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Osteopathy and football injuries

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Football is generally a safe and effective exercise. Nonetheless injuries often occur.

These may include minor contusions (bruising a ligament, tendon, or muscle), sprains (stretching or tearing a ligament), and strains (stretching or tearing a muscle or tendon). Fractures (broken bones) are much less common, but are more serious.

These injuries are caused by the stop-start nature of the game, the hastily applied multi-directional high loads imposed on the body and the unpredictability of what other players may do. This means that footballers are predictably prone to all sorts of musculoskeletal injuries.

Some players at greater risk
Footballers who lack flexibility are at increased risk of injury. Previously injured players are at a higher risk to repeat the injury. The majority of injuries in football occur in the lower body, mostly to the knees and ankles.

However, repeated or prolonged use (overuse) injuries are common problems, especially towards the end of a long and gruelling season. These injuries are the result of constant overloading of the body, resulting in the inability of the relevant structure being able to perform its normal biomechanical duties.

Extrinsic or traumatic injuries occur due to a sudden force, or impact, and can be quite dramatic. Injuries to the ankle, lower leg, and knee (usually sprains) are the soccer injuries that occur most often. After ankle sprains, medial collateral ligament sprains are most common. The pivoting and lateral movements of soccer contribute to these injuries.

Where osteopathy fits in
Osteopathy offers an ideal combination of preventative biomechanical analysis and therapy for football players.

Through specific diagnosis and treatment, it improves the rehabilitation of typical football injuries and helps prevent small discomforts from turning into severe injury.

The main goal is to restore the ability to function on the field of play. By improving the musculoskeletal structure of the player’s body, osteopathy may enhance performance and keep the player’s body functioning at an optimal level.

Intrinsic football injuries result from repetitive overuse of the body. This is more prevalent in players with structural imbalances and restrictions. This type of injury occurs over time due to stress on the muscles, joints and soft tissues without proper time for healing. These begin as small, nagging aches or pains, and can grow into debilitating injuries if not treated early.

Osteopathic evaluation prior to playing football will enable an osteopath to identify potential problems before they arise, minimising the possibility of this type of injury through treatment and advice.

Examples of overuse injuries:
Groin muscle strain/inner-thigh pain
Adductor-related inner-thigh pain usually requires a lengthy period of rehabilitation. Prolonged use of muscle may cause very small tears in the muscle which may lead to an overuse injury.

These early warning signs may help to prevent a groin strain:

  • No relief from stretching tight muscles after activity.
  • Decrease in sprinting ability.
  • Loss of distance with long kick.
  • Pain with deceleration.

Hamstring muscle strain
A strained hamstring muscle on a football player usually occurs as a result of maximal sprints down the pitch.

Reduced stride length when sprinting, particularly at the end of the match, may be related to hamstring shortness as a result of sitting at a desk or in a vehicle during your working day.

Calf muscle strain
This usually occurs as a result of chronic overuse or acute strain as the footballer attempts to accelerate from a stationary position or lunging forward, forcing the ankle into a toes-up position (dorsiflexion).

(Osteopath tip: Good flexibility can lower your chances of muscle strain. Always stretch well after warming up. Focus on stretching the areas most susceptible to strain, but don't neglect other areas. The more flexible you are, the less likely you are to stretch beyond your capacity and pull or tear a muscle.)

Iliotibial band friction syndrome/lateral knee pain
This involves friction between the femur (thigh bone) and the iliotibial band (the connective tissue on the outside of the thigh).

Friction occurs near the foot strike. Downhill running and poor lower extremity alignment may predispose a player to this type of injury.

Patellofemoral/anterior knee pain
Pain in and around the knee cap has many contributing factors, including volume/intensity of training and overall position over the lower limb.

Shin splints/medial tibial traction periostitis
Shin pain may be the result of excessive pronation (flat feet), training errors and poor flexibility.

Achilles tendon injuries/tendinopathy
Pain in the back of the ankle may arise from increased training volume or intensity, but may also arise insidiously due to micro tears in the muscle fibres.

If left untreated, this injury could lead to Achilles tendon rupture.

Plantar fasciitis
Pain under the heel is usually of insidious onset. Pain is typically worse in the morning, improves with exercise at first and is aggravated by standing.

Back and neck pain
Spinal pain is common in footballers due to the dynamic nature of the game as well as other maintaining factors.

(Osteopath tip: Instead of slumping in the changing room after a hard game, sit with your lumbar spine in extension. This will help avoid lower back pain disc problems. Adhering to good dynamic posture at all times, but particularly during training is a good preventative measure.)

Examples of extrinsic or traumatic injuries:
Knee ligament injuries

The two cruciate ligaments (anterior and posterior) are often referred to as the crucial ligaments in sporting activity due to their role in preventing pivoting, forward and backward motion.

Cruciate ligament injuries don’t always cause pain, but typically cause a loud ‘pop’ or ‘snap’ sound. Anterior cruciate ligament (ACL) injuries are more common in football and are usually the result of landing from a jump, pivoting or sudden deceleration.

The collateral knee ligaments (medial and lateral) also stabilise the knee from sideways motion and the medial collateral ligament is more commonly injured by extreme sideways opening of the knee, when the knee is slightly bent.

Knee cartilage (meniscal) injuries
Meniscal injury may result from compressing, twisting or pivoting the bent knee with extreme force. This will cause a tear in the cartilage between the tibia (shin bone) and femur (thigh bone).

(Osteopath tip: Normal muscle balance, aided by osteopathic assessment and an appropriate strength-training programme in the gym, will allow the body to absorb sudden changes of direction and reduce the potential for injury. The correct footwear and good field conditions will also help.)

Ankle sprains/lateral ligament injuries
Ankle sprains (stretching and tearing of ligaments) are common in football players due to rapid changes in direction on an uneven surface (grassy field).

When a footballer sprains an ankle, it will also eventually affect other areas such as the foot, leg, hip, pelvis and spine. If the anatomy connected to the ankle is not treated (for example by an osteopath), the potential for decreased circulation, weakness of the ligaments and persistent tenderness will remain.

Even if there’s no tenderness in the area of the injury, the ankle sprain could make an athlete susceptible to other injuries.

(Osteopath tip: A good warm-up and careful stretching may help prevent some sprains. To avoid unnecessary risk, always check the condition of the field before you play. Don't play on fields with holes or loose stones.)

Stress fractures
Stress fractures in the lower leg (tibia) and forefoot (metatarsals) are often the result of repeat impact on a hard surface or overuse.

(Osteopath tip: Wearing protective shin pads and appropriate football boots is important.)

Dedicated football player?
If you’re a dedicated football player, there’s every chance that you’ve experienced a frustrating lay-off due to one or more common injuries.

An osteopath will advise you on why these injuries are occurring. He/she will then treat the real cause of the problem. Many of these are preventable, given the correct stretching and muscle-balancing exercises. – (Dr Guy Ashburner, August 2007)

About the author:
Dr Guy Ashburner( BSc(Hons)Ost(U.K),D.P.O.), an osteopathic consultant, is sympathetic and motivated towards the rugby player’s need for speedy recovery and a rapid return to sporting endeavours. He is a member of The Osteopathic Sports Care Association and previously worked as a qualified personal trainer in west London, UK.

Contact details:
Dr Guy Ashburner BSc(Hons) Ost(U.K), D.P.O.
Osteopathic Consultant
To find out more, visit www.osteogoodhealth.com

Read more:
Osteopathy and rugby injuries
What is osteopathy?

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