The preferential use of the lower extremity in soccer leaves a very limited role for the upper extremity. There are only two situations in which a soccer player can touch the ball with his or her hands. One situation requires a player to throw a ball onto the field of play after it has been knocked out of bounds. This maneuver must be accomplished with two hands, requiring the player to hold the ball above his or her head and in some situations use the whole body in a whiplike action to propel the ball. A nuance to the throw-in includes using more of one hand than the other to put a spin on the ball. However, if there is too much use of one hand it can be deemed an illegal throw-in.

The other situation involves the goalie, who is the only player on the field allowed to touch the ball with his hands. This is extremely advantageous to the goalie since his or her primary way of stopping goals is either deflecting or catching the soccer ball. Catching the ball is preferred, so that no deflections can be kicked in for a goal. The goalie is also allowed to advance the ball by throwing it. This is typically done in an overhand bowling motion as opposed to the motion used by baseball and football players.

The upper extremity is also used in contact with opposing players in the struggle for ball control, field position, and jumping for head balls. These uncommon injuries to the upper
extremity are very amenable to myofascial release and a variety of osteopathic manipulative therapy. Goalies are particularly vulnerable to hand and finger injuries including contusions, dislocations, and lacerations from being stepped on by opposing players. Mobilization procedures are effective in reducing edema and improving range of motion with these injuries. It is important to also assess the cervical spine and specifically the scapulothoracic joint to look for related somatic dysfunction.

It is no surprise that soccer is thought of as a predominantly lower extremity sport. Certainly, the most efficient and often-used way to advance the ball and score a goal is by use of the foot. The rules of the game rarely permit players to use their hands other than the goalie. However, soccer is like many other sports in which the total body must work in a coordinated fashion.

A good example is the player who is attempting to shield the ball from an opposing player. He or she must first use superior foot skills and coordination of the lower extremity to maintain the ball in his or her possession. The player also must use the pelvis and thorax in an effective manner to shield the ball from the opposing player. His or her upper extremity is also being used in the shielding process for balance, and for obstructing the opposing player. The player then uses his or her lower extremity to pass the ball to a teammate and uses the whole body to avoid and separate from a defender. Once this is accomplished, he or she runs toward the goal, jumps in the air, and hits the ball with his or her head, a ball that is traveling at speeds of up to 80 and 90 mph. He or she twists and contorts the entire spine in order to powerfully deflect the ball into the net. This is but one scenario in soccer, which requires a coordinated effort of the entire body.

This example is reminiscent of the holistic approach that is central to osteopathic medicine. It also shows that soccer players require total body fitness to play the sport. This full level of body involvement means that injuries can occur in almost any part of the body. Manual therapy has been beneficial in treating soccer injuries and works as a powerful adjunct to physical therapy and rehabilitation. A holistic approach remains critical in treating these athletes.

A soccer player must show athletic diversity. Most individuals who watch soccer would consider it an aerobic sport. However, exercise physiologists who have studied soccer suggest that soccer consists of a more equal division between aerobic and anaerobic capacity. Though a soccer player does run close to 6 miles during a game, much of this running is done in bursts. Therefore, one needs both aerobic capacity to endure the 6 miles of running, and also the tremendous anaerobic capacity to perform the sprints and cuts that are key to the game.

Diversity also applies when considering the skills involved in participating in soccer, and the injury patterns that occur. Most people look at soccer and think that the only concern soccer players have is injury to their legs. Contrary to this belief, soccer is a sport in which the whole body is working to propel either the player and/or soccer ball to a specific point with varying levels of speed and strength. With this in mind, the pelvis becomes a good starting point for examining skills specific to soccer.