Availability Has a Price: The Real Cost of Injury in ECNL and MLS NEXT Soccer

When a Premier League player gets injured, the financial loss becomes visible almost immediately.

The player remains under contract. Salary continues to be paid. Medical and rehabilitation resources are required. The manager loses a selection option, and the club temporarily loses access to a player in whom it has invested significant financial resources.

During the 2024–25 season, Premier League clubs recorded 957 injuries with an estimated injury-related economic cost of approximately €285.7 million. Across multiple seasons, injury-related salary costs throughout Europe’s major leagues have reached into the billions.

Professional football therefore understands a principle that should receive considerably more attention in elite youth soccer:

Player availability has value.

For an ECNL or MLS NEXT player, the financial structure is obviously different. A 15-year-old athlete is not receiving a Premier League salary, and a youth club is not losing millions when a player becomes unavailable.

The cost, however, does not disappear.

It moves to the athlete and the family.

For many families competing within ECNL, MLS NEXT, and similar national platforms, thousands of dollars may already have been committed before the season begins. Registration, uniforms, tournaments, flights, hotels, rental cars, meals, private technical training, strength and conditioning, showcases, camps, and equipment can all contribute to the annual investment.

When an injury occurs, much of that investment has already been made.

The athlete stops participating.

The expenses do not necessarily stop with them.

Elite Youth Soccer Is Not the Average Youth Sports Experience

National youth-sports spending statistics can underestimate the financial reality of families competing at the highest levels of club soccer.

Research from the Aspen Institute has shown that American families are spending significantly more on youth sports than they were only a few years ago. Soccer is already among the more expensive major youth sports, with travel representing one of the largest categories of spending.

That national average, however, includes recreational and lower-cost programs.

ECNL and independent MLS NEXT programs operate in a very different financial environment.

Published fee schedules from competitive clubs show registration and program costs commonly reaching approximately $3,000 or more before travel, uniforms, tournaments, and additional team expenses are included.

For some programs, the documented combination of registration fees, league travel, regional events, uniforms, and individual travel costs can push annual expenses well beyond $5,000.

That still may not represent the family’s total investment.

Private technical coaching may be added.

Strength and conditioning may be added.

Showcases may be added.

Additional tournaments may be added.

Flights, hotels, meals, and transportation may occur several times throughout the season.

For families competing nationally, the true annual investment can therefore become substantially larger than the registration fee printed on the club website.

This is where the financial consequences of injury begin to look very different.

The Family Keeps Paying Even When the Player Stops Playing

Consider an ECNL player who sustains a significant knee injury halfway through the competitive year.

The registration fee has already been paid.

The uniform has already been purchased.

Tournament commitments may already have been made.

Flights and hotels may already be booked.

Private training completed earlier in the year cannot be recovered.

Strength and conditioning memberships may already be active.

The family’s financial commitment to the season remains largely intact, yet the athlete’s ability to participate in that season may suddenly disappear.

Professional football recognizes this as lost player availability.

Youth soccer generally calls it being injured.

From an economic perspective, the concepts are more similar than we often acknowledge.

The Premier League club continues paying for an athlete who temporarily cannot contribute on the field.

The youth family has already paid for developmental opportunities that the athlete can temporarily no longer access.

The scale is different.

The principle is not.

ACL Injuries Show How Quickly the Financial Cost Can Escalate

Anterior cruciate ligament injuries provide one of the clearest examples of the financial burden that can follow a serious youth-sports injury.

Research examining tens of thousands of commercially insured ACL reconstruction patients in the United States found that patients still faced meaningful out-of-pocket expenses despite having health insurance.

The surgical episode itself may involve deductibles and coinsurance. Imaging, orthopedic consultations, braces, follow-up appointments, and months of rehabilitation can create additional expenses.

Physical therapy is particularly important because rehabilitation following ACL reconstruction can extend for many months.

Pediatric ACL research has demonstrated the burden directly.

In one study involving families whose children underwent ACL reconstruction, more than half reported experiencing treatment-related financial burden.

Among privately insured families, nearly one-third reported using personal savings to help cover expenses.

Some families accumulated medical debt, and postoperative physical therapy was one of the most frequently identified contributors to the financial strain.

That means the family may effectively be paying on both sides of the injury.

They have already paid for the athlete to participate in an elite soccer environment.

Then they begin paying to restore the athlete’s ability to participate again.

Insurance Does Not Make an ACL Injury Free

Having health insurance does not eliminate the financial impact of a major sports injury.

Depending on the family’s insurance plan, they may still be responsible for deductibles, coinsurance, copayments, imaging expenses, rehabilitation visits, braces, and other costs.

High-deductible health plans can make this particularly noticeable.

There are also indirect expenses that rarely appear on a medical bill.

A parent may need to leave work early to drive an athlete to physical therapy.

Workdays may be missed for surgery, follow-up appointments, or specialist consultations.

