Sports specific injuries

FOOTBALL

PRESENTED BY-
HARSIRJAN KAUR
MPT SPORTS ii SEMESTER(2020-2022)
 Football remains the most popular collision sport in the
world.
 Participants include children, adolescents, and adults at all
levels of competition.
 With its inherent high rate of injury, large numbers of
players in this sport are affected by missed participation
time or more significant morbidity each year.
 Association football, commonly known as football , is a sport
played between two teams of typically eleven players.
 The game is played on a rectangular field of grass or green
artificial turf, with a goal in the middle of each of the short
ends. The object of the game is to score by kicking the ball
into the opposing goal.
 SOCCER/ASSOCIATION FOOTBALL

• Goalkeeper
• Defender (Centre-back, Sweeper, Full-back, Wing-back)
• Midfielder (Centre midfield, Defensive midfield, Attacking midfield, Wide
midfield)
• Forward (Centre forward, Second striker, Winger)
 AMERICAN FOOTBALL

The eleven players of the offense can be separated into two main groups: the five offensive
linemen(tackles, guards and centre), whose primary job is to block opponents and protect
their quarterback, and the six backs and receivers, whose primary job is to move the ball down
the field by either running with it or passing it.
Like their offensive counterparts, defensive linemen (also called rushers) line up directly on the
line of scrimmage.
Linebackers play behind the defensive line and perform various duties depending on the
situation, including rushing the passer, covering receivers, and defending against the run.
 Biomechanics of kicking
The soccer-style kick lasts for no longer than five seconds, depending on
the length of the approach. The intensity of the kick depends on how far
the kicker needs the ball to travel or how fast it has to go. As with any
action lasting less than 10 seconds, the kicker uses a purely anaerobic
metabolic pathway to produce the necessary energy to kick – in other
words, they are relying heavily on the ATP-PC energy system (adenosine
triphosphate-phosphocreatinase) for this action.
 Components of the kick
For a detailed analysis, the kick action is analyzed into six
stages :
• the approach
• plant-foot forces
• swing-limb loading
• hip flexion and knee extension
• foot contact
• follow-through.
 Internal risk factors for injury
• Previous injury
 previous injury in the first season was identified(in a study) as a
significant risk factor for injury in the subsequent season.(for
adductor, hamstring, quadriceps, and calf injuries)
 previous anterior cruciate ligament (ACL) injury is a risk factor for a
new knee injury, especially overuse injury(in another study).
• Genotypic differences
 genetic variations may be a risk factor for non-contact
musculoskeletal soft tissue injuries
• Psychological factors
 anxiety, negative life event and daily hassles are significant
predictors for injury
• Anthropometrics Studies have shown-
 players sustaining groin strain within a season had
significantly higher percentage of body fat than the group
without groin strains
 borderline significant association between increased weight
and patellar tendinopathy was found.
• Physical status
 decreased range of motion in hip abduction as a risk factor
for groin strain
• Newcomers to professional football
 Players who are promoted from youth academies are exposed
to several factors that may influence injury occurrence.
 These factors include, physical adaptation to new training
methods, changes in training and match loads, lack of social
support, and new relationships with players, coaches,
technical staff, and medical staff.
 a newly published study in Australian Rules football found an
increased injury rate for players during their first year in the
professional Australian football league compared to established
players
• Player age
 Previous literature has found that the injury rate for specific injury
types varies with age.
 Older age has been identified as a risk factor for Achilles tendon
injuries and calf injuries In contrast, younger age has been found to
be associated with stress fractures and fifth metatarsal fractures.
• Player position
 When studying lower extremity muscle injuries and MCL injuries of
the knee, lower injury rates were found for goalkeepers compared to
outfield players.
 In contrast, goalkeepers have been identified to have a higher rate of
upper extremity injuries
 Defenders have been found to have the highest rate of head/neck
injuries ..
 External risk factors for injury
• Pre-season training/seasonal distribution
 Studies have found an increased injury rate during the pre-season
compared to the competitive season, especially for training injury ,stress
