injury was a recurrence of a previous injury, please select the same injury
We will now move on to the EIGHTH (as in the eighth-oldest) injury your child sustained that resulted in at least one day of missed soccer participation and which necessitated medical care.
Regarding this EIGHTH injury, what type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
If this injury was a recurrence of a previous injury, please select the same injury
We will now move on to the NINTH (as in the ninth-oldest) injury your child sustained that resulted in at least one day of missed soccer participation and which necessitated medical care.
Regarding this NINTH injury, what type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
If this injury was a recurrence of a previous injury, please select the same injury
We will now move on to the TENTH (as in the tenth-oldest) injury your child sustained that resulted in at least one day of missed soccer participation and which necessitated medical care.
Regarding this TENTH injury, what type of injury did your child sustain?
* must provide value
Turf toe
Ankle sprain
Ankle - Sever's disease
Achilles tendinitis
Shin splints
Knee - ACL rupture
Knee - meniscus tear
Knee - patellar (kneecap) dislocation
Knee - Osgood-Schlatter's disease
Knee - Sinding-Larsen-Johansson syndrome
Knee - Patellar tendinitis (jumper's knee)
Knee - Quadriceps tendinitis
Knee - MCL (Medial Collateral Ligament) injury
Knee - LCL (Lateral Collateral Ligament) injury
Knee - MPFL (Medial Patellofemoral Ligament) injury
Knee - Osteochondritis dissecans
Groin (adductor) strain
Hip flexor strain
Hip labral injury
Athletic pubalgia (sports hernia)
Shoulder dislocation
AC (Acromioclavicular) joint injury
Fracture - clavicle
Fracture - foot
Fracture - ankle
Fracture - hand
Fracture - wrist
Low back pain
Pars injury (including fracture)
Sacroiliac joint pain
IT (Iliotibial) band syndrome
Chronic exertional compartment syndrome
Facial trauma
Laceration requiring suturing
Liver trauma
Spleen trauma
Concussion
Other
If this injury was a recurrence of a previous injury, please select the same injury
Regarding the FIRST injury, please specify the injury/injuries your child sustained not already addressed in the previous question.
* must provide value
Regarding the SECOND injury, please specify the injury your child sustained not already addressed in the previous question.
* must provide value
Regarding the THIRD injury, please specify the injury your child sustained not already addressed in the previous question.
* must provide value
Regarding the FOURTH injury, please specify the injury your child sustained not already addressed in the previous question.
* must provide value
Regarding the FIFTH injury, please specify the injury your child sustained not already addressed in the previous question.
* must provide value
Regarding the SIXTH injury, please specify the injury your child sustained not already addressed in the previous question.
* must provide value
Regarding the SEVENTH injury, please specify the injury your child sustained not already addressed in the previous question.
* must provide value
Regarding the EIGHTH injury, please specify the injury your child sustained not already addressed in the previous question.
* must provide value
Regarding the NINTH injury, please specify the injury your child sustained not already addressed in the previous question.
* must provide value
Regarding the TENTH injury, please specify the injury your child sustained not already addressed in the previous question.
* must provide value
For approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
Regarding the FIRST injury, approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
Regarding the SECOND injury, approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
Regarding the THIRD injury, approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
Regarding the FOURTH injury, approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
Regarding the FIFTH injury, approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
Regarding the SIXTH injury, approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
Regarding the SEVENTH injury, approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
Regarding the EIGHTH injury, approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
Regarding the NINTH injury, approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
Regarding the TENTH injury, approximately how many days did this injury keep your child from playing soccer?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30 days
In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
Regarding the FIRST soccer-related injury, In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
Regarding the SECOND soccer-related injury, In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
Regarding the THIRD soccer-related injury, In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
Regarding the FOURTH soccer-related injury, In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
Regarding the FIFTH soccer-related injury, In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
Regarding the SIXTH soccer-related injury, In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
Regarding the SEVENTH soccer-related injury, In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
Regarding the EIGHTH soccer-related injury, In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
Regarding the NINTH soccer-related injury, In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
Regarding the TENTH soccer-related injury, In what situation did the injury occur?
