Preventing and Treating Common Football Injuries

Football is perhaps the most physical and the most popular sport played in the US.  It demands a combination of explosive power, speed, agility, and coordination.  It is also one of the most dynamic sports, and the physical demands of the players vary tremendously based on position.  The movements required, include, but are not limited to, running, tackling, blocking, throwing, catching/receiving, kicking, cutting, squatting, jumping, and rotating. In order to perform one or any of these movements one must work to establish strength and coordination required for peak performance. In order to gain strength and coordination required for football, there are various muscles groups that need to be included in a work out program. These muscle groups include the hamstrings, quadriceps, core/abdominals, calves, biceps, triceps, back muscles (trapezius, rhomboids, erector spinae), shoulder muscles (deltoids, rotator cuff), and chest muscles (pectoralis major and minor). While the muscles are an essential component to playing football, nearly every joint of the body also plays a vital role.

 

The hip, knee, and ankle joints all play critical roles in the activities of football. They allow for the lower body to have fluid, strong, explosive movements.  The upper body joints also contribute to various movements with the sport, again dependent on position. The shoulder joint or girdle, elbow, wrist, and neck all contribute to let someone pass the ball.  Movement to throw the ball would include extension and external rotation of the shoulder, extension of the elbow, and supination of the forearm, followed by flexion and internal rotation of the shoulder, flexion of the elbow, and pronation of the forearm.

 

In order to protect the muscles and joints of the body football players regularly train to strengthen each of them. It is important to have a balanced workout that targets various muscle groups. Over developing one muscle group verses another will cause an imbalance in strength and can lead to an increased occurrence of injury. During the off-season football players will work on developing strength, power, range of motion, and speed. Most of these workouts will include low repetition, high weight activities and short bursts of anaerobic activities. Once off-season workouts finish and pre-season and regular season begin it is important to maintain what was gained during off-season workouts. These workouts will consist of higher repetition, lower weight activities along with more aerobic workouts.

While there are many different injuries that can occur from playing football, anything from a scratch to a broken bone, here are some of the more common injuries you are likely to see and some prevention tips.

Concussions

With the increased awareness of head injuries, concussions have become a hot topic in the athletic world. A concussion is an injury to the brain. The most common mechanism of injury in football is a direct blow to the helmet by another player’s helmet or knee. Whiplash type concussions are also common and occur when the body strikes the ground first from a forceful tackle and then the head accelerates and slams into the turf. No two people will react the same to a concussion, which at times can make them difficult to diagnose.  There are many common signs and symptoms that include headaches, dizziness, blurred vision, memory loss (short term and/or long term), sensitivity to light, difficulties with balance, confusion, and nausea. These signs and symptoms can be immediate but often times they are delayed in onset. Newer designs of helmets are better at preventing concussions.  Making sure helmets are well fitting and not cracked or broken in any way is important in minimizing the risk of a concussion. Strengthening the muscles in the neck can decrease the chances of suffering a whiplash-type concussion.

Ankle Sprains

An ankle sprain is the result of twisting or rolling the ankle in a traumatic fashion. This causes the ligaments of the ankle to stretch, fray, or even tear. The good news is that setting up a prevention/maintenance program can greatly decrease your risk for injury. The easiest and best ways to prevent ankle sprains are through strengthening the muscles around your ankle. Ankle 4-way with a theraband and balance exercises are some of the more common techniques to do so.

Contusions

Contusions are another name for a bruise. These are very common in football due to the physicality of the sport. While some contusions are minor, some can be very painful.  Some of the most severe contusions can occur in the quadriceps muscle or around the pelvis (also called a hip pointer), usually from a direct blow with a helmet. While prevention is more difficult here, being properly equipped with the correct pads (i.e.: quad or hip pads) will greatly reduce your chance of injury if you take a blow to these areas.

Knee Injuries

Common football knee injuries include ligament sprains/tears and meniscus tears.  Sprains, which range from stretching, fraying, or tearing of knee ligaments (ACL, PCL, MCL, & LCL) are often a result from an outside force or blow to the knee that causes the knee to bend or move in an unnatural way.  The ACL can be injured without contact as well, most often with a combination of deceleration and rotation of the knee joint. Specific warm-up and conditioning drills can help reduce the risk of ACL injury when performed before football activities.  Many of these programs are available online.

 

Linemen are at particular risk of spraining or tearing their collateral ligaments, the LCL and especially the MCL, due to the nature of their position.  They are generally engaged with an opposing player with both legs firmly planted on the ground and are susceptible to another player falling into or rolling into their knee. To help prevent these injuries, many teams especially at the college level and higher require their linemen to wear special braces to protect these collateral ligaments.

 

A meniscus tear typically involves the foot being planted and the knee rotating. This can occur either from cutting and losing balance or from being hit. Making sure the quads and hamstrings are of equal strength will do a great deal in preventing injury. Plyometrics is another exercise that can reduce the chance of injury, and a good example of this would be box jumps.

Muscle Strains

Muscle strains are a common injury in all sports. Some specific to football include quadriceps, hamstring, hip flexor, and groin strains. A muscle strain is stretching or tearing of the muscle fibers. This can result from an explosive move such as sprinting without being properly warmed up, or from overuse with constant training of the same muscle group. Maintaining flexibility of these muscle groups through frequent stretching can reduce the incidence of acute strains. Giving the body proper amounts of rest between workouts to increase strength and flexibility will greatly decrease the chance of suffering a muscle strain.

Heat Illness

Heat illness/injury is a major concern in the early portions of football season when temperatures and humidity are at their peak. The rigors of practice and games combined with the heat can cause excessive sweating that depletes the body of salt and water.  Early symptoms include excessive thirst and muscle cramping, especially the large muscle groups.  Prevention centers on adequate pre-hydration, and continued hydration during practice or games.  Restrictions on outdoor practices based on temperature or heat index also help minimize the risk of heat injury.

