The World Cup is in full swing and soccer enthusiasts the world over are doing their best to rationalize the flopping and writhing that each team’s players seem to do on every other play. There are lots of ways to know whether the player is “flopping” or is actually injured. While sports injuries can be very serious to an elite-level athlete’s performance, the sport of soccer seems to lend itself to an overwhelming amount of exaggeration. Maybe it’s the HUGE size of the field. It probably takes a bit of amplitude to get the ref to notice that you’ve been fouled. Could be the enormous advantage that some teams have during “set pieces.”

In any case, avid as well as novice watchers of the World Cup will now be able to tell if their team has lost their best player for the remainder of the tournament or if they are safe to flop another day. Here are three ways to increase your knowledge of the most common soccer injuries and to be able to tell if that guy is really hurt or just playing to the audience.

1. How Quickly Is the Player Up and Running Full Speed?

  • 15 seconds? Not hurt
  • 30 seconds? Not hurt
  • 2 minutes? Not hurt.

If the player, after going through all of the customary writhing and wincing in pain, is not removed from the game because he can no longer perform at a World-Class level you can be nearly assured that he was just playing it up for the ref. Breathe easily. Your best striker is exaggerating a bit. After all, think of the advantage that a nearly certain PK (penalty kick) goal would give a team on such a stage as the World Cup. Now, if that player is NOT moving after a collision, THIS might be a serious emergency. Concussions are quickly becoming recognized as a more prevalent injury in soccer and a blow to the head at the speeds we are seeing in this tournament could be devastating.

2. How Loud Is the Player Screaming?

The American Speech-Language-Hearing Association has kindly taken the time to research the types of noise we hear and how it compares. Let’s review some interesting information about noise:

“Painful”: Exposure to these types of sounds will lead to permanent hearing damage/loss

  • 150 dB = fireworks at 3 feet
  • 140 dB = firearms, jet engine
  • 130 dB = jackhammer
  • 120 dB = jet plane takeoff, siren

“Extremely Loud”

  • 110 dB = maximum output of some MP3 players, model airplane, chain saw
  • 106 dB = gas lawn mower, snowblower
  • 100 dB = hand drill, pneumatic drill
  • 90 dB = subway, passing motorcycle

If the footballer in question is putting on a display that is in the 120dB range or greater, you can bet that he isn’t in much real pain. In fact, the highest recorded scream/yell measured in at 128dB making a scream of that level nearly impossible for a fatigued and seriously injured athlete. All kidding aside, we’ve all seen the moment in each match where a glancing blow, even if to an area that might be moderately painful, yields a blood-curdling scream from what could be one of the most highly conditioned and tough athletes in the world. If your guy is making a scene you can rest easy; he’ll be back to his explosive self in just a few moments.

3. Do You See Blood or Bones?

Some of the most serious injuries are pretty obvious and it doesn’t take a sports physio to point it out. Concussions notwithstanding, as pointed out above, some of the most gruesome injuries to happen on the soccer pitch are easy to spot. Does that knee, ankle, or shoulder look a little off? Something not right about the way that the player's shin pad and sock are sitting at the moment; especially after a big collision? That player is probably going to have to come off immediately and get some medical attention. 

A possible 3b could be to see how quickly on-field medical staff rush on and off the pitch. The people on the sidelines are pretty skilled at triage (assessment of injury severity) and will NOT loaf on or off the field of play if they suspect a serious injury. At times, the slow speed of the sideline physios seem to suggest that they serve a dual purpose of providing medical assistance AND strategically giving their side a momentum swing or a breather.

Watch the slow-motion instant replays very closely. If a player's knee, ankle, face, or head are contacted then you might suspect an actual injury. The vast majority of instances will clearly show glancing contact if there is any contact at all and in most instances off of a hard bone like the tibia (largest lower leg bone) or the foot. In a sport that is played so aggressively below the waist, you can bet there will be contact. Soccer players are immensely strong and agile.

Now that you are a fully equipped HDTV sports physician, enjoy the rest of the World Cup.


Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist; and a Certified Myofascial Trigger Point Therapist. In addition, he holds a Master’s Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf, and martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought-after resource among elite-level athletes on the field and in the training room. The concept of ‘all the way well’ in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is.

Carlos remains active in several sports and is an avid agility training, power lifting, and adventure race runner. He is an advocate for his patients, clients and his fellow PT colleagues. He can be reached at [email protected].