Additional transportation may be required several times each week.

Schedules for siblings may need to change.

Even when medical insurance absorbs a significant percentage of the healthcare cost, the family still absorbs much of the logistical and financial burden.

The true cost of the injury therefore extends well beyond the surgery itself.

The Largest Loss May Still Be Time

Financial costs can eventually be recovered.

Developmental time cannot.

This may be the most important parallel between professional and youth soccer.

Professional organizations measure injuries partly through days lost because every unavailable day represents lost training and performance capacity.

Elite youth soccer should think about availability in a similar way.

A four-season prospective study following hundreds of academy soccer players documented thousands of injuries and more than 25,000 player-days lost from football.

For a theoretical 25-player squad, the injury burden represented hundreds of player-days lost during a single season.

Those are not simply medical statistics.

They represent lost developmental opportunities.

Technical repetitions were missed.

Training sessions were missed.

Competitive minutes were missed.

Sprint exposures were missed.

Strength sessions were missed.

Tactical situations were missed.

Teammates continued training and progressing while the injured athlete’s normal development was interrupted.

This becomes particularly significant with major knee injuries.

Research examining elite youth soccer has shown that cruciate ligament injuries can produce some of the greatest time-loss burdens of any injury category.

An average absence measured in months can represent a substantial portion of a young athlete’s competitive year.

For a developing player, four or five months is not simply time away from soccer.

It is time away from development.

For Female ECNL Players, the ACL Conversation Matters Even More

ACL injury deserves particular attention within female youth soccer.

Research has consistently shown that adolescent female athletes experience a higher incidence of ACL injury than their male counterparts in several field and court sports.

Soccer represents one of the sports in which this difference is particularly relevant.

This does not mean that an individual female soccer player is destined to experience an ACL injury.

It does mean that organizations working with female ECNL populations should take physical preparation seriously.

Strength development matters.

Landing mechanics matter.

Deceleration capacity matters.

Exposure to sprinting matters.

Neuromuscular training matters.

Progressive loading matters.

Recovery matters.

Return-to-performance progression matters.

The objective is not to claim that an athlete can be made injury-proof.

The objective is to build greater physical capacity for the demands the athlete will repeatedly face.

Being Back at Training Does Not Always Mean Being Available

Another problem with traditional injury reporting is that athletes are often classified too simply.

They are either injured or they are not.

Real return-to-sport progression is rarely that clean.

An athlete may return to technical training but remain restricted from sprinting.

They may complete warm-ups but not full-sided games.

They may train without contact.

They may participate in portions of practice while their total workload remains limited.

They may return to competition under restricted minutes.

Research in elite academy soccer has demonstrated that a meaningful percentage of injury burden occurs during these periods of partial participation.

This distinction is important.

A player can physically be standing on the training field without being fully available.

A player can be medically cleared without having returned to full performance.

A player can appear in a match without having restored their previous physical capacity.

This is why clubs need to move beyond a simple injured versus healthy classification.

Availability exists on a continuum.

Availability Should Become a Club Performance Metric

Elite soccer clubs track almost everything surrounding competition.

Wins.

Losses.

Goals.

Assists.

Standings.

Recruiting exposure.

College commitments.

Tournament results.

One question, however, should become equally important:

What percentage of our players were fully available to train and compete this week?

That information provides valuable context for player development.

Clubs should understand how many training days are being lost.

They should understand how many match days are being lost.

They should understand how often athletes are completing modified training.

They should understand the difference between return to participation and return to performance.

They should understand whether injuries are recurring.

They should understand the training exposure athletes accumulated before becoming unavailable.

None of these metrics can tell a coach exactly who will be injured next.

That is not their purpose.

Their purpose is to improve decision-making.

Injury Prediction Is Not the Goal

No legitimate performance system can guarantee that an athlete will remain injury free.

Soccer is unpredictable.

Contact occurs.

Players land awkwardly.

Feet become planted during rapid direction changes.

Growth and maturation alter physical capabilities.

Playing surfaces change.

Fatigue fluctuates.

Training exposure changes.

Fixture congestion changes.

Previous injury influences future risk.

The objective should not be to create an artificial injury-risk percentage and pretend that every future injury can be predicted.

The better goal is preparation.

We can improve strength.

We can progressively expose athletes to sprinting.

We can train deceleration.

We can develop landing and cutting strategies.

We can monitor training exposure.

We can track wellness.

We can improve recovery.

We can progress athletes more intelligently following injury.

These factors do not eliminate injuries.

They give coaches better information and athletes better preparation.

Injury-Reduction Programs Have Demonstrated Real Value

There is strong evidence that structured neuromuscular and injury-reduction programs can decrease injury incidence in youth soccer.

Research examining programs such as FIFA 11+ Kids has reported meaningful reductions in overall injuries, severe injuries, lower-extremity injuries, knee injuries, and ankle injuries.

The important lesson is not that one warm-up routine solves every injury problem.

