Football, the most popular sport worldwide, where, no matter the level (amateur, semi professional, elite), or type (5-a-side or 11-a-side), injuries are frequent. [1] Football is a high paced and physically demanding sport, where quick changes of directions and a certain level of athleticism have to be met. Due to the latter, most of the injuries found involve the lower limb (groin/hip, knee and ankle). They are mainly caused by traumatic event (collision with someone or something), or by overuse/overtraining. [2]
Most common types of football injuries:
• “Pulled”/strained muscle in the lower limb (mainly found in the groin, thigh and calf areas)
A muscle strain, more commonly known as a “pulled” muscle, is a partial or complete tear of muscle fibres, and is the most common type of injury in football. [3] The main muscles affected are the adductors (groin), the quadriceps and hamstrings (thigh) and gastrocnemius muscles (calf). In order to determine the severity of the strain, a grading system is used worldwide by medical practitioners. [3]
Grade 1 (mild) strain: a limited amount of muscle fibres are affected but there is no substantial loss of power and range of movement in the muscle.
Grade 2 (moderate) strain: a considerable amount of muscle fibres are torned. This is also accompanied by acute pain, swelling in the area, and decreased muscle strength.
Grade 3 (severe) strain: a complete rupture of the muscle. This mean either the tendon (structure that connects the muscle to the bone) is separated from the muscle belly or the muscle belly is torn in two parts. This is characterised by severe swelling and pain, and a complete loss of function of the muscle.
• Ankle sprain
Ankle sprains are the most common lower limb injuries in athletes [4]. It is the motion of twisting or “rolling” your ankle in an awkward position, compromising one or more ligaments in the area. Ligaments are a type of soft tissue that connect bones to other bones and prevent your joints from moving out of your normal range of movement.
The most common type of ankle sprain is the “classic rolling your ankle in”, mainly affecting the anterior tibiofibular ligament (ATFL) located on the lateral side of our ankles. [4]
As mentioned previously in the muscle strain section, a grading system is also used to determine the severity of ankle sprains. [5]
Grade 1 sprains involve minor swelling and tenderness, minimal or no functional loss, and no mechanical joint instability.
Grade 2 sprains include some pain, swelling, and tenderness over the damaged structures. Some loss in joint motion and some mild instability.
Grade 3 sprains are defined as a complete ligament rupture with significant swelling, haemorrhage, and tenderness. There is a complete loss of function and major loss of joint motion and stability.
• Anterior Cruciate Ligament (ACL) injury ACL injuries are the most common type of knee injury found in all sports. [6] The ACL runs diagonally in the middle of the inside of your knee. The ACL crosses with the posterior cruciate ligament, to form an “X” and are called the cruciate ligaments. The ACL prevents your shin bone (tibia) from sliding out in front of your hip/thigh bone (femur). It also provides rotational stability to the knee. ACL injuries are one of the most painful lower limb injuries. This can happen in many ways, such as changing direction rapidly, slowing down while running, landing awkwardly from a jump, or from a high impact/collision. [7] As the ACL is a ligament, the same grading system for ankle sprains is used for ACLs.
In most cases, ACL injuries will require surgical intervention and repair from a orthopaedic specialist. Post-surgical osteopathic or other manual therapy treatment is vital to restore the full function and use of the ACL, and stop preventing a future injury.
A few tips on how to avoid injuries: • Warm-ups and stretches
• Practicing and perfecting your technique
• Healthy lifestyle
Warm-Ups and Stretches There has always been debate and confusion about these two. Which one should we do pre and post physical activity? Is there one better than the other? The answer is: it depends. Warm ups are a type of mobility/dynamic stretch, meaning that you are actively stretching different areas of your body. This is found in different types of activities such as yoga, pilates, lifting weights, and team sports such as football and rugby. It is a conscious way to work and improve the link between our brain and muscles in order to relay a gesture. [11]
Some benefits are: • Building a mobile body, become master of its movements • Improving on strength, stamina and coordination Stretches are a type of static/passive movement. The latter is mainly performed when people feel pain/discomfort in a muscle(s) before or after physical activity, especially when a sense of rigidity is felt. After stretching, a sensation of relaxation and calmness can be felt. People can sometime describe a feeling of being “taller, by elongating their muscle(s)”. While this might the sensation felt, physically, it is not the case! You are, in fact, stretching the nerve, and decreasing it’s nervous information about the pain felt going to the brain. Nowadays, science thinks that the biggest benefit of stretching is to calm painful muscular areas by putting the nerve on stretch and reduce its “pain messages” sent to the brain. [11] The best advice I can give is to try both! Some people prefer to focus on mobility, and other on stretches. The most important thing is too listen to your body!
