Bone structure of the human foot
Playing sports such as football is generally acknowledged to be good for your health, however, participation is accompanied by risk of injury. Team sports athletes in particular are at very high risk of sustaining lower limb injuries.
Injuries sustained playing football typically involve the knee and ankle joints and the associated muscles, tendons and ligaments. Surprisingly, the majority of these types of injuries tend to be non-contact in nature. During strenuous team-games, match-play involves lots of twisting and turning, and the loads placed on the joints of the lower limbs can often exceed the tolerance of the surrounding structures. If the muscles can’t respond quickly and forcefully enough, injury can result.
Common football-related injuries include hamstring strains, sprained ankles, knee ligament damage, torn cartilage (washer-like structures within the knee) and less common injuries – but highly publicised due the their severity and time lost from match-play – such as rupture of the achilles tendon and fractures of the metatarsals (bones in the foot).
The knee is one of the most frequently injured joints in sportspeople and injuries often occur during rapid deceleration, coupled with a twist or change in direction. We often hear about footballers tearing their cartilage; Michael Essien recently sustained an injury to his meniscus, along with damage to the medial ligament. This effectively means that he’s damaged the washer-like structures – menisci – within the knee that are necessary to disperse load and reduce friction in the joint.
Whilst in isolation, a torn meniscus can be dealt with by key-hole surgery (arthroscopy) and can result in only a couple of weeks or so lost from sport. More severe injuries that involve the ligaments however, can mean more complex surgery and several months of rehabilitation.
Many people have heard of the anterior cruciate ligament (ACL), not least because of Michael Owen’s live demonstration of how to injure it during the last World Cup. Without doubt, high-level sport performers require surgery to remedy this problem, but surprisingly, the reason for this is instability and not pain. Once all the swelling has subsided, athletes with a torn ACL can usually run in a straight line without a problem, however, when they attempt to perform a twist or change in direction, their knee will collapse from underneath them.
There are several methods by which to replace the damaged ACL, the most common being to take a graft of the hamstrings tendons, or the middle third of the patella tendon (the thick structure that links the bottom of your knee cap to the lower bone of the leg) of the injured leg. The structure is surgically inserted into the place where the original ligament was situated and over a period of six months the ‘tendon’ remodels to act as a ligament. Under the constant care of a physiotherapist and without complications, a professional footballer could expect to safely return back to sport from about five and a half months following surgery.
Up to now, we’ve considered traumatic injuries, i.e. those that occur suddenly. However, it might be expected that a during the World Cup we also see the reporting of injuries resulting from overuse, such as stress fractures and tendinopathies (inflammation or minor damage to the tendons). These types of injuries tend to develop over a period of time and occur due to a gradual weakening and ultimately failure of the structure. For example, whilst there was much discussion around boot design when we heard about the infamous metatarsal injuries to David Beckham and Wayne Rooney, it might have been equally important to consider the cumulative amount of match-play and training each player had accrued prior to injury.
Each time we perform exercise, we need to give the body time to recuperate, remodel and become stronger. The amount of rest required is dependent on the intensity and duration of the prior exercise. However, if the body is continually ‘exercised’ without allowing proper restoration of the strength of the muscles, tendons, ligaments, bones, etc. then perhaps we’re creating a greater risk of injury and of system break-down.
Players have been selected to represent their country in the World Cup due to their excellent skill and ability, however, it is also likely that because of their mastery of the game, they’ll be arriving to participate in this demanding tournament following a long competitive domestic season and many hours on the field. Whilst effective prophylactic training programmes and individualised conditioning remain a supreme challenge for the exercise scientist, consideration of the cumulative hours of match-play and training each player has accrued prior to tournaments such as this might be equally as important in the strategy to keep players injury-free.
Professional football players are exposed to a high risk of injury and there is a continued need to investigate ways of reducing this risk. At this point, however, it’s fingers crossed that the pre-tournament preparation and conditioning keeps the England players fit and injury-free.
What to watch out for:
Let’s hope that there aren’t too many traumatic events during the tournament, but if you do spot an injury check-out when it occurred; there’s a significantly greater risk of injury towards the end of both halves compared to other periods of match-play.
Dr Claire Minshull, Senior Lecturer in Exercise Physiology and Health, Nottingham Trent University.
To view a video of Claire describing some of these injuries click here.
To speak to Claire, call the University Press Office directly on 0115 848 8785 or email worldcup@ntu.ac.uk
[To view Nottingham Trent University’s team of World Cup experts go to www.ntu.ac.uk/worldcup]
NTU World Cup 