What they tell the kids is that if they devote themselves to this, they'll get a scholarship. No doubt about it. That's the ultimate goal. The scholarship is everything. —Ben Ohai, parent of soccer players

Like thousands of other girls in Utah, Emma and Tess Burick, identical twins from Salt Lake City, played soccer year round largely with one goal in mind: It would lead them to the college game.

This was the carrot that was dangled in front of them by their club coaches: If you want a soccer scholarship, you have to play the sport year round. The Buricks began playing soccer at 7. By 10, they were playing at the club level — winter, spring and summer — and by 14 they were playing the high school season in the fall, the indoor season in the winter, and the club outdoor season in the spring, plus club tournaments during the summer and winter holidays.

Their bodies rebelled when they reached high school. As a freshman at Judge Memorial, Tess began to experience back pain while playing club games on back-to-back days and by the second day she couldn't play. An MRI revealed Pars Fractures in the L4 and L5 vertebra. The injuries sidelined her for several months and continued to bother her enough that she was forced to miss part of her sophomore school season and the winter and spring club seasons. Still struggling with back problems in the fall of her junior year of high school, Tess tore the ACL and meniscus in her left knee, sidelining her for another nine months.

Then there was Emma. In the spring of her freshman year, she tore two of the four major ligaments in her left knee — the ACL and MCL — plus the meniscus, knocking her out of action for more than six months. In the fall of her senior year, she tore the ACL and MCL in her other knee.

The sisters worked with private strength trainers and rehab specialists to return to play, but by the time their senior years arrived they had had enough. They quit soccer.

"Injuries were a big part of it," says Emma of the decision.

Says Tess, "I was either injured or coming back from an injury or training so I wouldn't get injured. Playing year round there was no break. It was constant training. It caught up with us."

The Buricks' story is hardly an anomaly. Because of their wider hips and other traits unique to their gender, female athletes already have a predisposition for injuries, especially to the knee. Add to that the stop-and-go, hard-cutting nature of soccer itself, combined with the year-round demands of the sport, and you have a recipe for injuries.

"We knew 14 girls during our high school years who had torn ACLs," says Emma. "Some of the girls had torn them more than once and one girl had torn it three times."

Dr. Russ Toronto, who has been treating sports injuries for more than 30 years in Utah, has had hundreds of soccer patients in his office. Although there have been few comprehensive studies on the subject, he believes that club soccer significantly increases the risk of injury, particularly non-contact knee trauma.

"The problem is that it is played year round," says Toronto. "They're never getting time off, and as a result they're getting repetitive-stress injuries because they're doing so much of the same thing all the time. Time away from the sport would be helpful. If you keep doing the same thing, the muscles fatigue and it loads up the ACL. It gets pulled in the same direction all the time and never gets to recover."

Club soccer has taken girls sports by storm, riding the crest of Title IX and the increased visibility of soccer, especially the U.S. women's team. Of the more than 41,000 kids who play club soccer under the auspices of the Utah Youth Soccer Association, half are girls. UYSA has enjoyed phenomenal growth. The organization started in Utah in 1978 with about 2,000 kids and enjoyed steady growth. In 1994, when the U.S. hosted the World Cup, boys and girls membership soared from 20,000 to 30,000 almost overnight. In the last five years, with the continued emergence of Real Salt Lake and the increased TV exposure of the sport, it has experienced another growth spike, adding 6,000 kids. Many of the elite teams were in action last month as clubs competed for state championships in the annual State Cup in Orem.

In the rush to win the hearts and minds of soccer converts in the U.S., the excesses were inevitable, especially on the girls' side where there is no competition with football and Title IX has created opportunities in the college ranks that aren't available for boys. It's not enough to play soccer in its season; girls are pressured to play the sport year round. This has not only produced more injuries, it has also meant a burdensome cost to families, time away from school and home, the loss of family time and vacations, and a specialization that frequently precludes playing other sports and having a broader experience during a child's formative years.

"It's a choice made by parents and kids," says Andrew Hiatt, executive director of UYSA. "Things have changed. Any more, it's come down to where the kids are specializing. It's an opportunity. Kids do piano lessons year round, as well. No one says you have to."

But playing the piano does not damage healthy ACLs or kill family time, and rarely does it cost thousands of dollars, nor are piano students routinely promised a scholarship or required to give up so many other things.

Life for the family and the girl revolves around soccer. Clubs play their league games from mid-August until the end of November, while the older girls play their high school season. They all play on various club teams to compete in out-of-state tournaments during the Thanksgiving, Christmas and New Year's holidays, followed by more tournaments in warm-weather states through March.