The lesson is that systematic physical preparation works better than simply hoping athletes remain healthy.

There is also an economic component.

Research evaluating neuromuscular training in youth soccer has demonstrated reductions not only in injury incidence but also in healthcare costs.

More recent economic modeling of ACL injury-reduction programs in U.S. high-school soccer estimated that every dollar invested in injury-prevention programming could generate several dollars in avoided ACL treatment costs.

That creates an important shift in perspective.

Physical preparation should not simply be viewed as another expense for families and clubs.

Done correctly, it is an investment in availability.

The Premier League Protects Availability. Youth Soccer Should Too.

The financial numbers are obviously different.

A Premier League organization may lose millions because a player cannot participate.

An ECNL or MLS NEXT family may lose thousands.

But the underlying principle remains the same.

Resources have been invested into the player’s ability to perform.

When the athlete becomes unavailable, that investment temporarily stops producing its intended return.

For the professional club, the balance sheet contains salary, transfer value, and performance.

For the youth family, the balance sheet may include registration fees, airline tickets, hotels, private coaching, strength training, healthcare deductibles, rehabilitation expenses, and missed work.

The athlete experiences another type of loss entirely.

Development.

That may ultimately be the most valuable currency of all.

Where GF XI™ Fits

This is one of the reasons we are developing GF XI™ — Player Performance Intelligence as a Ground Force platform.

The objective is not to create another dashboard filled with numbers.

The objective is to make player availability visible.

GF XI™ brings information that is often separated across multiple systems into one performance environment.

Team schedules and match-day structure can be viewed alongside wellness information, session RPE, workload, GPS data, high-speed running, sprint exposure, training participation, and other performance information.

The goal is not to predict injuries.

The goal is to provide coaches with better context before decisions are made.

Instead of asking only:

“Is this player injured?”

We can begin asking better questions.

What has the athlete actually been exposed to?

What did they complete during the previous match?

What does the upcoming training week require?

Are they participating fully or completing modified work?

Has their recent workload changed substantially?

Have they accumulated enough high-speed or sprint exposure?

What information does the coach need before prescribing today’s work?

Those are performance questions.

And they are questions that can improve how clubs manage availability.

Ground Force and the Physical Side of Availability

At Ground Force Strength and Conditioning Training Systems, our objective has never been simply to make soccer players stronger.

The larger objective is to improve their physical capacity for the demands of the game.

That includes strength.

Acceleration.

Deceleration.

Sprint exposure.

Change of direction.

Reactive strength.

Movement competency.

Recovery.

And progressive loading.

These qualities are not isolated components of training.

Together, they help athletes tolerate and perform the demands they repeatedly experience on the field.

GF XI™ provides the information layer surrounding that process.

Ground Force provides the physical-development system.

One provides context.

The other develops capacity.

Together, the goal is not to promise an injury-free season.

The goal is to create a more prepared athlete and a better-informed soccer organization.

The Real Return on Investment Is Availability

Families competing in ECNL and MLS NEXT environments are already making significant investments in player development.

The question is no longer whether elite youth soccer is expensive.

It clearly is.

The more important question is whether enough attention is being placed on protecting the athlete’s ability to participate in what the family is paying for.

Because when a player loses four months to an ACL injury, the loss is much larger than the medical bill.

It is four months of training.

Four months of competition.

Four months of physical development.

Four months of technical repetitions.

Potential showcases.

Potential recruiting opportunities.

And potentially thousands of dollars already committed to a season in which the athlete can no longer fully participate.

Professional soccer understands this equation.

Elite youth soccer should begin measuring it as well.

In the Premier League, availability has financial value.

In ECNL and MLS NEXT soccer, availability has financial value too.

But for the developing athlete, its greatest value may be time.

And once developmental time is lost, there is no refund.

References

Aspen Institute Project Play. Family spending on youth sports and the growing financial demands associated with participation in organized youth sports.

Carbone, A. D., et al. Trends in healthcare expenditures and patient out-of-pocket expenses in primary anterior cruciate ligament reconstruction. American Journal of Sports Medicine.

Marshall, D. A., Lopatina, E., Lacny, S., & Emery, C. A. Economic impact of neuromuscular training compared with standard warm-up programs in youth soccer. British Journal of Sports Medicine.

Materne, O., et al. Injury incidence and burden in a youth elite football academy: A four-season prospective study of 551 players aged U9 through U19. British Journal of Sports Medicine.

Peterson, C., Li, T., & Norcross, M. Return on investment of anterior cruciate ligament injury-prevention programs in the United States. Journal of Athletic Training.

Veith, S., Whalan, M., Gibson, N., & Sampson, J. A. Exploring the true burden of time-loss injury and partial participation in elite academy football. Science and Medicine in Football.

Xu, A. L., et al. Financial burden of pediatric anterior cruciate ligament reconstruction. Journal of Pediatric Orthopaedics.