As non-contact sports go, football involves a lot of contact. The result of this or the fact that footballers go over easily, are injuries.
Three of the commonest ones are torn cartilage, ankle sprains and anterior cruiciate ligament tears. Below are the in’s and oput of these injuries and how to treat them:
The menisci are the shock absorber cartilage of the knee consisting of two crescent shaped pads of cartilage. The inner knee menisci (medial menisci) is larger than the outer menisci (lateral menisci). The important role the menisci play for optimum knee function includes: – spreading the load across the joint, up to 50% of supporting loads in standing and 90% in flexing (knee bending). – improve joint congruency – increase the surface area of the knee joint allowing body weight to be spread across a greater area – they assist in synovial fluid circulation.
The meniscus get injured commonly, with medial menisci more likely than the lateral. The limited healing potential of the menisci , due to their blood supply only reaching the outermost 10% to 30% means they often require professional intervention. The mechanism of injury is usually a twisting injury to the knee with the foot planted.
Typical signs of a meniscal tear include:
– swelling of the knee
– increasing pain when attempting to fully squat to floor
– difficulty moving through range of motion
– or unable to fully extend
Painful knees require full assessment by a physiotherapist or orthopaedic surgeon. Symptomatic tears can result in further damage to articulate surfaces of the knee. Surgery is not always necessary and this can be discussed with a professional.
In the case of ‘bucket Handle’ tears, where a meniscal flap or loose cartilage causes frequent locking in the knee, surgical intervention may be indicated. Both types of tears in the knee include ‘degenerative’ tears which are part of the normal wear and tear process, but has been known to occur in athletes in their twenties.
To help your self during the initial stages of any injury, follow the PRICE guidelines:
The application of ice should be for 10 minutes and can be repeated every two hours. Make sure the ice pack is NOT put directly on the skin as it can cause ice burns. Compression can come in the form of ‘tubing-grip’ and elevation is making sure your knee is above your hip.
Physiotherapy can help to gain further ranges of motion in the knee, and strengthen the surrounding muscles of the knee with a specific treatment programme personalised to your requirements. Soft tissue massage or sports massage can help to reduce the initial muscular bracing response secondary to pain. Sports taping and specifically kinesiology taping can help not only with the initial swelling but also to assist with muscular rehabilitation.
Returning to sport may take time and surgery will lead to a long rehabilitation process but again this can be assisted with physiotherapy. Athletes with meniscus tears can use ‘pool running’ to functionally simulate running and assist in returning to running sports. The buoyancy of the water will reduce the loads acting on the meniscus and the resistance offered when moving through the water will functionally strengthen the muscles.
The Ankle Sprain
The lateral ankle sprain is one of the commonest sporting injuries in the world. As a therapist, we see these types of sprains in patients that play weight-bearing sports. Most athletes can walk them off with the self-management of PRICE in the initial stages. However, there is a difference between mild ankle sprain and severe ankle sprains. Incorrect management can easily turn a recovery time from 3-4 months into 12-18 months.
Severe ankle sprains, once cleared of any fractures on x-ray, typically present as:
– a history of heavy weight bearing and rotary force type injury
– significant swelling
– lack of normal movement
– and inability to walk or run without pain
The first week of rehabilitation is crucial and a clear diagnosis needs to be achieved. If weight bearing can be tolerated, then rehabilitation and inflammation management can begin. If weight bearing can not be tolerated, then significant damage to the ankle may of occurred. In this case weight bearing needs to be re-introduced steadily from partial weight bearing to full weight bearing, then walking. Each step should be delayed and introduced at the right time, this will be increasing frustrating for the athletes as they want to return to sport sooner ratherthan later.
Rehabilitation from ankle sprains firstly begins with swelling management and isolated range of motion in the pain free range. Getting the ankle moving is also key to manage the swelling. Swelling can be managed with PRICE advice as well as kinesiology taping to increasing swelling dissipation.
The progression with rehabilitation then focuses on introducing instability, such as wobble boards in order to stimulate the neuromuscular control systems. All therapy should be functional and sports specific once full weight bearing can be achieved. Once returning to running, strapping and taping can assist in stabilising and supporting joints and muscles. However, a word of warning, don’t be reliant on these strapping once the pain dissipates, it can become habitual and superstition to use them.
The Anterior Cruciate Ligament Tear
The Anterior Cruciate Ligament (ACL) is the most commonly injured of the four major knee ligaments and is commonest amongst footballs. It often comes injured in combination with the meniscus tear. It has an important role in stabilising the knee and providing the body with proprioceptive feedback. Specifically, the ACL is responsible for maintaining the correct relationship between the femur and tibia throughout movement of the knee, stopping excessive tibial translation forwards.
The ACL can be ruptured typically with sudden twisting motions such a changing direction with the lower leg planted to the ground and turning inwards. Instant signs of an ACL rupture are pain, swelling, and potentially ‘popping’ noise. Later signs can be giving way in the knee or feeling of instability.
The management of ACL ruptures can be operative or non-operative. Returning to sport may take time and surgery will lead to a long rehabilitation process but again this can be assisted with physiotherapy. Typically, the athletes wanting to return to sports requires surgical intervention and a 9-12 month rehabilitation programme. Footballers have a whole medical team dedicated to their return to math fitness and typically return to playing within about 6 months. The more complex injuries require more intervention.
The ACL requires full assessment but rehabilitation, guided by a physiotherapist, need to be thorough and starting from basics. All rehab should have instability in the programme as this challenges the body’s neuromuscular control and proprioceptive feedback.
If you want to prevent furhter injuries and last longer through the season, then check out the next post on injury prevention exercises.