The FIFA World Cup has begun and although injuries in Football tend to be common occurrence, big efforts are made within the sport to help prevent injuries. This includes implementing strategies such as modifying rules within the game, or monitoring athletes throughout their training, time spent in matches and sleep activity (amongst many others) to reduce the risk of injuries.
Recent injuries during the World Cup tournament so far have seen France’s Lucas Hernandez suffer a rupture to the anterior cruciate ligament (ACL) in his knee and Iran’s goalkeeper Alireza Beiranvand suffer a head clash and suspected concussion, in addition to Harry Kane hurting his ankle in the first match.
We spoke to Dr Bruce Paton, The Institute of Sport Exercise and Health (ISEH) and University College London Hospitals (UCLH) Consultant Physiotherapist, to find out more about the common and worst lower limb injuries within the game, while discussing some of the reasons and causes for this. Dr Paton also talks about treatment and recovery times for certain injuries, and shares insight on whether this has improved over the years. He also talks about the preventive measures Football clubs are taking to help reduce injuries.
Injuries in football:
There are many reasons for increasing injury rates in football, this is explained below:
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At an elite level, athletes’ tissues within their body are functioning to a maximum capacity on the edge of their “envelope of function” (the amount of activity that can be tolerate or manage without any pain-related symptoms or injuries). And with players always aiming to exceed their previous performance during games, they will often push themselves beyond their maximum limit and tissues break down.
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In contact running sports like football, the game involves a fast-moving field of play environment with a “controlled chaos” – meaning athletes are having to continually adapt their movement and speed to the environment around them. There is evidence of faster reaction times to changes of direction compared to other sports, such as, endurance sports. The contact also means high speed/ force injuries with collisions – such as fractures or concussions are more likely.
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Increasing match play for elite players with their club, or commitment with their national team (especially in World Cup years) has unsurprising contributed to more injuries in the sport. In addition to this, timetabling congestion of games, and increasing international travel.
This all leaves less recovery time between matches with interruption of athlete’s body clock and less time for preventative type exercises. The intensity of match play has increased as the clubs become more competitive and the level of physicality in players has gone up. This has resulted in more time and faster pace of running in games.
Common injuries in Football
Muscle Injuries: e.g, Hamstring or rectus femoris tears
Muscle and Hamstring injuries are the most common time loss injury in football, as players spend much time out of play to recover. The average time out of matches for a hamstring injury is about 21 days; high grade injuries can involve up to 3-4 months out of matches to recover.
Most hamstring injuries rehabilitate well, but there may be a risk of another injury. Prevention programmes are particularly important for athletes who have had past injuries. Rehabilitation tends to be longer if the injury involves the tendons or muscle tendon junctions (MTJ) vs the muscle tissue itself
Sometimes injuries (especially tendon or MTJ injuries) will fail to rehabilitate, and require surgical treatment of the hamstring, the factors that influence this include:
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the type of tissue injured, this being the muscle or tendon (tendons heal much more slowly – muscle tissue has satellite cells for healing, which are like natural stem cells)
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the involvement of the sciatic nerve – which sits near the hamstring attachment and can be injured or scarred into the healing tendon.
When an injury happens before a major tournament like World Cup, it can be devastating for an athlete – an example of this would be with Chelsea and England left back Ben Chilwell, who suffered a hamstring injury. A player such as Ben would have huge drive to get out and play, and if there is a way of getting an athlete to compete, the medical staff and coaches will do everything possible to prepare this – even if this may be later in the tournament to allow for more healing time.
Some consequential injuries suffered by athletes however can breakdown badly if pushed too hard too soon – resulting in a career threatening injury. The player and medical staff are often faced with the choice between one big tournament or the athlete’s career.
Ligament injuries in football: e.g, Knee/Ankle ligament tears
Ligament injuries are less common than muscle strain injuries and they occur most commonly in the knee and ankle in football. They can sometimes be more severe than muscle injuries because ligaments can take longer to heal:
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Bony injuries around the knee/ ankle are thankfully rarer but because of the knee and ankle biomechanics, ligament injuries are more common than bony injuries (some knee or ankle injuries happen without contact – and can relate to pivoting movements at speed or ankle sprains. Luckily they can be prevented with good training programmes such as the FIFA 11 Plus)
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Although some ligaments (e.g, medial collateral ligaments in the knee or lateral ligaments in the ankle) will generally heal with good rehabilitation making for a fast return to the game, other ligaments for example, the anterior cruciate ligament (ACL) in the knee, will frequently not heal after tears, which will often leave the knee unstable in certain rotary movements (even with good rehabilitation). This type of injury is more consequential and may require surgery – with options such as ACL reconstruction.
Bone Injuries: e.g, ankle fractures or contact injuries, such as Concussion
These injuries are thankfully rarer in football but are more consequential, with players suffering potential long term (life long) effects if not managed well immediately. They also require more time to rehabilitate.
What is being done to help minimise injuries?
Many sports (including football) have sought to protect players by changing their laws/ rules around equipment, types of play, or management of serious injuries such as concussion.
Injury prevention programmes are present in many sports, (especially football) but injuries can involve a vast range of factors, some that are controllable and others that are very difficult to control. Large studies like the UEFA Champions League Study which has run since 2001, with findings published in the British Journal of Sports medicine suggest that injury rates in football have improved for some injuries, but have remained the same for some types of injuries like hamstring injuries.
Clubs and medical / physiotherapy and coaching / training staff must balance off the need for very high performance, but also consider the need for recovery and tissue adaptation after games and training.
Strategies used by clubs to prevent injury:
Monitoring players training and match play workloads: Clubs will often use sophisticated equipment like GPS. Sleep and activity and strength monitoring and employing data analysts to review the large amounts of data produced.
This often enables the clubs to give players an individualised approach as well as overseeing the whole team’s goals.
Research evidenced in injury prevention programmes: Clubs will often adapt this research to their environments. The FIFA F-marc 11 plus is a combined injury programme developed over several years and released in 2010 after large studies showing effectiveness has proved a good programme over 10 years with good evidence of injury prevention (in youth and adult/ mens’ and womens’ teams) of multiple types of football injury including Knee, hip and hamstring injuries and also more traumatic injuries like fractures.
A video of this can be watched on Youtube.
Learn more about the FIFA 11+ injury prevention programme.
Make an appointment:
Dr Bruce Paton is a dedicated consultant physiotherapist with vast expertise managing both athletes and the general population for lower limb musculoskeletal disorders - Dr Paton also has a specalist interest in trauma, orthopaedics and rheumatology.
To enquire about a private appointment at our leading facility in Central London, please contact our team by calling +44 (0)20 3447 2800 or by emailing info@iseh.co.uk. For appointments via the NHS, please contact your GP in the first instance.