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At Physio.co.uk, we treat a wide range of patients, who present with a multitude of different injuries.

A healthy portion of these patients are sportspeople, who have sustained injuries while performing their particular sport or activity. As a result, we quickly become accustomed to the common conditions that are associated with each type of sport.

This knowledge can be important when diagnosing a particular injury based upon the clinical presentation, while an understanding of the movements and actions that are involved in each sport is essential when returning a patient back to their specific activity.

Below we have compiled a list of the 3 most commonly seen injuries in football, along with looking why these injuries are likely to occur within the sport.

Enjoy!

  1.  Hamstring Strains

hamstring strains physiotherapy

Hamstring strains are amongst the most common injuries sustained within any level of football.

Research shows that between 8% and 25% of all injuries sustained in professional football are attributed to hamstring-related injuries, with the vast majority of these being muscle strains.

An injury is caused by extensive mechanical stresses being exerted during movements, resulting in the tearing of muscle fibres. The number of muscle fibres that are affected allow the injury to be graded as follows:

Grade 1 (Mild)

         Limited number of fibres affected

         Nil decrease in strength

         Nil reduced ROM

Grade 2 (Moderate)

         Tearing of up to half of muscle fibres within the unit

         Swelling and significant pain

         Reduction in strength (minimal – moderate usually)

Grade 3 (Severe)

         Complete rupture of muscle (either separation of muscle belly or tendon from muscle)

         Severe swelling and pain

         Complete loss of function  

The severity of injury will then obviously dictate the type of input required, as well as determine the length of time required before return to sport can be achieved.

Why?

Strength Imbalances

The hamstring group within the footballing population appears to be particularly at risk due to potential muscle strength imbalances. It is generally accepted that football is a highly ‘quads dominant’ sport, in which the quadriceps muscle group situated at the front of the thigh is responsible for a high proportion of associated actions within the sport, eg explosive sprinting, powerful knee extension (ie during kicking movements).

Therefore, rather than the hamstring group being particularly ‘weak’ when tested in isolation, it is instead suggested that injuries may be sustained due to an insufficient strength ratio between muscle groups at the front and rear of the thigh.

As a result, professional football teams invest a significant amount of resources to ensure that their players are regularly monitored and strength tested to ensure they are not pre-disposed to such injuries.

Muscle Length Deficits

Reduced hamstring length (as well as other neighbouring muscles) may also be a risk factor for sustaining hamstring strains within the sport.

Insufficient length within musculature will result in an increased amount of tension transmitted through the muscles, which may increase the chances of injury.

Within the professional game, the research doesn’t indicate that insufficient hamstring length contributes to the significant number of hamstring injuries seen each season.

This is probably because deficits in hamstring length are unlikely to exist in higher level athletes when considering the amount of time invested in maintaining lower limb range of movement, along with the relative ease of testing muscle length. However, in lower level formats of the game, this may be a factor that needs to be considered in order reduce likelihood of injury.

Previous Injury to Hamstring Group

Players who have suffered previous hamstring strains are far more susceptible to suffering re-injury, with research suggesting this risk is 2 to 8 times greater than their previously uninjured counterparts.

While it is recognised that many of these players suffer re-injury before full healing of associated structures is complete, (ie under 8 weeks of initial injury), research also shows that these individuals are at significantly increased risk of sustaining further injury up to years afterwards.

Furthermore, research also suggests an increased risk of injury within neighbouring muscle groups (ie calf muscles), which highlights the importance of considering the knock on effect that these injuries may have upon surrounding areas.

  1. Quadriceps Muscle Contusion

Quadriceps Muscle Contusion physiotherapy

Muscular contusion injuries are regarded as potentially the most commonly sustained injury within football, and it may be safe to say that anybody who has played the sport for a significant amount of time will have suffered some degree of this type of injury!

A contusion (or ‘’dead leg’’) is caused by a sudden impact to an area of muscle, typically the inner, outer or central aspects of the thigh, resulting in pain, swelling and tenderness.

While injuries of this nature are often regarded as less significant that other more severe types of sporting injuries, the effects can often be debilitating to the athlete involved if the damage sustained is substantial.

This damage to structures can be classified as being either:

Intermuscular – the tearing of the muscle itself AND its surrounding layers. Initial injury may result in increased bruising as a result, yet this is able to drain away more easily.

Intramuscular – result of tearing of the muscle and its fibres WITHIN its surrounding layers. The result will be an increase in pressure within the muscle, as well as less visible bruising. These injuries can result in considerable loss in range of movement and function and may take longer to recover from.

Contusions can then be further classified depending upon the amount of damage that caused as a result of injury, these are as follows:

Grade 1

         Tightness and pain in thigh area

         Minimally reduced ROM

         Pain on weight bearing/altered walking pattern

         Minimal swelling

Grade 2

         Tightness and pain. Some sudden ‘twinges’ during activity.

         Reduced ROM

         Unable to weight bear pain-free

         Resisted movements are painful

         Swelling may be present

Grade 3

         Severe pain and tenderness

         Significantly reduced ROM

         Unable to walk unaided

         Severe swelling and bruising

         Any contraction of the muscle is painful

The effects of the injury can fluctuate significantly, with some players able to continue participation immediately afterwards with little consequence, whereas others may take several weeks to return to the previous level of activity.