Many of the girls also play an indoor season that runs from October through the end of March. The club spring season begins at the end of March and goes to the end of May, culminating in the State Cup. Then it's time for club-team tryouts, followed by more summer tournaments and then fall league play begins again in August.

Those who aspire to play on ODP teams (Olympic Development Program) participate in tryouts in the fall, train from January to March and play tournaments in June and July while also playing for their club and high school teams. In other words, girls play for several teams throughout the year, often at the same time during the various overlapping seasons. This is not to mention the various clinics and camps players attend.

"It's a never-ending cycle," says Bruce Cuppett, chairman of the State Cup and coach of the Sparta Girls Academy.

It's not cheap, either. By the time parents pay club dues, travel and hotel bills, tournament and camp fees and more, it costs thousands every year. Ben Ohai, whose daughters Megan and Kealia went on to star at USC and North Carolina, respectively, estimates it cost him at least $6,000 a year per girl out of his school-teacher's salary. Hailee DeYoung, who earned a soccer scholarship to the University of Portland, says her parents paid $10,000 a year. Another parent, whose daughter is being recruited and requests anonymity, says he pays $10,000 annually. Matt Lyons, another club soccer parent whose daughter Madie recently committed to play for BYU, puts the cost at $15,000.

All of the above are the lucky ones. At least their daughters have been or will be rewarded with scholarships, which is a rarity despite all the promises.

The motivation to play soccer year round often is a scholarship, and the club game is considered the vehicle to get one. High school teams consist largely of whatever students happen to live in school boundaries. Club teams are composed of kids from everywhere — some have been known to drive from Logan to Salt Lake several times a week to play on a particular team — so they are essentially all-star teams. That's why the club game is considered superior to the high school game by aficionados, although the school sport gets the media attention. Because the talent is concentrated on club teams and all top players play club, college coaches tend to focus on club soccer when it comes to recruiting. They're able to see many of the best players simply by attending a handful of tournaments. That's why aspiring players believe they must play the club game, and that means a year-round commitment of time and money.

"What they tell the kids is that if they devote themselves to this, they'll get a scholarship," says Ohai. "No doubt about it. That's the ultimate goal. The scholarship is everything. They point out their previous players who got scholarships and tell them they can do the same thing if you play club soccer."

DeYoung agrees. "College coaches don't care about high school," she says. "There are lots of girls from other states who don't even play high school soccer, which is a shame. It's club and ODP (Olympic Development Program). Coaches were always trying to get us not to play high school. They told us we'd have more time to get scholarships. They think if you continue to play club you can get into more tournaments for more college coaches to see you, and they tell you you'll get so much better if you play club and not high school."

The problem with the scholarship carrot is that few players are offered such a reward. According to a report in the Deseret News, in 2011 only 86 soccer scholarships were awarded in the entire state; in 2010, it was 82. And some of those were awarded to boys, though not many (because of Title IX, non-football athletic scholarships tend to go to girls). Even if the newspaper missed a few scholarships, the number certainly is revealing. To make matters worse, the vast majority of those scholarships are partial, meaning parents still have school costs.

"Many of these club coaches make some big promises to the kids about scholarship opportunities that await them if they compete for their club team," says Roger Buhrley, a veteran high school track coach at Syracuse High who, like most prep coaches, has developed a certain contempt for club sports and their excesses. "The kids are paying some big money to the clubs and to their personal coaches in pursuit of these scholarships. For the amount they pay, they could pay their way through Harvard."

Says Cara Christensen, whose daughter Natalee was recently awarded a soccer scholarship to the University of San Diego and currently plays for Sparta, "If you put that money in the bank you could go to any school in Utah for four years easily."

These are commonly repeated themes in the soccer world, even by the sport's biggest devotees. Is it worth it? Usually the debate not only includes financial considerations, but the other sacrifices that the girls and their families make — family vacations, class attendance, participation in other activities.

"This last fall was the first time I spent Thanksgiving at home in 12 years," says DeYoung, a recent graduate of Portland and a veteran of five collegiate seasons and a decade of the club game.

Says Ben Ohai, "You really have to sacrifice. Everything is soccer. We didn't go on family vacations. Every weekend was a soccer tournament. All our resources went to that. We didn't go fishing. Skiing was out. Family trips were connected to soccer. You know how many Thanksgivings we missed? Probably 10 in a row."

Many top-level club coaches discourage kids from doing other sports or make it impossible to do so simply because of the time commitment they require. Many of the girls buy into the notion of specialization, but those players who want to participate in other activities after school find it impossible or exhausting.