fracture, fifth metatarsal fracture, patellar tendinopathy ,hamstring
muscle injury, overuse injury and re-injury .
 In contrast, the injury rate for hamstring muscle injury has been found to
be increased during competitive season compared to the pre-season
• Match associated variables
 A study found a higher rate for head/neck injuries at away matches
compared to matches played at home venue where another study found
found a lower injury rate in matches played away compared to home
matches
 the rate of moderate and severe injuries increased with the importance of
the match
 The injury rate has also been found to vary during the match with trends
towards an increased injury rate in the end of the first and second halves.
• High match and training load
 In a cohort of European football clubs, high total seasonal football
exposure was identified as a risk factor for patellar tendinopathy
 In contrast, data from the FIFA World Cup present a linear
relationship between an increasing number of recovery days
between matches and a higher injury rate.
• Weather and playing field conditions
 In Czech football, about a fifth of players cited poor pitch quality
as a causative factor for their injury.
 Studies in Japanese football found rainy weather to be associated
with reduced injury rate
• Team success
 A study evaluated the relationship between seasonal injury rate
and team success in Qatar first-division football and found that
lower injury rate was strongly correlated with team ranking
position, more games won, more goals scored, greater goal
difference and total points.
 Sports Specific Injuries
 Head and Neck
 Concussion
MOI-Caused by direct blow to the head , face , neck or elsewhere on the body with
an impulsive forces transmitted to the head.
Grade 1-Treatment should include removal from play and observation on the
sideline. After headache, dizziness, impaired concentration,and retrograde
amnesia have resolved for a brief period, return may be considered.
Grade 2-Initial management is similar to that for grade 3 concussions.
Grade 3-treated as though they have a concurrent cervical spine injury.
 Facial injuries(nasal injuries)
MOI-Caused by direct blow .
Initial management involves ensuring a secure airway and controlling the bleeding
by external pressure or intranasal packing. Evaluation of the intranasal structures
may be allowed by spraying 0.25% phenylephrine hydrochloride to shrink the
mucosa. Septal hematoma, a collection of blood between the cartilage and
mucoperichondrium, should be ruled out; this injury manifests with bluish-red
bulging in the nasal vestibule. Players should be referred for realignment and
counseled about possible deformity. Return to play is allowed with protective gear.
 Cervical sprains and strains
Strain – MOI- when muscle is overloaded or stretched.
Muscles commonly involved are SCM , trapezius , rhomboids , erector spinae , scalenes ,
and levator scapulae .Athletes with instability may require surgical treatment. Otherwise
treatment should include rest, ice, and a brief period of immobilization. Return to play
may be considered after full, painless range of motion has returned.
Sprain – MOI - Compressive – type injuries that result in neck pain without severe muscle
tenderness
Cervical spine fractures and dislocations with resulting neurologic injury
MOI- Flexion with ant compression and posterior distraction , lateral flexion , or rotation
that stretch the convex side and impinge on the concave side , extension with distraction
anteriorly and compression posteriorly and direct axial compression .
 Shoulder
 Brachial plexus injuries-
MOI- Downward displacement of the shoulder with concomitant lateral flexion of the
neck towards the contralateral side. Proposed mech include – brachial plexus stretch or
traction injury , nerve root compression in the intervertebral foramen or injury from
direct blow. Initial evaluation should include checks for a full, painless range of motion of
the neck. Upper-extremity sensory and motor testing should be next. Attention should be
paid to the deltoid, biceps, and external rotators, which are the muscles most often
affected. When full, painless range of motion and normal strength have returned, the
athlete may return to play.
Mechanism of Injury to the brachial
plexus (burners).
 Acromioclavicular joint injuries
MOI- FOOSH
o Treatment of types I and II is non-operative, with the use of a sling for
several days to weeks, activity modification, and isometric exercises,
followed by range of motion and progressive resistance exercises.
o Treatment of type III injuries remains controversial; most surgeons favor
initial non-operative management, with some exceptions.
o Operative treatment is recommended for types IV, V, and VI AC joint injuries.

