Soccer injuries: pain in the beautiful game

Soccer is the most popular sport in the world. Though it is enjoyable and helps to develop fitness, agility, and teamwork, injuries often occur. The lower limbs are usually affected as it is where the running, tackling, jumping, stopping and kicking occurs. Dr Michael Soon, orthopaedic surgeon from Parkway East Hospital, gives us the lowdown on common soccer injuries and how to manage them.

According to the doctor, injuries can be broadly classified into two types:

Overuse injuries occur over time due to the stress on muscles, tendon, joints and bones caused by the lack of time allowed for healing to take place. They usually start as mild ache or pain, but can slowly develop into a chronic injury if not treated early.

Common overuse injuries include patellar tendonitis, which causes pain at the front of the knee due to kicking and sprinting. Achilles tendonitis causes pain over the back of the heel, while shin splints are a particularly painful condition to have. Some players are also prone to groin pain due to overuse of thigh and abdominal muscles.

Acute injuries are caused by trauma, like a twist in the ankle or knee, either with or without impact from contact.

Ankle sprains are the most common injury that a player will encounter, causing a tear in the ligaments situated outside of the ankle. This injury can be managed by B.R.I.C.E. treatment - brace, rest, ice, compression and elevation. With this, about 85% of players can return to sports after a short period of time. However, if there is persistent pain or instability like a repeated ankle sprain, the problem may be more serious and professional medical attention should be sought. Further tests like magnetic resonance imaging (MRI) or even surgery might be required for treatment.

Knee injuries are where most of the serious injuries occur as it is a complex joint capable of delivering powerful forces from the thigh for running, jumping, and kicking. The ligaments of the knee have to support the joint as the body twists and turns, lands from jumping, and cope with sudden changes of direction.

The medial collateral ligament (MCL) is the structure that connects the inside of the thigh bone to the inside of the shin bone. When a sudden force is applied to the outside of the knee in, say, a tackle, the inside of the knee can 'open up'. Depending on how bad the tear is, this injury can be managed with a brace of four to six weeks, allowing it to heal on its own. However, a bad tear of the MCL or when coupled with other complex injuries, surgery may be required.

The meniscus is the shock absorber of the knee. It supports the thigh bone on the shin bone. Though strong when supporting weight from the top (during standing or jumping straight), it is weaker when twisted. A sudden change of direction or a bad fall can apply twisting forces that can tear this shock absorber in the knee, leading to pain and swelling. Occasionally, the knee can also lock. The player will need to undergo MRI to determine the type of treatment. Usually, surgery is required to repair the tear or trim of badly torn portions.

The anterior cruciate ligament (ACL) tear is the most feared of injuries for the soccer player. This ligament is important in maintaining stability when changing direction, jumping, and sprinting. Once the ACL is ruptured, surgery is required with the use of a graft, usually a tendon from the player's body, to be placed within the knee joint by drilling holes in the bone. The tendon is then tightly secured with medical screws, and will change into a ligament over time.

For whatever the injury, post-operative rehabilitation is very important. Dr Soon advises that the player must diligently follow up with physiotherapy to ensure that his joints regain full range of movement and power before returning to the game.

How do I prevent such injuries?
A lot of soccer injuries are preventable. The best protection is proper warm-up and physical conditioning to prevent injuries that can ruin a game, a season, or in some cases, a career. A proper warm-up helps to gradually increase body temperature, allowing nerves to respond faster. Muscles and tendons are also allowed to stretch and attain their full range of motion, thereby preventing an injury.

The player can also wear the appropriate protective gear where possible. So warm-up, enjoy the beautiful game, and stay safe.

Publication of article by courtesy of Dr Michael Soon, Orthopaedic Surgeon from Parkway East Hospital.