Association Football is the single most popular sport in the UK. Over 240 million players are registered worldwide and there are millions more recreational players. Statistically, there are more injuries associated with football than with other sports. Older players are more likely to suffer an injury than children and adolescents. The areas that are commonly affected are the foot, ankle, calf, knee, thigh, hip and groin.
Most injuries can be attributed to trauma (such as colliding with another player) or to overuse. Traumatic injuries have a rapid onset that can be related to a specific incident, whereas overuse injuries develop gradually.
There are several common lower limb injuries associated with football and knowing how to prevent and treat them is important for footballers.
A hamstring strain or tear
The hamstring is the large muscle and tendon structure at the rear of the leg. It can become strained or torn when it’s stretched beyond its normal range. This normally happens when sprinting during a football game, but it can also build up over time if the muscle becomes fatigued.
Hamstring injuries are graded according to how severe the injury is. The mildest hamstring injury is a grade 1 and this is a mild strain or muscle pull. It feels like a sudden pain in the back part of the leg. Over the next day or so, it can hurt if you try to move the leg, but the function of the muscle is normal and there is complete recovery within a few days.
A grade 2 injury is a partial muscle tear. This is much more painful, and the affected area will feel very tender. There can be bruising and swelling on the back of the leg and the muscle may not work properly. This will be noticed as a loss of strength. It can take months to fully recover from a grade 2 hamstring injury.
People who have suffered a grade 3 hamstring injury often describe a sudden "popping" sensation accompanied by pain and tenderness. The area is usually very bruised and swollen and it is impossible to use the affected leg. Because the muscle is completely torn, it can take months to properly recover. Once a player has suffered a hamstring injury they are more likely to suffer another one.
It is important to treat a hamstring injury correctly, right from the start.
Current medical advice is to rest the affected leg by keeping it still and using crutches if necessary to avoid weight-bearing. Ice packs should be applied to the affected area every two to three hours and left in place for 15 to 20 minutes. Swelling and movement can cause further damage to the muscle, so it is best to reduce it by applying an elastic bandage or elasticated tubular bandage and elevating the leg.
Footballers can reduce their chances of suffering a hamstring injury with stretching and strengthening exercises, as well as warming up correctly before training and games.
Ankle sprains and strains
A sprained ankle occurs when the soft tissue around the ankle joint (usually the ligaments or the joint capsule) are stretched too far. This often happens as the ankle is twisted inwards when changing direction or during a tackle. The damage causes tissue bleeding, swelling and pain.
The initial treatment is very similar to that for a hamstring injury. A careful regime of rest, ice, compression and elevation should ensure recovery within a few weeks. Painkillers may also be useful. However, strenuous exercise may need to be avoided for up to two months to prevent the risk of causing further damage.
Further sprains and strains may be prevented by taping and bracing the ankle. Research has shown that this can significantly reduce the incidence of recurring ankle injuries. A physiotherapist may be able to prescribe strengthening exercises using a wobble board. This device can re-educate the balance and proprioception (position sensing) functions.
Anterior cruciate ligament (ACL) injury
Ligaments are bands of tissue that join two bones together. The anterior cruciate ligament helps to connect the femur (the thigh bone) to the tibia (the shin bone) and so holds the knee joint together. ACL injuries are common in football and in other sports where sudden stops and changes in direction are common. Typically, a footballer suffers an ACL injury as they land from a jump onto a bent knee which twists. It can also be caused by an over-extension of the knee or contact with another player.
People who have an ACL injury often describe a "popping" feeling in the knee area followed by swelling, pain and a sensation of instability or ‘giving way’. Immediate treatment is the same as for other soft tissue injuries and should be a combination of rest, ice, compression and elevation. In milder ACL injuries, this may be sufficient. Physiotherapy treatment is also useful for rehabilitation and specific strengthening exercises will be prescribed. During this time, the knee may be braced, and crutches may be used to avoid weight-bearing.
Footballers inevitably continue to put strain on the ACL and they may be offered surgical repair, especially if the knee is buckling. During keyhole surgery, the damaged ligament is removed and replaced with a segment of tendon graft. This is usually the hamstring or the patellar tendon. It acts as a matrix around which new ligament tissue can grow. A period of rehabilitation and gradual return to sports training follows the surgery. It usually takes about six months before the reconstruction is strong enough to return to playing football.
Footballers can reduce their risk of ACL injuries with appropriate training drills that require balance, power, and agility. Plyometric exercises that involve high-intensity jumping have proved to be very effective. Strength training of hamstrings and the gluteus maximus muscle, together with proprioceptive training (on a wobble-board), helps balance and reaction times.
Footballers are exposed to several risks during training and games, which can sometimes result in injury. However, modern biomechanical research and suitable training regimes can go a long way to reducing those risks.