 Glenohumeral instability
MOI- is often a blow to the abducted, externally rotated arm for anterior
dislocations or, less commonly, a blow to the adducted, internally rotated arm
for posterior dislocations.
o Prevention-Correction of poor tackling techniques
o Rehabilitation consists of strengthening of the internal and external rotators
of the shoulder.
o Recurrent cases -Open capsulo-labral reconstruction is usually suggested in
the contact athlete
Improper tackling technique can result in
anterior shoulder dislocation. Hill-Sachs fracture in a fullback who
Note the position of the arm, which is suffered an anterior dislocation when
completely abducted, creating a lever he fell while blocking.
that can result in a large moment across
the shoulder
 Rotator cuff injuries-
 MOI-The mechanism can be repetitive microtrauma or an acute
injury. Pain with overhead activities and with throwing are typical
complaints

Rehabilitation with strengthening of the rotator cuff, deltoid, and

scapular stabilizers is often successful in patients with cuff-related
complaints. Posterior capsular stretching is also important.
 Elbow
The incidence of elbow injuries in football players is difficult to estimate because most
series include them with other arm, forearm, and wrist injuries.
 Dislocation
MOI-may occur after a fall on the outstretched upper extremity. Rehabilitation after elbow
dislocation follows a brief period of immobilization, then protected range of motion.
 Medial collateral ligament injuries resulting in valgus instability also occur in football.
MOI-levering of the humerus out anteriorly as the olecranon is locked in the olecranon
fossa in full extension.
Rehabilitation for valgus instability generally consists of rest followed by supervised
stretching and strengthening. If this is unsuccessful, surgical reconstruction of the ulnar
collateral ligament with a graft through bone tunnels may be necessary.

 Forearm, wrist and hand

These relatively unprotected parts of the body are often brought into contact with
helmets, pads, cleated shoes, and the ball.
 Contusions of the dorsum of the hand and metacarpal fractures.
Ice, compression, and protective padding should be used for contusions. Stable
metacarpal fractures may be treated with a hard cast for practice and a soft cast for
games. Unstable fractures should be treated with internal fixation and return to play with
 The scaphoid is the most commonly fractured carpal bone, and these injuries are
common in football players.
MOI- FOOSH with extended wrist. Nondisplaced fractures are treated in a short
arm–thumb spica cast with a softcast for games. Return to play for some skilled
position players may be difficult. Displaced fractures, delayed unions, and nonunions
are managed with internal fixation and possibly bone grafting.

 Tear of the thumb ulnar collateral ligament(gamekeeper's or skier's thumb)

MOI- Forced abduction of the thumb . Inadequate treatment may result in difficulty
in activities that require pinch. Partial tears of the ulnar collateral ligament are stable
to radial stress and should be treated in a thumb spica cast for 3 weeks, with
additional protection afterward. Complete injuries demonstrate instability on radial
stressing of 30 degrees greater than the uninjured side.

 Injuries to the phalanges and interphalangeal joints-

evaluated with stressing of the interphalangeal joints and radiographs when the
possibility of fracture exists. Most sprains are treated with buddy taping and range-
of-motion exercises.
 Terminal extensor tendon insertion avulsion (mallet finger) may occur after the
player is struck by the ball. Inability to extend the distal interphalangeal (DIP).
managed with splinting in extension for 6 to 8 weeks unless a fracture involving
25% of the articular surface is present, in which case open reduction and internal
fixation should be performed.

 A central slip avulsion (traumatic boutonnière)- painful, swollen proximal

interphalangeal (PIP) joint should be tested for ability to extend against resistance.
Treatment is with extension splinting of the PIP with the DIP free for 6 to 8 week

 An avulsion injury of the flexor digitorum profundus tendon (jersey finger) may
occur when a player grasps an opponent's jersey. The player is unable to flex the
DIP joint. The injury should be managed with surgical repair. The urgency of the
repair depends on the degree of retraction of the tendon..