Why?

When considering the actions involved in football it is fairly easy to appreciate why these types of injuries are sustained so readily within the game.

Football is a contact sport, predominantly involving the lower limbs, where players are travelling at high speeds and constantly challenging one another for possession of the ball.

As a result, it is to be expected (unavoidable in fact) that collisions will occur, and the quadriceps muscles are the most obvious recipient of these types of impact due to their location at the front of the thigh.  

Therefore, as football is then so heavily reliant upon forceful contraction of the quadriceps group, injury to these areas will require full recovery before a player is able to return to their previous level.  

  1. ACL Injury

acl injury physiotherapy

The Anterior Cruciate Ligament (ACL) is one of 4 main ligaments that retain the knee and remains among the most commonly injured structures within contact sports.

The ACL itself is cord-like structure that attaches from the femur (or thigh bone) to the tibia (shin bone) and works in tandem with the Posterior Cruciate Ligament (PCL) to form an ‘X-Shape’, helping to keep the two surfaces in close contact with each during movements.

It is estimated that around 3% of amateur athletes sustain ACL injuries each year, and for higher-level athletes, this percentage may even rise to 15%. Upon injury, patients will usually present with acute pain that occurs during a specific action, with people often reporting an audible ‘popping’ sound with more significant ACL injuries.

Ligamentous injuries of this nature are generally classified as follows depending on the amount of damage sustained to the structure:

Grade 1 – Overstretching of ligament fibres but no actual tear. Tenderness may be present but no instability felt during movement or specific tests of the knee.

Grade 2 – Partial tearing of ligament fibres. Some bleeding and swelling at site of injury. Instability may be noted during movement or laxity present during testing.

Grade 3 – Complete rupture of ligament. May even present with reduced pain compared to Grade 1 or 2 injuries. Expect laxity during testing and reports of instability from the patient.

These grades of injury will then decide what type of intervention is required (Grade 3 injuries will require surgical intervention in almost all instances), which will then dictate the length of recovery before returning to activity.

Why?

Role of the ACL

The ACL’s role is to prevent excessive ‘shifting’ of the surfaces of the knee joint throughout its various stages of movement.

Whilst it is regarded to work in conjunction with the PCL, the ACL itself is thought to provide 85% of the restraining force required.

As a result, it is easy to understand why this ligament may then become overloaded during certain movements and cause injury to this structure in isolation.

Mechanism of Injury

Physiotherapy session

This then highlights the mechanisms that are required to cause damage to the ACL. It is recognised that the injury may occur as the result of a direct or non-direct form of contact, however more commonly ACL injury is sustained during non-contact movements, such as changing direction or landing.

When we consider that footballers are required to consistently;

         Perform quick turning movements at varying degrees of knee bend

         Use explosive bursts of acceleration followed by deceleration  

         Carry out unpredictable landings on a single leg stance,

…it is easy to recognise why these injuries are sustained so commonly.

Gender

It is widely recognised that females suffer ACL injuries at a far more frequent rate than their male counterparts, with research estimating that they may be between 3 and 9 times more likely to sustain injury.

This is not believed to be attributed solely to one factor, but instead is likely due to numerous reasons, such as;

         Strength or control differences  – reduced muscle strength and/or control can result in decreased stability

         Increased ‘Q’ Angle – due to the larger width of pelvis size in females, the angle between the femur and the tibia is greater, which can lead to an increase in knee positions that are risk factors for sustaining ACL injury

         Ligament laxity – increased laxity in the ACL in this population may be attributed to structural differences or alterations in hormones

         Anatomical differences – due to altered shape and size of the structures in the knee that the ACL originates from and attaches to

As many of these factors that contribute towards risk of sustaining ACL damage within football remain unavoidable, there is an increased emphasis upon ensuring that players maintain adequate strength, endurance and control of surrounding muscle groups to reduce chances of sustaining injury.

Finally…

We hope you enjoyed our blog on the 3 most commonly seen injuries in football.

Stay tuned for our follow up article- treatment of common football injuries.

 

References

  1.    Mueller-Wohlfahrt et al (2012). Terminology and Classification of Muscle Injuries in Sport: A Consensus Statement. Obtained from: http://bjsm.bmj.com/content/early/2012/10/17/bjsports-2012-091448.full?g=widget_default
  2. Prior, M. et al (2009). An Evidence-Based Report of Hamstring Strain Injury – A Systematic Review. Obtained from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445075/
  3. Noyes, F. & Westin, S. (2012). Anterior Cruciate Ligament Injury Prevention Training in Female Athletes- A Systematic Review of Injury Reduction and Results of Athletic Performance Tests. Obtained from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435901/
  4. Van Mellick, N. et al (2016). Evidence-Based Clinical Practice Update: Practice Guidelines for Anterior Cruciate Ligament Rehabilitation Based on a Systematic Review. Obtained from: http://bjsm.bmj.com/content/early/2016/08/26/bjsports-2015-095898.full?sid=f0183f65-f8ac-4772-8091-6aac8f941439
  5. Hoth, P & Amendola, A. (2014). Contusions, Myositis Ossificans, and Compartment Syndrome of the Thigh. Obtained from: http://link.springer.com/chapter/10.1007/978-1-4899-7510-2_9

 

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