Concussion

Perhaps the most important aspect of concussion treatment is early diagnosis and preventing further injury.  Sustaining a second concussion episode before the first has resolved can lead to rapid swelling of the brain causing permanent brain injury or even death.  This is why stricter guidelines for return to play after concussion are being adopted across the country at all levels of football.  It is important to heed the advice of your on-field medical personnel (team physician or athletic trainer) in all matters relating to concussions during games.  Neurologic testing after a concussion can help determine when it is safe to return to play.  Rest, both physical and mental, can speed recovery and is advised until cleared by a physician to return to activity.

(Note: In addition to any musculoskeletal football injuries, concussion management is offered at our Saturday Sports Clinics during the fall football season.  Click here for more details.)

Ankle Sprain

The initial treatment of an ankle sprain should include rest, ice, compression, and elevation (RICE) to control swelling and pain. Mild sprains during a football game can be treated with taping and return to play if pain permits.  More severe sprains may require physical therapy or treatment by the trainer to restore range of motion and muscle strength to help stabilize the ankle joint. Bracing or taping may also be used to help provide support when returning to activities.  Balance or proprioception exercises are important once the initial pain goes away to help restore the function and coordination of the ankle.

Knee Injuries

The treatment of a knee sprain will depend on which ligament is actually affected. Initially, treatment should begin with the RICE principle to decrease pain and swelling. Next, the focus should be on restoring full range of motion within the knee joint. If the affected ligament is not completely torn rehabilitation exercises should begin through physical therapy. The goal of physical therapy is to restore the strength and flexibility of the surrounding musculature to help better support the knee joint. If the affected ligament is completely torn, surgical intervention may be warranted.

 

MCL sprains are graded on the severity of the ligament tearing, where grade I means that the ligament is only stretched or a few fibers are torn and grade III means a complete tear.  MCL sprains can generally be treated non-operatively, even grade III tears.  The more severe the tear, the longer it takes before the ligament is healed enough to return to sports.  Healing time can range from 2 weeks for some grade I tears up to 8 weeks for some grade III tears.  Often in football, a special hinged knee brace is used to treat MCL sprains/tears, which selectively limits motion and helps to protect the ligament from stresses while healing.  These braces can be worn during return to play once the ligament has healed enough to be stable.

 

ACL injuries are treated differently than MCL injuries, as most ACL tears are complete ruptures that will not heal on their own.  After an ACL tear, the knee will be unstable during the complex cutting and twisting motions required in football.  A brace alone cannot provide the stability to the knee that is needed for a dynamic sport like football.  ACL tears are treated surgically by reconstruction the ACL with a graft, and there are several graft options available.  Rehabilitation for ACL reconstructions may take 9-12 months to allow the graft to incorporate into the body and restore the strength and proprioception of the knee.

Muscle Strains

Acute muscle strains should be treated with the RICE principle to help control inflammation and pain. Physical therapy is commonly used to regain range of motion, strength, and flexibility of the specific muscle group. A compression sleeve may also be used to help provide compression and decrease pain when returning to activities. With muscle strains (especially the hamstrings), it is important not to return too fast before the muscle has had time to heal, as the muscle will be more vulnerable to repeat injury.

Occasionally, a severe proximal hamstring strain can result in an avulsion of the tendons from their attachment on the bone of the pelvis.  This sometimes needs surgical treatment if a large bony fragment is displaced of if the tendons are significantly retracted.

Heat Illness

The treatment of heat injury/illness focuses first on hydration and fluid replacement. Cooling techniques such as fans and ice are important in the early treatment as well. If untreated, heat injury can progress to heat exhaustion or heat stroke, which can result in death. If injury progresses past the early stages, prompt medical attention is necessary and may require transfer to an emergency room for treatment. It is critical that players and coaches be educated on the signs and symptoms of heat injury and the need for adequate fluid replacement.

[toggle name="How long do I have to wait to return to football after a concussion?"]It depends on multiple factors, including the severity of the initial concussion, the number of past concussions, and the duration of the symptoms. All concussion symptoms (including headache) should be resolved before return to play, no matter how long it takes. Decisions on return to play should be made by a member of the medical team. [/toggle]
[toggle name="What is the best drink to prevent heat illness/heat exhaustion during practice or games?"]It is best to avoid sugary drinks, especially so-called energy drinks, as they can actually exacerbate dehydration. Also, avoid excessively cold drinks as they can cause cramping of the stomach muscles. Water and sports drinks have proven to be the best drinks for rehydration during activity. [/toggle]
[toggle name="When is it too hot to practice/play football?"]In the state of Kentucky, football competition (practice or game) in full gear is not allowed with a heat index of over 100 degrees. All outdoor sports, even without any pads or gear, are required to be stopped at a heat index over 104 degrees. For a full explanation of the KHSAA rules regarding heat and competition, see this document. [/toggle]
[toggle name="It sounds like football is dangerous, should I let my son play football?"]That is obviously a very personal decision that a parent has to make. Yes, there are many injuries that occur in football and some of them can have long-term consequences. There are also many benefits of sporting activity like football, including physical fitness and cooperation/team skills. For an interesting discussion on this topic, read this article from Dr. David Geier’s site.[/toggle]

This article was written in conjunction with Ray Hibbert, ATC, an employee of KORT Physical Therapy and Head Athletic Trainer at Kentucky Country Day (KCD). Ray is nationally certified with the National Athletic Trainers Association Board of Certification. He has a Bachelor Degree in Athletic Training with a Minor in Physical Fitness. Ray is also recognized as a Personal Trainer through the National Council on Strength and Fitness. In his free time Ray enjoys golfing, fishing, and watching football