 Lumbar spine- Offensive linemen are particularly susceptible, apparently

because of repetitive extension loads sustained when coming out of a stance for
blocking. Weight lifting may also be contributive, especially squats .
 Spondylolysis, a defect in the pars interarticularis, is also a common
condition in football players. Players with back pain and spondylolysis
should participate in a rehabilitation program until symptoms subside
before returning to play.
 Spondylolisthesis, Higher-grade slips, progression, and neurologic findings
warrant further evaluation and possible surgical treatment. Bracing is
advocated by some in certain situations. A rehabilitation program should
include hip flexor stretching to decrease lumbar lordosis.
 Hip
 A contusion over the iliac crest (“hip pointer”) is probably the most
common injury to the hip area managed with ice and compression initially.
Later, range-of-motion exercises and protective padding are used for
return to play.
 Avulsion fractures occur at the anterior superior iliac spine (sartorius),
anterior inferior iliac spine (rectus femoris), ischium (hamstrings), lesser
trochanter (iliopsoas), and iliac crest (abdominals). Unless displacement is
severe, these injuries are managed with protected weight bearing, ice,
and activity modification. Progressive range of motion and strengthening
are initiated as pain resolves. Return to play is allowed when full, painless
range of motion and strength have returned.
 Iliopsoas strain
MOI- overuse injury resulting from excessive hip flexion such as kicking . Common in
sprinters and footballers . Treatment – Avoid aggrevating activities , stretching of psoas
and strengthening involving resisted hip flexion exercise -Mobilisation of lumbar IV jt
at origin of iliopsoas results in inc in muscle length.
 Thigh
 Quadriceps contusions
MOI-direct blow from a helmet or shoulder pad as a player is being tackled. Initial
treatment consists of attempts to decrease hemorrhage with ice, compression, and
protected weight bearing. Some advocate strapping the knee in full flexion to limit
edema and hemorrhage and maintain motion. Early pain-free range of motion is
important, but overly aggressive therapy may be detrimental by increasing the
hemorrhage. Return to play is allowed once range of motion and strength have
returned to normal.
 Quadriceps Strain
-Occur during sprinting , jumping or kicking. Most common in rectus femoris as it
passes over two jt. TREATMENT- Principles of treatment are similar to those of thigh
contusion. - low resistance and high reps ex ( loss of strength more marked than thigh
contusion) Concentric and Eccentric ex with low wts. General fitness can be
maintained by swimming and upper body training.
 Hamstrings strain
Common injuries in football and field hockey( Sports involving high speed running
and kicking ).
-Non contact injury.
Management – first 48hrs – PRICE. Early mobilization (pain free, active knee extnsn
in sitting following 10-15 min of icing). Subsequent- Stretching ( Hams , quad,
iliopsoas). Strengthening – Hamstring (conc and eccentric) , Gluteals and adductor
magnus . Soft tissue treatment – (hams and gluteal trigger pt) -Neural stretching
and Spinal mobilization. Cross training bike and Stability program

