16 Sep Football, Soccer, and Cross Country: The Injuries We See Every September
Every fall, the same thing happens on Long Island. The last week of August arrives, and thousands of student-athletes go from a summer of unstructured activity to two-a-day practices in 85-degree heat. Football players put pads on for the first time in ten months. Soccer players start sprinting and cutting on grass that’s still hard from August. Cross country runners jump from casual summer mileage to real training volume in a matter of days.
Then September hits, and our schedule fills up.
It isn’t that fall sports are unusually dangerous. It’s that fall sports start all at once. Injury risk in young athletes is driven less by the sport itself and more by how quickly the workload increases — and preseason is the single steepest workload spike of the entire year. Bodies adapt to training. They just need more than a week to do it.
Why September Is Different
Three things stack up at the same time.
The volume jump. A tissue that hasn’t been loaded in months — an Achilles tendon, a growth plate, a quad tendon — doesn’t have the capacity it had in June of last season. Preseason asks for that capacity immediately.
The heat. Early-season practices are the hottest of the year. Dehydration and fatigue change how athletes move, and fatigued movement is sloppier movement. A tired athlete decelerates worse, lands worse, and cuts worse.
The calendar pressure. Roster spots get decided in the first two weeks. Nobody wants to sit out for a “little” hamstring tightness in the middle of tryouts, so small problems get played through until they become large problems.
Football: What We See Most Often
Ankle sprains. The most common injury in the sport by a wide margin. Cleats plant, a pile shifts, and the ankle rolls. The first sprain is usually straightforward. The problem is that a poorly
rehabbed ankle loses stability and proprioception, which is why the second and third sprains come easier than the first.
rehabbed ankle loses stability and proprioception, which is why the second and third sprains come easier than the first.Knee ligament and meniscal injuries. Cutting, planting, and contact combine to make the knee the most consequential joint in football. ACL, MCL, and meniscus injuries are common enough that we treat them year-round, and September is when many of them happen.
Hamstring strains. Almost always in sprinting, almost always in the first two weeks, almost always in an athlete who hasn’t sprinted at full speed since spring. Hamstrings need exposure to high-speed running before they can tolerate it.
Shoulder injuries. Blocking, tackling, and landing on an outstretched arm produce AC joint sprains, labral irritation, and rotator cuff strains. Linemen and defensive players take the brunt of it.
Low back pain. Repeated extension, heavy lifting in the weight room, and blocking posture add up, especially in linemen and especially in athletes in a growth spurt.
Soccer: What We See Most Often
Ankle sprains and knee injuries. Same mechanisms as football, minus the pads. Planting to change direction is the highest-risk moment in the game, and it happens hundreds of times per match.Groin and adductor strains. Kicking, lunging into tackles, and lateral pushing off load the adductors hard. Groin pain that gets brushed off as “tight hips” early in the season is one of the most common things we end up treating in October.
Hamstring strains. Sprint-heavy sport, sprint-heavy injury. Recurrence rates are high when athletes return based on how they feel rather than on how the muscle actually performs.
Hip flexor irritation and hip pain. High kicking volume plus deceleration equals a lot of demand on the front of the hip.
Achilles and calf problems. Soft grass, low-support cleats, and repeated acceleration make the calf complex a common complaint, particularly in older high school athletes.
Growth-related pain in younger players. Osgood-Schlatter (pain at the front of the knee, just below the kneecap) and Sever’s disease (pain at the back of the heel) show up constantly in middle school and early high school athletes during preseason. These aren’t injuries to “tough out” — they respond well to load management and targeted work, and they get worse when ignored.
Cross Country: What We See Most Often
Cross country injuries are almost entirely a volume story. There’s no contact, no cutting, and no pile — just a lot of repetitions.
Shin splints (medial tibial stress syndrome). The signature early-season complaint. Pain along the inside of the shin that shows up when mileage climbs too fast, often in an athlete running in worn-out shoes.
Stress fractures. The injury we most want to catch early. Shin, foot, and hip stress fractures start as a vague ache during runs and progress to pain that lingers afterward, then pain with walking. Bone pain that gets worse over consecutive weeks deserves attention immediately, not at the end of the season.
Achilles tendinopathy and plantar fasciitis. Hills, uneven trail surfaces, and a sudden jump in weekly mileage load the whole posterior chain of the lower leg.
Runner’s knee (patellofemoral pain). Pain around or behind the kneecap, often traceable to hip and quad strength that hasn’t kept up with training volume.
IT band syndrome and hip pain. Common in athletes who ramp up quickly, run mostly on cambered roads, or have limited hip stability.
The Mistake Almost Everyone Makes
Here’s the pattern we see every single fall. An athlete tweaks something in week two. They sit out a few days, ice it, and the pain settles. They feel fine walking around school. So they go straight back into a full practice — same volume, same intensity, same everything.
