Overview of Muscle Injuries
Muscle injuries are common in football and are frequently sustained in both training and playing. These can occur either through direct contact or non-contact mechanisms.
Examples of non-contact injuries are strains of the hamstring, thigh or calf muscles while direct contact injuries include severe muscular bruising as a result of being kicked.
92% of muscle injuries in football are reported to affect the four major muscle groups of the lower limb according to Ekstrand et al, (2011). Breaking this down further equates to injuries to the hamstrings (37%), adductors (23%), quadriceps (19%) and calf muscles (13%).
These are the generally-accepted figures for muscle injuries in football and provide a comparative baseline for similar studies. Ueblacker et al (2015) gave the overall figure for thigh muscle injuries as 25% of all injuries sustained so the stats can and do vary.
What is important to remember though is that often the stats don’t differentiate between newly-sustained injuries and recurrences of previous injuries.
Injury grading
Injuries to muscles and ligaments are graded according to their severity based on the American Medical Association Standard Nomenclature of Athletic Injuries (1966).
Although other grading scales are currently being considered, these are less universally adopted and injuries still tend to be graded under the old system as either one, two or three.
Broadly speaking, a Grade 1 muscle strain is simply the tearing of a few muscle fibres and these usually heal relatively quickly; rarely taking longer than 10 to 14 days to heal.
Grade 2 injuries involve more than a few muscle fibres and take on average anything between two and six to eight weeks. Depending on the extent of the injury, however, this can be considerably longer.
Grade 3 muscle injuries constitute a complete rupture of the muscle or ligamentous tissue and can sometimes require surgical repair.
Often a severe Grade 2 calf tear involving a significant percentage of muscle fibres can be confused with a Grade 3 tear; since the symptoms are often the same.
It’s easy to get carried away with the numbers though if you’re not careful. A minor Grade 2 injury which presents as little more than a strong Grade 1 injury in practice can be counterbalanced at the other end of the scale by a severe Grade 2 injury bordering essentially on a Grade 3 rupture!
The injury grading system is only a guide and as you can imagine, injuries fitting into the different grades can vary according to their severity. It’s sometimes easier just to talk about injuries in simple terms as being either minor, moderate or severe.
This explains why so many different players with the same injuries will vary so much in their response to treatment.
Injury Treatment and Management
The management of soft tissue injuries is a high priority when dealing with footballers and football injuries.
A simple muscle strain is defined as the tearing of a few fibres; and the classic example of this is feeling a sharp pull or tear while running, sprinting or changing direction.
When a muscle tears, it bleeds around the affected area. The early application of ice helps to limit this during the early, important, stages of injury treatment.
By restricting the damage to the muscle through the colder temperatures, the increased flow of blood to the injured area can be limited through early applications of ice-packs which will help to minimise swelling.
The importance of early cold applications is essential to any soft-tissue muscle injury since ice reduces pain through having a sedative effect on nerve endings and also reduces swelling.
After the acute stage where the priorities of applying ice and rest have passed, treatment generally consists of heat applications, gentle massage and stretching, plus specific exercises to strengthen the muscles affected.
Football places a high demand on muscle tissues due to the requirements of the game, therefore after the early stages of injury treatment have passed, the emphasis changes to one of active exercise with a focus on strengthening and stretching.
Often referred to as ‘Stage 2’, this intermediate stage of rehabilitation is usually delivered on a progressive basis and is activity-driven; generally forming the longest part of the rehabilitation progress.
Finally, we get to the later and functional stages of rehabilitation where footballing activities are introduced.
It’s at this stage where we need to be careful and only encourage a return to play once the player is capable of performing all the functional aspects of the game without pain and at the same levels as before the injury occurred.
In healing terms, the body doesn’t replace injured tissues on a like for like basis; therefore damaged muscle fibres are repaired using a form of scarring which leads to a non-uniform approach to tissue repair.
This makes the likelihood of further injury a strong possibility if the healing process is disturbed too soon by over-enthusiastic treatment or exercise.
For that very reason, Hagglund et al (2006) demonstrated that the biggest risk of recurrent or repeated injury comes from having sustained a previous injury to the same structure, so it’s essential not to try to push too hard at any stage of the rehabilitation process.
So if you try to come back to play too soon then you are simply increasing your chances of sustaining a similar injury in the future (Orchard et al, 2005).