Practicing and perfecting your technique As the old saying states: practice makes perfect! Practising your technique will help you become a more complete footballer. Wether you play once a week, in a cold rainy Sunday morning, or at an elite level on a Saturday at the Emirates Stadium, the same principle applies, practicing every day for a certain amount of time will benefit you greatly.
Examples of drills to improve your technique:
• Juggling • Shooting • Passing • Dribbling It is important for you to try and work with both feet!
Examples of drills to improve your athleticism:
Running, short and long distances to improve your acceleration and sprint speed, and your stamina respectfully
Balance and agility drills, involving quick changes in direction
Strength Playing different types of football (4v4 for example), will not only allow you to develop your technical abilities but also develop the understanding, the mental side of the game. [8]
Healthy lifestyle From an osteopathic point of vue, our body is engineered for movement! As a sport, football has great benefits in order to promote health and functionality on our body. [9]
Indeed, some health benefits in football include: • Increase and develop muscle mass and bone strength • Building strength, stamina and speed • Training the brain by focusing and improving coordination • Promoting teamwork, being social and boosting confidence
• A reduced risk of injury and illness
• Confidence in being well-prepared for match play
• Consistency in achieving high level performances in matches
If you have any queries about sports injuries or you simply wish to come and seek osteopathic treatment, please do not hesitate to contact us!
Until then take care, listen and trust your body.
Alexandre Calamaro
Registered Osteopath
This article is for educational purposes only! If you are unsure/worried of your injury or what to do next, please seek professional medical help. Do not try to self-diagnose or self-treat it as more harm can be done.
References: [1] Pfirrmann D, Herbst M, Ingelfinfer P, Simon P, Tug S. Analysis of Injury Incidences in Male Professional Adult and Elite Youth Soccer Players: A Systematic Review. J Athl Train. 2016;51(5):410-424. doi: 10.4085/1062-6050-52.6.03
[2] Owoeye, O.B.A., VanderWey, M.J. & Pike, I. Reducing Injuries in Soccer (Football): an Umbrella Review of Best Evidence Across the Epidemiological Framework for Prevention. Sports Med - Open 6, 46 (2020). https://doi.org/10.1186/s40798-020-00274-7
[3] Mueller-Wohlfahrt H, Haensel L, Mithoefer K, et al Terminology and classification of muscle injuries in sport: The Munich consensus statement British Journal of Sports Medicine 2013;47:342-350
[4] Halabchi F, Hassabi M. Acute sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop. 2020;11(12):534-558. Published 2020 Dec 18. Doi:10.5312/wjo.v11.i12.534
[5] Lynch SA. Assessment of the Injured Ankle in the Athlete. J Athl Train. 2002;37(4):406-412 [6] https://www.nhs.uk/conditions/knee-ligament-surgery/
[7] Anterior Cruciate Ligament (ACL) Injuries - OrthoInfo - AAOS, https://orthoinfo.aaos.org/en/ diseases--conditions/anterior-cruciate-ligament-acl-injuries/
[8] Hintermann, M., Born, D., Fuchslocher, J., Kern, R. and Romann, M., 2021. How to improve technical and tactical actions of dominant and non-dominant players in children’s football?. PLOS ONE, 16(7), p.e0254900.
[9] Ben Fletcher, The health benefits of playing football - https://www.pushdoctor.co.uk/exercise/ the-health-benefits-of-playing-football