Football fever: Common football injuries

As a FIFA Medical Centre of Excellence, the team at Fortius follows football closely, not necessarily who is winning or losing, but more around the issues of player injuries and return to play, in progressing new research and sharing new techniques and innovation. We treat footballers at every level of the game from the elite to weekend recreational dabblers. But the knowledge and experience we gain treating professional footballers and other elite athletes, enables us to provide a better standard of care for all our patients.

As Mr Simon Ball, Knee Consultant, said at a recent lecture “Elite footballers are under constant pressure to perform consistently at the peak of their ability. There is no let-up. If injured, they need a solution that enables an optimal return to play with low risk of re-injury".

In essence footballers are “living wear simulators”. They show, in a relatively short period of time, what will happen to the general population over many years following certain injuries.

There are many lessons to be learned from their care, including the need for improved strength and conditioning, along the lines of the FIFA 11+ research, which has demonstrated reduced injuries of between 30 – 50%. Elite athletes who are part of clubs with a positive injury prevention culture generally have excellent trunk and pelvic stability and superb neuromuscular control of the knee. This reduces the risk of injury but also enables them to cope with minor damage to the knee. During a pre-signing medical it is not uncommon for there to be minor changes on the MRI scan of the knee but the player will often show no symptoms, playing regularly at the highest level with no pain or swelling.

The majority of footballing injuries occur in the lower limbs, such as the hip and groin, knee, foot and ankle. These injuries may be caused by a collision with another player or landing awkwardly from a jump, or they can be a chronic injury, which develops over time.

Some of the most common football injuries:

• Muscle injuries: are the  most common injuries in most sport and can vary depending on their severity and grade, which can easily be determined from an MRI and/or ultrasound scan .  Assessment is important as early recognition can guide management. Most injuries are relatively minor, but some can involve the central tendon within certain muscles and have a high rate of recurrence.
• Achilles tendon pain and tendinopathy: Another common overuse injury, is caused by wear and tear on the Achilles tendon, which connects the calf muscle to the heel bone and is important in being able to bring the foot downwards, going on tip-toe, and also providing a good push-off when walking or running. Pain in the Achilles tendon, more common among middle-aged athletes, can be caused by a number of factors, including a rapid increase or change in a training regime, insufficient recovery set aside and not having the muscle/tendon capacity to cope with the level of exercise. Rolling over on your foot, which often happens in football, can put extra strain on the tendon. However, in some cases, the tendon can sometimes become painful for no apparent reason, even when someone is in regular training; this may be due to arthritis or other inflammatory disorders. Read more on achilles tendinitis and treatment here.
• Ankle sprains and instability: The ankle joint acts as a hinge between the leg and foot where the bones of the leg meet the top of the ankle joint. These bones are held securely together by ligaments, strong bands of collagen tissue, and muscles attached to the bones of the foot add to the stability of the joint. Ankle sprains are usually caused by the foot being twisted suddenly, often with the sole pointing inwards, which called an ‘inversion injury’. Read more on ankle sprains and treatment here.
• Meniscal injury: Torn knee cartilage is usually a torn meniscus. The meniscus is the piece of cartilage in the knee joint that cushions the knee as it moves in multiple directions, as commonly occurs during a game. There are two menisci in each knee joint and they can be easily damaged or torn. Meniscal injuries usually happen when the knee is suddenly twisted in a bent position while the foot is still in contact with the floor. The medial meniscus is more commonly injured than the lateral meniscus because it’s less mobile. Injuries usually result in immediate pain, followed by gradual swelling in the knee and limited movement. You may then experience pain on the medial side (inside) of the knee during certain activities such as twisting, kneeling and deep bending. Sometimes the knee can lock in position if part of the meniscus becomes trapped in the joint. Read more on meniscal injury and treatment here.
• ACL injury: The anterior cruciate ligament lies deep in the knee joint, connecting the shin bone to the thigh bone. It stabilises the knee, preventing the lower part of the leg from moving too far forward and the knee joint from excessively rotating. Footballers are prone to tearing this ligament when twisting or changing direction suddenly or landing on a knee that is over-extended. Direct contact from another player can also be a cause. A significant number of patients hear a ‘pop’ or ‘snap’, and/or the knee gives way, followed by swelling within a few hours. You may find that you are unable to put all your weight on the affected leg and that you cannot fully straighten or bend it. In the longer term the knee may feel unstable and may even give way, particularly with a change of direction or rotation. Over time this leads to repetitive damage to the joint surface and meniscus (cartilage), potentially leading to the early onset of osteoarthritis. Read more on ACL and treatment here.

The consultants at Fortius Clinic are committed to continual research and education to provide the very highest standard of care and best possible outcomes for their patients.