 Knee
The structure most commonly injured is the MCL followed by the menisci and the
anterior cruciate ligament (ACL).
Linemen often sustain MCL injuries after being blocked in the side of the knee or
when a player rolls onto the lateral leg, causing a valgus stress. Receivers and
defensive backs may be more likely to sustain a noncontact ACL injury.
Rapid deceleration and cutting can place excessive strain on the ACL. Running backs
often sustain contact injuries while being tackled.
The most common mechanism of injury to the
medial collateral ligament is seen when a player
gets struck by an opposing player on the outside
lateral aspect of the knee, which produces valgus
force with tearing of the medial collateral ligament.
 Medial Collateral Ligament
MOI- Valgus stress to the partially flexed knee. Most common injury in football. In
contact sports when opponent falls across knee from lateral to medial. Physical
examination confirms tenderness over the MCL and increased laxity with valgus stress
at 30 degrees of flexion.
Grade 1- Management includes weight bearing as tolerated, with return to play after
full range of motion and strength are achieved.
Grade2 and 3-Treatment for isolated MCL injuries is now generally nonoperative, with
bracing and rehabilitation. Return to play is allowed after tenderness and swelling
have resolved and range of motion and strength have returned. Braces are often used
on return to play.
 Lateral ligaments
less common than MCL, often seen in combination with more extensive posterolateral
corner or cruciate injuries.
Varus stressing at 0 and 30 degrees is used for basic evaluation. Mild injuries may be
treated nonoperatively with bracing and rehabilitation, but the threshold for surgical
treatment should be much lower than for MCL injuries. Early primary repair of
significant injuries has yielded superior results compared with reconstruction for
chronic instability.
 Anterior cruciate ligament
MOI- frequently a noncontact, deceleration, rotational injury. Valgus,
hyperextension, or varus contact injuries may also cause ACL rupture.
Associated collateral ligament or meniscal injuries are common, especially
with contact injuries.
Management of ACL injuries may be operative or nonoperative depending on
many variables. Functional instability often results in players who require the
ability to accelerate, decelerate, and cut.
Nonoperative management includes aggressive rehabilitation with hamstring
strengthening to limit anterior tibial translation. A functional knee brace is
used on return to play.
Operative treatment includes reconstruction using autograft or allograft
tissue. Return to play is usually possible in 6 to 9 months, although some
athletes have returned earlier.
 Posterior cruciate ligament
MOI-direct blow to the anterior tibia with the knee flexed ; however,
hyperflexion, hyperextension, valgus, or varus stresses can also cause injury
to the PCL.
Potential mechanism of PCL injury includes direct contact
with an anterior force applied to the proximal tibia.
 Menisci
MOI- int or ext rotation of knee over the foot planted.
Catching, pain, swelling, and joint line tenderness are common findings. McMurray's
test may be positive.
Treatment – Initial RICE + NSAIDS and analgesic
Long term – Physical therapy – ( ROM + PRE)
Symptomatic players usually require arthroscopic treatment to return to
competition quickly. Partial meniscectomy may allow early return to play, but at the
possible increased risk of later arthritic changes. Meniscal repair, however, requires
prolonged absence from participation.
 Patellofemoral joint
Dislocations of the patella
MOI- mechanism usually involves external rotation, quadriceps contraction, and
extension of the knee.
Initial examination findings may include a tense hemarthrosis and medial
parapatellar tenderness.
Initial management includes rest, ice, compression, and immobilization. Range-of-
motion and quadriceps-strengthening exercises with particular attention to the
vastus medialis obliquus should follow. A knee sleeve or patella taping is often
 Patellar tendonitis (jumpers knee)-
MOI-Activities involving jumping or changing direction
common overuse injury involving inflammation of the tendon at the inferior
pole of the patella.
Nonoperative treatment is successful in most players and includes
hamstring stretching, quadriceps strengthening, bracing, oral
antiinflammatory agents, and avoidance of repetitive jumping and certain
knee extension exercises. For those with persistent complaints, operative
excision of degenerative tendon may be necessary and is usually successful.
 Fat pad syndrome (Hoffa disease)
MOI- Seen in football esp in linemen who have repeated trauma to the ant
aspect of knee or Sudden onset with hyperextension injury. Repeated
trauma to the anterior knee may lead to fibrous changes in the patellar fat
pad. Pinching of the fat pad between the femoral condyles and tibial
plateau may cause pain in extensionTreatment with ice, activity
modification, stretching and strengthening, and padding is usually
successful. Unresponsive cases may be treated with arthroscopic
debridement of the thickened fat pad.
 Foot and ankle
 Medial and lateral ligament sprains
Most injuries are sprains sustained when cutting and changing
directions and involve supination of the foot, causing injury to the
lateral ligament complex. Another mechanism involves pronation with
external rotation of the talus. This may occur when the athlete's body
is twisted away from the injured side or when another player falls on
the posterior aspect of a downed player's leg.
Treatment includes protection, rest, ice, compression, and elevation.
Limited immobilization is sometimes used for severe sprains.
Rehabilitation should include strengthening and proprioception
exercises. On return to play, braces, taping, and high-top shoes may
be used for protection. Surgical reconstruction is reserved for those
with symptomatic chronic lateral instability.
Mechanism for external rotation injuries to the ankle.
A: With the foot fixed to the ground, the athlete's body
is twisted away from the injured side.
B: The player's foot is externally rotated when he
receives a blow to the lower leg.
Turf toe
injury to the first metatarsophalangeal (MTP) joint complex.
The use of lightweight, flexible shoes on hard artificial turf has
been credited with increasing the frequency of this injury.
MOI- The usual mechanism is forced dorsiflexion of the first MTP
joint, which causes stretch of the plantar structures and impaction
of the proximal phalanx on the dorsal metatarsal. This often occurs
when a player falls on the posterior aspect of another player's leg.
Radiographs should be evaluated to rule out associated fractures,
including fractures of the sesamoids.
Early treatment is with protection, rest, ice, compression, and
elevation. Taping and use of a stiff-soled shoe offer protection for
return to play. These injuries may cause prolonged time lost from
athletics. Hallux rigidus and hallux valgus may be late sequelae of
this injury.
Mechanism of injury for turf toe. Forced dorsiflexion
of the first metatarsophalangeal joint commonly
occurs when a player falls across the posterior
aspect of another player's leg.
 How to prevent the injuries ?
PRE-SEASON HEALTH AND WELLNESS EVALUATION
• All players should have a pre-season physical examination with their
primary doctor to determine their readiness to play.
• It is an important step to uncover any condition that may limit
participation.
• Football players should be given adequate time to acclimatize and
recover during preseason training.

