Mobility Aids: What Are They?
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5 Most Common Football Injuries
Football is the most popular sport in the UK, with millions of people participating in various levels of the sport. In 2021 there were over 11 million registered football players in the UK across different age groups, genders, and levels of competition. The sport is physically demanding, with the average amateur player covering 8km and the average professional covering 11-12km. Whilst the game is mostly aerobic (low to moderate intensity), about 15% of its high intensity sprints or movements.
This high demand, and intermittent intensity of the game can lead to players becoming injured. Here, we look at 5 of the most common footballing injuries.
Ankle Sprains
The severity of the injury can keep you out of playing for a few days to a few months, and in severe cases may require surgery. One of the most common things we are asked is if you should go to hospital. We use a set of guidelines called the Ottawa Ankle Rules, to guide whether imaging is required – more on those guidelines can be found here. In the initial stage, if there is a concern about possible fracture or associated injuries it is sensible to seek medical advice to rule this out.
As with all soft tissue injuries we should be protecting the injured site, appropriately resting it, icing it, compressing it and elevating it.
Dependant on the severity of the injury, gentle rehabilitation exercises can start within a few days. Starting with range of motion, exercises progress to strengthening, balance and proprioception. As the ankle feels more stable, pain and swelling reduces, rehabilitation can progress to more functional exercises.
A sprained ankle can increase your risk of re-injury as much as 40– 70%, but the correct post-injury physiotherapy exercises significantly decreases the risk.
Muscle Strains
Similarly to ankle sprains, a muscle strain can range from mild to severe and keep you out of playing for several days to several months. The signs of muscle strains; include pain when performing movements that require contraction of the muscle, pain on stretching, and pain on pressing on the affected area.
With a partial or total rupture of the muscle you may feel a lump in the muscle, with a dip next to it. Most muscle strains are not severe enough to require input from an orthopaedic surgeon, but if you have any doubt about the severity of your injury, then a medical consultation should be sought.
After following an initial protocol of protecting the injured site, appropriately resting it, icing it, compressing it and elevating it, rehabilitation exercises can be started. The aims of early rehabilitation for muscle strains is to regain normal muscle length, minimise scar tissue formation and promote healing of the muscle fibres. Progressive overloading of the muscle will aid to increase muscle strength and control, leading onto functional exercises and a return to sports.
The biggest risk factor for a muscle strain, is previous muscle strain and re-injury is not uncommon. Therefore, is important that players continue with a structured program after return to play, including appropriate warm-up and cool down and strengthening exercises.
Knee Injuries
ACL Injuries
An ACL injury, whether you opt for surgery or conservative treatment, will mean a considerable amount of time away from the game – likely to be 12 months plus. Notable players who have suffered ACL injuries include Virgil van Dijk, Roy Keane, Michael Owen, Leah Williamson, and Beth Mead.
Injured players often report hearing a pop, the knee will generally feel unstable and you may struggle to walk on it. Usually you will get large amounts of swelling in the first few hours. Whilst surgery is not always indicated for an ACL injury, it is important to get the knee checked as soon as possible so that all treatment options can be explored.
Early physiotherapy treatment for ACL injuries, for both surgical and non-surgical patients is important. Even if you are having the ACL reconstructed it is important to get good range of motion, strength and stability prior to the operation.
MCL Injuries
The MCL is the ligament on the inside of the knee, and most people recover without surgery, but you should be checked at hospital if you have excessive swelling, struggle to weight bear or if your knee feels unstable.
Footballers often complain of pain when changing direction and side foot passing the ball. Most patients return to physical activity within 3-6 weeks and are at pre-injury level at 3 within 3 months. These type of injuries have a tendency to linger without appropriate rehabilitation and load management. Physiotherapist can help with early management, exercise prescription and progression and Return to Play (RTP) Protocols.
Meniscus Injuries
The menisci are two crescent shaped pads of cartilage which sit within the knee. They are a shock absorber, and generally have a degree of wear and tear as we get older. As we get older it is quite normal to get degenerative tears within the meniscus, the body is usually able to adapt well to these, with the muscles around the knee helping to offload the affected area.
