Football

ACL Tear 

The ACL is a ligament located inside the knee and has a major role in its stability. A tear in that ligament will result in loss of appropriate function of the knee joint and therefore will affect activities of daily life like walking, going down the stairs and especially playing sports. An ACL tear will result from two distinct mechanisms. The first and most common is with a sudden change of direction accompanied with a sudden feeling of instability while running and changing directions. The second cause will be with hyperextending the knee. Both may lead to a pop and there will be swelling and pain in the knee. Recurrent instability and episodes when the knee gives way will be present.   

During examination there will be commonly swelling around the joint with marked instability during functional tasks. The strength may be affected as a result of pain but is not always present. The range of movement will be decreased in a case of significant knee swelling. Specific clinical tests will reveal laxity of the ACL which will then need to be confirmed with radiological investigation. An MRI will show the damage in the ACL as well as any associated injuries of the meniscus or other ligamentous structures in the knee. 

Management: 

The management of an ACL with associated meniscus injury or other ligamentous injuries is commonly operative aiming to restore normal anatomy. In an isolated ACL tear the management will depend upon the level of activity, age and goals of the client. For sporting individuals an operation is more appropriate because of the increased demands on the knee which requires stability. An operation aims to regain normal stability and prevent osteoarthritis. 

In both cases, the rehabilitation will aim to initially reduce the swelling and regain the normal mobility. Following, the strength phase is initiated with progressive loading exercises. Once strength is regained in both two-leg and one-leg stance, the explosive exercises will initiate to prepare you for the demands of the sport. Return to sport is achieved normally at 9 months following operation, however this highly depends on each individual. 

MCL Tear 

The MCL is a thick ligament located at the inside of the knee and is one of the main stabilisers of the joint. Its main function is the stability of the knee from excessive inward movement during functional tasks. A tear in this ligament can range from mild to severe with the latter significantly affecting function of the individual. 

During examination there may be commonly swelling around the joint with or without instability during functional tasks depending on the grade. The strength is not commonly affected, and range of movement will commonly not be significantly reduced. Specific clinical tests will reveal laxity or pain of the MCL which will then be confirmed with radiological investigation if a severe grade is suspected. An MRI will show the damage in the MCL as well as any associated injuries of the meniscus. 

Management: 

The management of MCL in mild to moderate grades is conservative with relative rest, ice, pain and swelling management. Full range of movement and strength will be regained before commencing to balance exercises. Once all the previous steps are completed, functional training and sport-specific exercises will be initiated to prepare you for returning to sport. 

Operation will be the management for a full tear of the MCL which will aim to regain normal stability and prevent chronic instability and osteoarthritis. The steps of rehabilitation after the operation are the same as with the conservative management, however with a longer duration. 

Ankle sprain 

An ankle sprain is very common in a sporting environment but it can happen in the general population. The twisting of the ankle will injure a complex of ligaments on the inside or outside sides and may range from a mild sprain to a tear. The most commonly affected ligaments are on the outside which are a result of an inward twisting of the ankle. Following an ankle sprain there will be immediate swelling with pain. The inability to walk on the foot is a strong indicator that an X-Ray will be required to rule out any fractures. 

During examination there will be commonly swelling around the joint with marked instability during functional tasks. The strength will be affected as a result of pain but is not always present. The range of movement will be decreased due to swelling. Specific clinical tests will reveal laxity or pain of the ligaments depending on the grade of severity. On a severe ankle sprain with suspected tears of multiple ligaments it has to be confirmed with radiological investigation. An MRI will show the damage in the ligaments and will guide the management in the severe cases. 

Management: 

The management of ankle sprain in mild to moderate grades is conservative with relative rest, ice, pain and swelling management. Full range of movement and strength will be regained before commencing to balance exercises. Once all the previous steps are completed, functional training and sport-specific exercises will be initiated to prepare you for returning to sport. 

Operation will be the management for a full tear of multiple ligaments which will aim to regain normal stability and prevent chronic instability and osteoarthritis. The steps of rehabilitation after the operation are the same as with the conservative management, however with a longer duration.

Osgood Schlatter

This pathology refers to a developmental issue in the knee where the tendon of the knee-cup causes a small fracture on the tibia of the lower leg. This is a common complain of the children participating in sport and aging from 8-14 years old.   

During examination there will be tenderness along the attachment of the tendon on the tibia. A presence of a lump with swelling and redness is common if the individual continues to participate in the same level of activity and ignoring the symptoms. Postural and movement abnormalities may be present in the individual predisposing for further injury.  

Management: 

The management of Osgood Schlatter is non-operative and includes pain management, avoiding aggravating activities, strengthening and stretching the muscles that are limiting normal movement mechanics. The application of ice, tape and other modalities may be used to allow the individual to achieve a quicker recovery. 

The duration of symptoms can stay up to 24 months, however early management may be able to identify predisposing factors and reduce recurrence.

Hamstring tear/strain 

Hamstring strains in football is common especially during sprinting. The hamstring is a large muscle located at the back of the leg and is main function in bending the knee and extending the hip. These movements are necessary for running and weakness, fatigue or muscle imbalances may lead to injury. 

The symptoms of a hamstring tear will be sudden onset of pain while running that is localised but soon becomes a general ache. Depending on the degree of tear, there may be visible bruising further down the leg and tenderness. Sleeping can be affected especially the first days after the injury due to the inflammation that accumulates while recovering. During the morning the feeling of stiffness may be experienced and it is normally relieved with walking. The pain may range from mild ache to severe discomfort depending on the irritation of the underlying structures and your daily activities.

Examination will commonly reveal a tenderness on palpation of the affected leg, with or without bruising. There may be pain on functional activities and the most provocative testing will be bending the knee against resistance. 

Management: 

The management of a hamstring strain depends on the grade and can range from 2-8 weeks. Management is almost exclusively conservative and initiates with relative rest, application of ice and compression. Following this a gradual loading program will be recommended by your physiotherapist in order to restore full capacity in the muscle and correct underlying weaknesses and muscle imbalances that are predisposing to injury. Following successful strengthening program, sport-specific rehabilitation will follow with the aim of re-introduction to sport. 

Calf tear/strain 

Calf sprains in football and running are not uncommon and are normally present with a sudden stretch of the muscle. This can be either from changing direction, landing from a jump or sudden acceleration The calf consists of three muscle located at the back of the lower leg. Is main function in flexing the ankle and assists in bending the knee. These movements are necessary for running and weakness, fatigue or muscle imbalances may lead to injury. 

The symptoms of a calf tear will be sudden onset of pain while running that is localised but soon becomes a general ache. Depending on the degree of tear, there may be visible bruising further down the leg and tenderness. Sleeping can be affected especially the first days after the injury due to the inflammation that accumulates while recovering. During the morning the feeling of stiffness may be experienced and it is normally painful with walking. The pain may range from mild ache to severe discomfort depending on the irritation of the underlying structures and your daily activities.

Examination will commonly reveal a tenderness on palpation of the affected leg, with or without bruising. There will be pain on functional activities and there may be complete loss of the ability to flex the ankle. A gap may be able to be palpated. 

Management: 

The management of a calf tear depends on the grade and activity level. In the older individual conservative treatment will normally be recommended, however in the sporting individuals an operation may be used for an earlier return to sport.  The management of both groups consists initially of relative rest, application of ice and compression. Following this a gradual loading program will be recommended by your physiotherapist in order to restore full capacity in the muscle and correct underlying weaknesses and muscle imbalances that are predisposing to injury. Following successful strengthening program, sport-specific rehabilitation will follow with the aim of re-introduction to sport.