Two weeks later, they’re back, usually worse.
The issue is that absence of pain is not the same thing as readiness. Rest quiets down irritated tissue, but it doesn’t restore the strength, tendon capacity, balance, or movement control that were lost — either to the injury or to the time off. Sitting still feels fine because sitting still is easy. A game is not easy.
The second version of this mistake is the athlete who never stops at all. They play through the groin strain or the shin pain for six weeks, moving differently the whole time to protect it. Compensation is remarkably good at creating a second injury somewhere else: the classic case is the athlete who guards a sore ankle all season and shows up in November with knee or hip pain on the other side.
A Phased Return to Play
Every injury and every athlete is different, and this is general education rather than a plan for any specific situation. But a well-structured return generally moves through four stages, and you earn your way into each one.
Phase 1 — Calm it down. Reduce pain and protect healing tissue while keeping as much safe motion and activity as possible. This is rarely total shutdown. Complete rest tends to backfire, leaving an athlete stiffer and weaker than they needed to be. Hands-on treatment, mobility work, and modified activity belong here.
Phase 2 — Rebuild strength and control. Load the injured area on purpose, in a controlled, progressive way. For a hamstring, that’s eccentric strengthening. For an ankle, single-leg strength and balance. For shin splints or an Achilles, methodical calf and foot loading. This is the phase self-directed recoveries skip, because it’s the least obvious and the least fun.
Phase 3 — Restore the movements the sport actually demands. Straight-line strength isn’t enough. Football and soccer players need deceleration, cutting, jumping, and landing mechanics rebuilt at real speed. Runners need a gradual, structured return to mileage and to hills, not a jump back to where they left off.
Phase 4 — Return to competition, gradually. Drills before scrimmages, scrimmages before games. Partial practice before full practice. Add one variable at a time — volume or intensity, not both — so that if something flares, you know exactly what caused it.
A Simple Readiness Check
Before an athlete steps back into full competition, you generally want to be able to answer yes to all of these:
- Full, pain-free range of motion in the injured area?
- Strength on the injured side comparable to the uninjured side?
- Sport-specific movements — sprinting, cutting, jumping, landing, hills — without pain during or the day after?
- A full-intensity practice or workout completed without a flare-up?
- Confident, not tentative, when moving at game speed?
That last one carries more weight than people expect. An athlete who is protecting something moves differently, and moving differently is how a single injury turns into a season of injuries.
Staying Healthy Through the Season
A few habits go a long way:
Warm up for real. Not a lap and a stretch. Light movement, progressive sprint build-ups, and a few change-of-direction reps before anything happens at full speed. Structured warm-up programs are among the best-supported injury-prevention tools we have in soccer.
Respect the ramp. Increase mileage or practice volume gradually rather than all at once. For runners in particular, a modest weekly increase with a lighter week built in beats chasing a number.
Take heat seriously. Hydrate before practice, not just during. Fatigue from heat shows up as bad mechanics long before it shows up as cramping.
Check the shoes. Cleats that fit and provide real support, running shoes that haven’t been worn for 500 miles. This is the cheapest injury prevention available.
Build in recovery. One genuinely lighter day per week. Sleep is not optional for teenage athletes; it’s when tissue actually adapts.
Strength train off the field. Two short sessions a week focused on hamstrings, calves, hips, and core will do more for an athlete’s durability than extra practice reps.
Say something early. The injuries that end seasons are almost always the ones that were reported late.
When to See a Physical Therapist
Come in sooner rather than later for pain lasting more than a week or two, pain that’s getting worse instead of better, swelling that won’t settle, a joint that feels unstable or gives way, pain at night, bone pain that worsens week over week, or an injury that’s now been aggravated more than once.
That last one is worth repeating: a recurring injury means something in the underlying mechanics hasn’t been addressed. Rest alone won’t fix it, because rest was never the missing piece.
At All-Star Physical Therapy, we treat student-athletes throughout the fall season, and our approach is individualized rather than protocol-driven. Our therapists are McKenzie-trained, we work with patients one-on-one, and our focus is getting an athlete back to the sport they care about — not just clearing them to walk around without pain. Whether it’s a sprain or strain, tendinitis, patellofemoral pain, a stress-related overuse injury, a rotator cuff repair, or a full ACL reconstruction, the goal is the same: return you to your season stronger and better prepared than you were before it started.
We also offer in-home physical therapy services if getting to the clinic is difficult during recovery.
Ready to Get Back in the Game?
We have two convenient Long Island locations in Syosset and Seaford, with early morning and evening hours so treatment fits around school, practice, and game schedules. Request an appointment and let’s build your return-to-play plan.
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