When we twist and turn, it is possible to tear the meniscus (an acute tear) – there are various types of tear, and the severity depends on the rehabilitation time and to whether surgery is indicated. Pain levels in an acute tear range from mild discomfort to high level pain. Players often describe an increase in clicking or locking of the knee, tenderness along the joint line and a feeling of instability. Swelling or increase in stiffness usually occurs 1-2 days after the injury.
The meniscus has a very limited capacity to heal, but the body may be able to adapt. A physiotherapist can guide you on strength and proprioception rehabilitation exercises to help to reduce pain and swelling and get you back to pre-injury level.
If you have a large tear, or physiotherapy doesn’t help after 3 months of conservative treatment then surgery may be needed.
Thigh Contusions (Dead Leg)
Range of motion 24 hours after the injury can be a good marker of how long it is going to take for you to return to sport – but it is usually a few days to a few weeks. Usually a dead leg will improve on its own, but recovery times can be increased with appropriate physiotherapy exercises, hand on techniques and taping.
During the first 24-48 hours it is important to follow normal soft tissue procedures, protecting the injured site, appropriately resting it, icing it, compressing it and elevating it. It is important not to massage the leg, take ibuprofen or undertake vigorous exercise during this time
Myositis Ossificans and Compartment Syndrome are two possible complications of a dead leg, and should you feel that you’re are not improving as you should, or have any worries about your injury it is important that you see a physiotherapist or other healthcare professional.
Concussion
A concussion a mild brain injury that disrupts normal brain function – it is serious and should be treated as so.
If you have any doubt about whether a player has sustained a concussion, then they should be removed from the field of play. Any player with suspected concussion should see a medical or healthcare professional, even if the symptoms resolve!
Concussions do not only occur from a direct blow to the head, but can occur from rapid movement of the head (think whiplash type injuries). The player also does NOT have to be knocked out to sustain a concussion.
Signs of a concussion include;
· Headache
· Dizziness
· Mental clouding, confusion, or feeling slowed down
· Visual problems
· Nausea or vomiting
· Fatigue
· Drowsiness / feeling like “in a fog” / difficulty concentrating
· “Pressure in head”
· Sensitivity to light or noise
These signs may appear immediately or may come on after the initial injury, so it is important to monitor any player who has had a head injury.
Players may not report these symptoms, but may just not seem right. We have removed players from games, where they report that they feel fine but they have shown signs such as poor positional sense, are making strange decisions, or just are generally “off”. Remember IF IN DOUBT – SIT THEM OUT.
999 should be called for anyone exhibiting the following symptoms
- Severe Neck Pain,
- Deteriorating consciousness (more drowsy),
- Increasing confusion or irritability,
- Severe or increasing headache,
- Repeated vomiting,
- Unusual behaviour change,
- Seizure (fit),
- Double vision,
- Weakness or tingling / burning in arms or legs.
Anyone with a concussion – or a suspected concussion should NOT:
Be left alone or consume alcohol in the first 24 hours
Dive until cleared by a doctor
After an initial concussion or suspected concussion – the MINIMUM return to play time should be 19 days for adults and 23 days for under 19’s. After a second concussion the player Any player with a second concussion within 12 months, or if the recovery is taking longer than normal, within should be assessed and managed by a healthcare provider with experience in sports related concussions working within a multidisciplinary team.
It is very important to undertake a standardised return to play protocol, and this should be guided by a healthcare professional, such as a physiotherapist.
The FA has brilliant guideline for return to play protocols, as well as free online courses for those who play or are involved in football (or any other sport). They are highly recommended and can be accessed at www.englandfootball.com/concussion
Whilst this article is titled “5 Most Common Footballing Injuries”, we see most of these injuries from many other sports with quick acceleration/deceleration and change of direction, including cricket, hockey, basketball, rugby, tennis, volleyball and korfball.
Physiotherapists at SB Physiotherapy and Sports Injury Clinic, have a wide range of experience working with elite levels footballers, including as part of the Medical Team at Millwall FC, Crystal Palace FC, Chelsea FC, the Kenyan Football Federation, Beitar Tel Aviv, and Maccabi Netanya. As well as elite level handball and international korfball.
Should you like to book an appointment with one of our physiotherapists, then please call us on 01293 365011 or email info@sbphysiotherapy.co.uk
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