The Buricks tried to run track but found it "stressful," racing to soccer practice after an exhausting workout on the track. Kealia Ohai placed fourth in the 100-meter dash as a sophomore on her high school track team, but couldn't find the time between all the soccer commitments to participate the next two years.

"Soccer constantly conflicts with anything else," says Ben Ohai. "In track, every time we had a meet we had soccer. They occupy so much time. It's really hard to do another sport. They don't have a normal high school experience."

Many club soccer coaches encourage or even pressure girls to specialize at young ages. It is revealing that Katie Larkin, a former BYU All-American who played professionally for two years and is now an assistant ODP coach, says players don't have to choose one sport "but as soon as they hit 13 or 14, that's the age they have to buckle down and choose one over the other. That being said, you could still play two sports but you need to make one a priority."

Dr. Toronto, who takes a fierce stance against year-round soccer, notes, "Of all the sports I take care of, soccer coaches are the most jealous of their players, the least willing to cooperate with kids who are doing other things — definitely, more than any other sport. They are the most restricting. You can't do anything else."

Some of the more cynical parents wonder if there isn't a conflict of interest. The clubs stay in business through player fees, and many of the coaches are paid, although few make a full-time living doing it. One prominent high school coach notes, "A lot of clubs tell the kids that to get scholarships they have to play club and do this and that … but that's how they make their money. It's a money-making thing."

Says Lyons, "These coaches hold these kids almost hostage, denying them opportunities to do other things. Then you see kids who should be told it's not going to work out (for a scholarship), but they're taking their money. The parents are hoping some college coach is going to show up and offer a scholarship. It's not going to happen. They could have saved their money and sent her to college."

All this notwithstanding, the most troubling aspect of young athletes specializing in soccer is the physical toll. In 2008, a New York Times Magazine cover story explored the injury risks of women's sports and focused on soccer. The article was written by Michael Sokolove and was adapted from his book, "Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women's Sports."

Sokolove wrote, "Even football players, according to NCAA statistics, do not rupture their ACLs during their fall seasons at the rates of women in soccer, basketball and gymnastics. If girls and young women ruptured their ACLs at just twice the rate of boys and young men, it would be notable. Three times the rate would be astounding. But some researchers believe that in sports that both sexes play, and with similar rules — soccer, basketball, volleyball — female athletes rupture their ACLs at rates as high as five times that of males."

Sokolove notes that the NCAA's Injury Surveillance System tracks injuries suffered by collegiate athletes, calculating the frequency of certain injuries by the number of occurrences per 1,000 "athletic exposures" — practices and games. The rate for women's soccer is 0.25 per 1,000, or 1 in 4,000, compared with 0.10 for male soccer players. The rate for women's basketball is 0.24, more than three times the rate of 0.07 for men.

"The ACL injury rate for girls may be higher — perhaps much higher — than it is for college-age women," writes Solokolove, "because of a spike that seems to occur as girls hit puberty."

Sokolove quotes Anthony Beutler, who at the time was a major in the U.S. Air Force and a professor at the School of Medicine of the Uniformed Services University in Bethesda, Md. In 2001-02 Beutler served as a physician for the women's soccer team at the Naval Academy. In his first year with the team, seven players were lost for the season with ACL injuries. "I thought to myself, What in the heck is going on here?" Beutler told Sokolove in 2008. He reported that when the women's team suffered three torn ACLs in a subsequent season, "They thought that was great, a fortunate year. Think about that. Just three. It's bizarre."

There is also fear of serious injury to another part of the body on the soccer field: The brain. Studies indicate that girls soccer ranks second only to football for concussions among young athletes. That's partly because girls' smaller, weaker bodies make them more vulnerable to concussions and partly because soccer players often lead with their heads to strike (or "head") the ball out of the air with the top of their foreheads, which leads to head-first collisions with other players. Research also suggests that the act of heading the ball itself causes brain injury, and one can only imagine the cumulative effect of this after playing the game for years. Dr. Robert Cantu, one of the nation's leading experts on sports concussions, believes heading the ball should be banned.

By the time she finished her soccer career, DeYoung had had four surgeries on her nose (the result of collisions), a sprained right shoulder, a sprained ankle that required a year of healing before she could kick a ball without pain, eight hip flexor injuries, a groin injury that persisted for a year and required cortisone injections, a back injury, and a subluxated left shoulder. This was the result of playing a spring/summer club season (10 games, plus 5-7 games for the State Cup, plus another 5-7 games in the regional tournament), then the high school season (as many as 26 games), the late fall club tournaments (3-4 tournaments that consist of 3-5 games each), followed by ODP play (3-5 games) and region camp in the summer (one week, including 5-9 games, plus evening practices, followed by another five days of training and another 4-5 games). If she had played on the national team, there would've been another couple of weeks of training camps and "live-in" camps.

