Football is one of the most physically demanding sports, requiring speed, agility, power, and endurance. These high physical demands come with an increased risk of injuries, both traumatic and overuse. In this article, we’ll explore why football injuries are so common, discuss the most prevalent injuries, and provide guidance on their symptoms, causes, treatments, and prevention strategies.
Why are injuries so common in Football?
Football combines rapid direction changes, physical collisions, high-speed sprints, and repetitive ball striking. These elements contribute to a higher incidence of injuries compared to many other sports. High-intensity matches and frequent training sessions can increase susceptibility to both acute injuries and long-term overuse issues.
What are the most common Football Injuries?
1. ACL Injuries
Football ACL injuries often occur due to sudden pivots, sharp changes in direction, or improper landings from jumps, common in football. These movements place high stress on the anterior cruciate ligament (ACL), leading to tears or ruptures. Symptoms include a loud “pop” sound at the time of injury, followed by intense knee pain, swelling, and a feeling of instability.
ACL injuries typically require surgical reconstruction using either a hamstring or patella tendon graft, followed by an intensive six-to-nine-month rehabilitation process. Prevention of modifiable risk factors for ACL injuries typically involves focusing on unilateral strengthening of the lower limb through different planes,trunk control, neuromuscular control and improving ability to absorb forces.
Another important factor to consider is reactive strength. Having good levels of reactive strength along with short ground contact times is vital for the body to load and unload the lower limbs when performing which will help promote better control and absorption of forces which will reduce injury risk.
2. Ankle Injuries
Football ankle injuries, such as sprains or strains, frequently result from awkward landings, rapid direction changes, or uneven surfaces. Individuals who suffer a lateral ankle injury have double the re-injury risk in the year after the initial injury (Verhagen et al., 2005). These injuries manifest through sharp pain, swelling, and difficulty bearing weight on the affected foot.
While most ankle sprains can be treated with protection, optimal loading, ice, compression and elevation (POLICE), severe cases might necessitate immobilisation or even surgical intervention.
To prevent ankle injuries, footballers should engage in proprioception training to enhance balance and control, strengthen the lower limb muscles through the use of isometrics, concentrics and eccentrics. A heavy focus should be through the calf complex along with intrinsic foot musculature. Plyometrics and ankle stiffness will also play an important role in the prevention of ankle injuries. Footwear, such as custom orthotics, also plays a crucial role in injury prevention.
3. Hamstring Injuries
Football hamstring injuries are commonly caused by overstretching or a sudden burst of acceleration while sprinting. Players often experience sharp pain in the back of the thigh, accompanied by swelling and possible bruising.
Treatment typically begins with POLICE, followed by a gradual return to activity, incorporating flexibility, strength and rate of force development exercises. During the rehabilitation process other modifiable risk factors will need to be addressed such as; neural tension, lower back stiffness and anterior pelvic tilt.
Recovery time frames for hamstring injuries depend on the British athletics muscle injury classification (BAMIC) grade and whether there is tendon involvement. Hamstring injuries with tendon involvement take roughly around 2-4 months to recover whereas a myofascial injury takes around 7-21 days.
Prevention strategies include adequate flexibility, hip extension strength, regular eccentric hamstring exercises, trunk control, biomechanics and regular exposure to high speed running in order to reduce the risk of injury. Addressing strength imbalances through the use of technology can be an important aspect of injury prevention which can be done with here at KPI through our in-depth athlete profiling system (APS).
4. Groin Strain
Groin injuries are common in football which account for around 18% of all injuries (Mosler et al., 2018). Common injury mechanisms to the groin/adductor complex are ball striking/passing, overstretching or intense lateral movements.
Symptoms following an injury to the groin include pain and tenderness in the region of the inner thigh which is reproduced on outer range stretch and resistance testing (Abate et al., 2023). The RTP time for a groin strain is dependent on the severity of the injury and if there is any tendon involvement which is common for groin injuries.
Initial treatment follows POLICE principles then a graded exposure to isometric, concentric and eccentric strengthening through different planes of motion before progressing onto plyometrics. Then finally progressing through a graded pitch based running program where end stage rehab would focus on max ball striking and change of direction. Injury prevention exercises for groin injuries include adequate hip range of movement, lateral hip, trunk and adductor strengthening, plyometrics and agility drills that simulate game-like movements.
5. Achilles Tendon Injuries
Football achilles tendon injuries typically occur from overuse or a sudden increase in physical intensity, such as explosive sprints or abrupt changes in direction. Players may feel pain and stiffness in the back of the lower leg,which can lead to swelling and ultimately impaired function which can persist and negatively affect performance. In severe cases, a “pop” might occur which indicates a tendon rupture often leading to surgical intervention and a lengthy rehabilitation period.
To reduce the risk of an achilles tear and/or achilles tendinopathy footballers should focus on good isometric and eccentric calf strength, intrinsic foot mobility and strength, regular exposure to plyometrics, pitch load management and supplementation of collagen and vitamin C which may be beneficial for improving tendon stiffness and connective tissue remodelling.
6. Medial Collateral Injury (MCL)
Injury to the MCL is common within football which on average leads to a median loss of 33 days (Lavoie-Gagne et al, 2021). The three most common mechanisms for an MCL injury in football are; direct contact to the knee, contact to the leg or foot and sliding.
Management includes immediate bracing to protect the ligament along with ice and compression to manage any pain and swelling. Also during this time to maintain quadricep muscle activation a neuromuscular electrical stimulation machine (NMES) should be used.
This is before progressing through a graded rehabilitation process which involves unilateral strengthening of the lower limb, multidirectional plyometrics and a progressive pitch reloading. Caution must be taken towards end stage rehab when there is the introduction of max ball striking/passing, blocked tackles and high speed cutting movements. Injury prevention exercises for this particular injury include proprioception, lower limb strength, plyometrics and trunk/hip control.
7. Contusions (Deadleg)
Contusions to the lower limb are common in football given the contact nature of the sport which occur following blunt trauma to the quadriceps for example. If incorrectly managed then contusions to the lower limb muscles can be serious leading to myositis and/or compartment syndrome. Contusions cause muscle fibre damage which leads to formation of a hematoma causing pain, discomfort loss of range of motion and typically muscle inhibition.
Early management of a contusion includes immobilisation, ice, compression and elevation. Then once the pain has settled and there is adequate range of motion then a functional return to sport is carried out.
8. Concussion
A concussion is a brain injury which results in a disturbance of brain function which will have an effect on the way someone thinks, feels, behaves and remembers things. Common symptoms of a concussion include; headaches, dizziness, memory disturbance, nausea, balance problems and sensitivity to light. Concussions are typically caused by a direct blow to the head but can also be caused by heading the ball or when a blow to another part of the body results in rapid movement of the head like a whiplash.
Any player who is suspected of a concussion must be removed from play immediately (IF IN DOUBT SIT THEM OUT). Following the removal of play the player should be referred to a medical professional for further examination (SCAT) and information on the correct return to play timeframes which is dependent on age, level of participation and access to appropriate medical professionals. Initially, there is 24-48 hours of complete rest which includes physical and also cognitive rest (resting the body & brain). Once the initial rest period has been completed then a gradual return to play is carried out over a number of days or weeks as symptoms allow.
Football injuries are a prevalent risk for players of all levels, from amateurs to professionals. Understanding common injuries, their symptoms, and preventative strategies can help players stay fit and resilient throughout their careers. At KPI, we emphasise the importance of evidence-based approaches in preventing injuries to help athletes perform at their peak consistently. In the unfortunate event that an injury occurs then we have experienced practitioners at KPI to assist you in your return to performance.
