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Simon Ball, Consultant Orthopaedic Surgeon 

Treating professional footballers is an immense privilege but also a great challenge.

Established professionals have been through a rigorous selection process and have made it to the “top”. They are therefore, more often than not, put together right - their skeletal alignment, muscle strength and neuromuscular control combined with immense talent enables them to perform at the highest level and do things that the recreational athlete can only dream of. Perhaps the greatest example of this is Cristiano Ronaldo.

As a consequence, the injury rate per minute played is actually low in elite football when compared to the recreational athlete. However, injury does happen and is part of the game.

Types of injuries

The most common injuries that will be seen during the tournament will be musculotendinous contusions and sprains. Players will often make a full and relatively quick recovery from such injuries but, due to their tight schedule, it will result in players missing part or all of the tournament. This is devastating for the player as for most the World Cup is a once in a lifetime opportunity.

More serious injuries involving bone, cartilage and/or ligaments are less likely and one hopes that this type of injury is not sustained.


Management of all injury requires focus, attention to detail and the utilisation of a multi-disciplinary approach to provide a treatment pathway that will ensure optimal recovery and safe return to play. Player involvement and engagement throughout this process is crucial.

On return to play the body will be put to the test due to the intensity of the game, so recovery has to be complete, rehabilitation robust and the process of return to play logical and supported by science. Technological advances with regards to video analysis of movement patterns and GPS data enables a more robust assessment of when a player is “ready”. A slow return, with a gradual build up of minutes played, is always recommended and it is essential to take note of the player’s feedback and confidence. Return to play and return to peak performance are two very different things and it is important that the player, team, staff and supporters appreciate this.

Failure to complete the program, combined with a premature return to play, leaves the player at risk of further injury. Re-injury on return often does not involve the part of the body that was originally injured. This is now termed “Second Injury Syndrome”. Poor preparation and conditioning will increase the risk of this.

Can injuries be avoided?

Mal-alignment (static and dynamic), poor technique, weakness and fatigue increase the risk of injury. This is demonstrated by the fact that the injury rate during a professional football game typically peaks in the last 10 minutes of the game. There is also a rise in incidence just before half time, which is most likely due to loss of concentration.

Many injuries may in fact be simply bad luck. However, the evidence clearly suggests that at all levels preparation reduces the rate of injury. The body has to be prepared for the stress and strain it is put under during match play. In the controlled environment of the training ground and gym, the body should be stressed to a level that exceeds what is endured during the somewhat unpredictable match play. This is logical. Performance and preparation are also closely linked.

Prior to the World Cup players should be perfectly conditioned. However, many players have already played a long season of football and so fatigue may be an important factor especially as the tournament progresses.

Recovery is essential and is often underestimated by most watching the game, including the ex-professional TV pundits! The stress of the modern game is huge and the body needs to be given adequate time to recover. This is a biological process and whilst it can and will be optimised, one must appreciate that biology and physiology has to be respected.

In summary injury avoidance is all about preparation, preparation, preparation.

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Fortius Clinic will be attending the Arab Health convention this January, coinciding with the official launch of a dedicated joint replacement centre in West London.

The 2018 Winter Olympics in South Korea started this month, an exciting line-up of events to keep us all gripped and eager to hit the slopes this winter. From cross country skiing to ski jumping, these professionals need to be in peak condition to face the world’s best athletes and achieve superior performances. Fortunately for all skiing enthusiasts, many gym machines and exercises have been lifted from skiing techniques – helping you prepare your body for the intensities of the slopes and reduce the chance of injury.

-New West London Joint Replacement Centre launches this week

-First-of-its-kind partnership between healthcare leaders Fortius Clinic and Bupa

-Facilities set a new standard in hip and knee replacement treatment with latest robotic technology