* must provide value
Practice Competition Recreational Play
From whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Regarding the FIRST soccer-related injury, from whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Regarding the SECOND soccer-related injury, from whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Regarding the THIRD soccer-related injury, from whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Regarding the FOURTH soccer-related injury, from whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Regarding the FIFTH soccer-related injury, from whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Regarding the SIXTH soccer-related injury, from whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Regarding the SEVENTH soccer-related injury, from whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Regarding the EIGHTH soccer-related injury, from whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Regarding the NINTH soccer-related injury, from whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Regarding the TENTH soccer-related injury, from whom did you receive treatment for this injury? (Check all that apply)
* must provide value
Please list any care provider(s) not already selected in the previous question who treated your child for this injury.
* must provide value
Did your child undergo surgery for this injury?
* must provide value
Yes
No
Regarding the FIRST soccer-related injury, did your child undergo surgery for this injury?
* must provide value
Yes
No
Regarding the SECOND soccer-related injury, did your child undergo surgery for this injury?
* must provide value
Yes
No
Regarding the THIRD soccer-related injury, did your child undergo surgery for this injury?
* must provide value
Yes
No
Regarding the FOURTH soccer-related injury, did your child undergo surgery for this injury?
* must provide value
Yes
No
Regarding the FIFTH soccer-related injury, did your child undergo surgery for this injury?
* must provide value
Yes
No
Regarding the SIXTH soccer-related injury, did your child undergo surgery for this injury?
* must provide value
Yes
No
Regarding the SEVENTH soccer-related injury, did your child undergo surgery for this injury?
* must provide value
Yes
No
Regarding the EIGHTH soccer-related injury, did your child undergo surgery for this injury?
* must provide value
Yes
No
Regarding the NINTH soccer-related injury, did your child undergo surgery for this injury?
* must provide value
Yes
No
Regarding the TENTH soccer-related injury, did your child undergo surgery for this injury?
* must provide value
Yes
No
What type of surgery did your child require as a result of this injury? (Choose all that apply)
* must provide value
Please describe the surgery performed on your child for this injury
* must provide value
What type of fracture fixation did your child undergo? (Please list all that apply)
Has any first-degree relative of your child (sibling or parent) sustained a tear of the anterior cruciate ligament (ACL) or other ligament in the knee?
* must provide value
Yes
No
This refers to any ACL tear and not just those sustained while playing soccer.
If known, what ligament(s) tears has the first-degree relative experienced?
Please check all as appropriate
Has any first-degree relative of your child (sibling or parent) ever sustained a patellar (kneecap) dislocation?
* must provide value
Yes
No
Has your child ever sustained a concussion while playing soccer?
* must provide value
Yes
No
How many concussions has your child sustained while playing soccer?
* must provide value
1 2 3 4 5 More than 5
At what age (in years) did your child sustain their first soccer-related concussion?
* must provide value
Who made the definitive concussion diagnosis of the most recent concussion?
Parent Coach Athletic Trainer Nurse Physical Therapist Chiropractor Massage Therapist Physician (MD/DO) Other
Who made the definitive diagnosis of the most recent concussion?
* must provide value
How many days was your child held out from soccer participation due to the concussion?
* must provide value
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 More than 30
When not participating in organized soccer, has your child ever participated in an off-season soccer workout program?
* must provide value
Yes
No
What types of off-season workout activities has your child performed? (Choose all that apply)
* must provide value
Please specify what type of soccer workout or training program your child participates in other than those listed in the previous question.
* must provide value
Are you familiar with the FIFA 11 training program?
Yes
No
Has your child ever taken any supplements for soccer performance?
* must provide value
Yes
No
This could include any of the following: Multivitamin, caffeinated supplements, energy drinks, creatine, glucosamine, protein, and many others.
What supplements has your child taken for soccer performance? (Check all that apply)
* must provide value
What other supplement(s) has your child taken for soccer performance? (Please list all that apply)
* must provide value
Does your child routinely perform any post-participation cool down or recovery activities?
* must provide value
Yes
No
What types of recovery activities does your child perform? (Please check all that apply)
* must provide value
Has your child ever been diagnosed with a medical condition that limited their soccer participation?
* must provide value
Yes
No
What type of medical condition limited your child's soccer participation? (Choose all that apply)
* must provide value
Please specify what medical condition(s) prevented your child from participating in soccer activities.
* must provide value
Our commitment to enhancing the safety of youth soccer at Emory Sports Medicine relies on community participation and we sincerely thank you for your time!