"All my friends on the national team have injuries, like knee problems, ACLs," DeYoung says. They just work you and work you and work you. Nobody ever learns or puts two and two together. The national team might not even have the best players; it's whoever can stay healthy. I had at least six teammates who had knee surgery and some of them more than once."

Cuppett, a veteran club soccer coach and administrator, is a voice of reason in the club soccer ranks. He acknowledges the excesses, but says the sport is improving. For one thing, there is oversight now, with a tracking system to detect players who train or play too much. There also is a push to implement a training program that utilizes a series of exercises that can help prevent the knee injuries that plague the sport. Cuppett believes club soccer is making progress in addressing the other excesses, whether it's the players' time commitment or coaches who overwork their players simply because they must win to keep their jobs.

"Some clubs see that," he says. "But some (coaches) do what is best for the player. They emphasize rest, school, taking time off. I see that more and more. People are figuring it out. The national average for burnout is 75 percent — either kids quitting or they don't want to play anymore and just want to be a kid. It's been studied. Kids are tired of playing. I get players coming to me saying, 'Bruce, I just want a weekend off. I just want to be a kid.' More and more we realize that we don't need to train more than an hour and a half at a time. People are waking up and saying these girls have to have a life beyond soccer. I tell my parents to find something they like to do. Make soccer a seasonal sport. The choice comes when they get older."

Dr. Toronto has had a front-row seat to the problems with the club soccer game, and he pulls no punches when he discusses it. "It bothers me that this is happening to kids," he says. "No one is standing up for them. This isn't the best way. It's OK to play soccer, but do something else in the summer and winter.

"The kids are afraid to tell the coach even if they have an injury. The parents are chicken, too. They ask me, 'Can you call the coach for us?' I give them a note to give to the coach. Parents are unwilling to take charge of what's happening with their kids. They're intimidated. They're afraid to intervene for their kids in general. I've heard of families altering vacation plans to accommodate soccer workouts.

"It just seems like the coaches have so much control over the kids, and the parents allow it to happen for fear their kid will suffer some repercussions. Whole families are controlled by a soccer coach. I see this pattern of parental fear of coaches. It isn't limited to soccer, but it seems more prevalent. Parents no longer seem willing to be their child's advocate at the risk of offending a coach who they are actually paying money to so their kid can play. The whole youth sports movement is not good for the health and well being of the kids and their families with the direction it is going."

Despite such concerns, the players love the club game, including the travel, the training and the camaraderie. "I had a great experience with club," says Larkin. "I had the time of my life. I had to sacrifice a lot, but I never thought of it as a sacrifice. I traveled all over. I experienced more and did more."

"I don't know if my parents would agree, but it was worth it (to play club)," says Cloee Colohan, a former club player who plays for BYU. "There were sacrifices. I was always doing homework on the road. Friends would ask if I could do something and I would have to say, 'Sorry, I have soccer.' We traveled a lot. I was home for three weeks and then off to another tournament. I played other sports till eighth grade, and then I just couldn't do it or make it work. I wish I could've done more. I had to focus on something. It was a lot of time to put into one thing in your life. But I would never take any of it back."

The high burnout rate notwithstanding, the girls embrace the sport while acknowledging its flaws and knowing their parents' concerns. Says Ben Ohai, "Parents complain about the time and money commitment. There's a constant debate in the stands about whether it's worth it."

Apparently, most decide it is. As Matt Lyons says, after expressing his frustrations with the sport, "I do it because my kid loves it. ... Soccer has been more than just an expensive game. For my daughter and family it has been an unbelievable network of friendships. These kids hang together through thick and thin. Soccer just happens to be what they love to do, their activity of choice. Soccer players do have to make sacrifices based on their commitment. I would bet the majority of these kids play soccer because it is what they love to do with their time, scholarship or not."

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As for the Buricks, they are now 20-year-old sophomores at the University of Portland, one of the powerhouses in women's collegiate soccer, but they are not playing on the school team. They gave up on their dream of playing the college game. Instead, they play intramural soccer. As a postscript, the injuries have continued. As a Portland freshman, Emma tore the meniscus in her right knee in an intramural game.

"I've definitely missed soccer," says Tess. "But all the stress that came with the injuries and working to come back — I don't miss that more than I miss playing."

Editor's note: Deseret News staff writer Doug Robinson has coached high school track and/or football for more than 20 years. It was through coaching that many of the issues with club soccer came to his attention.

Email: drob@desnews.com