PREVENTION OF CONCUSSION
• All on-field personnel should review, practice and follow their venue
emergency plan and be trained in administering first aid, AED use, and
cardiopulmonary resuscitation (CPR).
• Regarding concussions, if in doubt, sit them out.
• Athletes with a concussion must be removed from practice or
competition and should not return that day and not until given
• clearance by an approved medical provider according to the institution’s
PRE WORKOUT AND WARMUP
• Perform proper warm-up and cool-down routines.
The warm up should begin approximately 30 minutes before kick-off:
 The warm up should begin with 10 minutes of running to increase core
and muscle temperature. This should be start with simple jogging.
 Once body temperature has been raised, static stretches should be
performed for all major muscle groups but should not be painful.
 Following stretches, the player should actively mimic activites that he
may have to carry out in game- i.e. without a ball, he should go through
the actions of side foot passing, high kicking, jumping and heading,
squatting and jumping,etc.
 The once warmed up and flexible, the players should introduce a football
and go through functional activities. These include heading, short and
long passing with feet, running backwards, sideways, skipping,
stopping/starting, sprinting, and sprinting and turning.

• Consistently incorporate strength training and stretching

HYDRATION
• Hydrate adequately to maintain health
and minimize cramps.
• Keeping properly hydrated is one of
the most important steps all athletes
need to take. When working out or
playing, athletes should only drink
when thirsty.
• Football players should have
unrestricted access to water during
practice or competition and replace
every pound lost with 20 ounces of
fluid before the next practice.
• Don’t replace water with sugary sports
drinks such as Gatorade, focus on
drinking water when needed
• Stay active during summer break to
prepare for return to sports in the fall.
STAYING FIT AND PREVENTING OVERUSE
• Many players overuse their bodies by playing sports year round without a break. This is
very dangerous and will lead to a very short athletic career. Be sure player are in good
physical condition at the start of football season.
• During the off-season, stick to a balanced fitness program that incorporates aerobic
exercise, strength training, and flexibility.
Gradually increase your activity level and slowly build back up to a higher fitness level as
football season approaches.

USE OF PERSONAL PROTECTIVE EQUIPMENT

• Wear properly fitted protective equipment for the protection of the body during the
course of football game.
• Basic equipment worn by most football players include helmet, shoulder pads, gloves,
shoes and thigh and knee pads and a jockstrap or compression shorts with or without a
protective cup.
• Neck rolls, elbow pads, mouth gaurds, hip pads, tailbone pads, rib pads and other
equipment may be worn in addition to the aforementioned basics.
• Equipment should be made of synthetic materials; foam rubbers, elastics, and
durable ,shock resistant, molded plastic.
• Tackle with the head up and do not lead with
the helmet.
 THANK YOU

Reference for risk factors –

Department of Medical and Health Sciences, Division of Community Medicine,
Linköping University, Sweden, Kristenson K. Risk factors for injury in men´s
professional football [Internet]. Linköping University Electronic Press; 2015 [cited
2021 May 6]. Available from:
http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-117170