By Rachel Hodson

Before working at the Octagon clinic I was fortunate to work at the official Chiropractic Clinic for the Milton Keynes Football Club (MK Dons) the year they became top of the first division, under the management of Pete Winkleman and Paul Ince as coach. We worked alongside the team’s physiotherapist, fitness trainers and podiatrist.  Working as part of a multi-disciplinary team provided the players with expert knowledge with respect to all aspects of their performance.

As the team's Chiropractor I not only tended to sports injuries and aided the physiotherapist in rehabilitation, but also corrected compensatory patterns formed as a result of the injury.  Compensatory patterns are altered movement patterns, formed initially as a result of pain.  Unfortunately once the injury has healed these new learnt compensations remain; these can result in weak, tight muscles which affect joint function and ultimately overall performance.  If treated soon after injury, compensatory patterns are more easily overcome as the new movement pattern has not been learnt and ingrained into the nervous system. 

I not only treated football injuries, but regularly treated the whole team, not just the players but the manager and their families too! By providing regular treatment, small injuries that may go unnoticed by the player, were not able to become a problem for the future.  This allowed for peak performance every match and aided in maintaining mobility and maximum muscle strength, which ultimately provides joint protection.  

Most football injuries are traumatic in nature, often as a result of contact with another player.  Studies have shown that 49% of injuries are to joints, with sprains and contusions being the most common injuries, 46% and 25% (3) respectively and 89% of injuries occur in the lower limb.(3) Some injuries are however the result of overuse, or re-injury of a previous sprain/strain.  With good rehabilitation training and effective preventive care, these should be kept to a minimum. (2, 3,4,5)

Remember once you have injured an area, it weakens.  To reduce the chance of re-occurrence you must do the appropriate exercises to help strengthen the area.

Ankle sprain

This is the most common football injury. There are 3 types of ankle sprain and they can be graded 1 (mild, minimal bruising), 2 (moderate, slight bruising, visible limp 2-14 days) or 3 (severe, diffuse bruising, unable to weight bear).

• Inversion: most common.
• Eversion: rare and often most severe.
• Diastasis: often accompanies inversion sprains (high sprain).

In the acute phase the P.R.I.C.E. (protect, rest, ice, compression, elevation) protocol should be followed. Rehab exercises should be started on the non-injured side within tolerance, and pain free range of motion exercises on the injured side.

The post-acute stage aims to restore strength, flexibility, endurance, coordination and adaptability.  The aim is to restore the injured side equal of the non-injured side (90%). (1)

Knee sprain

As with all sprains these can be graded 1-3. Treatment is much the same as with ankle sprains, although rehab exercise are muscle specific to the injured area.  Ask your Chiropractor for specific exercises and frequency.

With grade 1 or 2 sprains athletes can be expected to return to normal activities within 4-8 weeks.  In activities such as football, which is high risk a brace should be worn.  Recovery rates are generally longer in the older patient.

It is important to remember signs and symptoms may disappear within a few weeks but the ligament can take up to a year to regain its maximum strength, and full recovery can take longer.  Nutrition is vital in helping both preventing these types of injures and in recovery, (see article on anti-inflammatory nutrition).

Strains

The most common football strains are groin (adductor) and hamstring.  These occur when the muscle is suddenly overstretched and result in a sudden painful twinge in the area of strain (occasionally they can be chronic).  As with sprains the initial treatment should be P.R.I.C.E.  Rest from sporting activities should be for approximately 2 weeks, and alternating cold and hot should be used on the muscle only when swelling has subsided (1).

Rehabilitation exercises should begin slowly and as you are ready your Chiropractor will give you more sports specific exercises.  It is important to be patient, as with all injuries, returning to your sport before you are ready could result in further injury.  Mild strains take 2 weeks to be symptom free, but expect 4-6 weeks (1) before returning to ballistic type exercises and playing in a match.  Running is the most common cause of a hamstring strain and over 62% occur during matches, thus it is paramount to be careful when returning to your sport, re-injury rate is approximately 12% (5).

Neck and head injuries

These are not common footballer’s injuries, however can occur when a poor contact is made with the ball with the head, or from a direct blow with another player.  It is important to be checked primarily for concussion and any injury to joints, ligaments or muscles in the neck.  

Other foot and ankle complaints

Footballers are notorious for wearing snug fitting boots, deemed essential for good contact and ball control.  This does however have a detrimental effect on their foot health.  Many players suffer with reoccurring in-grown toenails and haemorrhaging under the nails.  The local pain caused by these aliments results in altered spinal biomechanics, which ultimately results in altered movement patterns, thus increases chance of injury.

I worked very closely with the team’s podiatrist, educating players on footwear and finding a compromise on singular match performance and longevity within the sport. 
Ill fitting footwear long-term can result in eventual degenerative arthritis, primarily in the big toe and painful bunion formation.  Once these changes have occurred they are irreversible, therefore sensible fitting shoes are paramount from an early age (see article on footwear).

References:
1) Carnes, M & Vizniak, N. Quick Reference Conservative Care Conditions Manual. 2nd Ed, Professional Health Systems, 2007, pgs 211-299.
2) Hagglund, M; Walden, M & Ekstrand, J.  Previous Injury as a risk factor for injury in elite football: a prospective study of twp consecutive seasons; British Journal of Sports Medicine; 2006, 40; 767-772.
3) Soderman, K; Adolphson, J; Lorentzon, R & Alfrdson, H.  Injuries in adolescent female players in European football: a prospective study over one outdoor soccer season; Scandinavian Journal of Medicine & Sports; 2001; 11(5); 299-304.
4) Wong, P & Wong Y.  Soccer Injury in the Lower extremities, Literature Review; British Journal of Sports Medicine; 2005, 39; 473-4.
5) Woods, C; Hawkins, R D; Maltby, S; Hulse, M; Thomas, A & Hodson, A.  The Football Association Medical Research Programme: an audit of injuries in professional football – analysis of hamstring injuries; British Journal of Sports Medicine; 2004, 38; 36-41.