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AFM Magazine


The Five Most Common Injuries in Football

What teams need for an adequate athletic training program
by: Valerie Hunt
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Identifying the five most common injuries in football is a difficult task considering the large array of choices. After all, football is a contact sport, and contact breeds injury even in the best circumstances.

According to a 1995-97 NATA injury surveillance of 10 high school sports, football players suffered more injuries than any other athletes, with more than half of those injuries occurring in practice.

Keep in mind that many things can be done under the guise of prevention, but the most significant aspect of prevention is the concept of treating an injury immediately, correctly and preventing further injury or complications.

It is up to the coaches, athletes, athletic administration, athletic training professionals and medical community to work together and support one another in the effort to provide the best care possible to each athlete. Having immediate care rendered by a competent allied health professional such as an NATABOC certified athletic trainer (ATC), along with the communication and support between the coaches, administration and ATCs, are perhaps the most valuable components of a good sports medicine program.

Knowledge is another key. Just as coaches study opposing teams, they should know the risks of injury prior to practice and game time. Here is a selection of common injuries found in football. They include contusions, ankle sprains, muscle/tendon strains, brachial plexus stretch and concussions. These categories combine less intensive injuries with frequent occurrence, and more extensive injuries that may occur less often but leave an impact when they pay a visit to a team.

CONTUSIONS

Contusions are perhaps the most common injury in football due to the nature of the sport. Contusions are simply bruises caused by blunt force trauma to the body, and they can occur to soft tissue (muscles and tendons) as well as bones. Most contusions cause little more than discomfort and resolve very quickly.

Some contusions, however, can cause much more of a problem, either due to the type or amount of tissue that suffered damage, or improper care and treatment.

Trauma causes tissue damage, which results in internal bleeding and loss of strength in the affected area. A quick functional test is a simple method to help determine return to play status following a contusion. Treatment for contusions should include the RICE (Rest, Ice, Compression, Elevation) regimen that will help reduce the swelling and therefore allow for a quicker recovery.

In addition, it is very important to protect the contusion from subsequent trauma with the application of protective padding. Once any contusion occurs, the most beneficial management following the RICE regimen is the protection from further injury.

Even the most minor of contusions can benefit from being protected with padding from subsequent trauma. Preventing the repeated trauma to a contusion can be the best medicine. In rare cases, recurring contusions to a thigh or biceps muscle can cause a condition known as myositus ossificans, which can turn "just a bruise" into a debilitating injury.

First Aid Tip: RICE and PROTECT with padding
Average time loss: No time loss to several weeks
Best Prevention tip: Wear properly fitting uniform properly at all times

STRAINS

Ligaments that are torn are considered sprains. Ligaments are non-elastic, non-contractile tissue that connect bone to bone in a joint.

Another common injury to football players is a sprained ankle. Statistics have indicated the vast majority of ankle injuries occur to the lateral (outside) aspect of the ankle. The common mechanism for this injury is when the foot rolls inward, resulting in tearing of the ligaments located on the outside of the ankle.

Signs and symptoms include pain and swelling, and treatment is the RICE regimen. To rule out the possibility of a fracture, it is important that a doctor or ATC evaluate ankle injuries that result in swelling. This is especially important in young high school aged athletes, whose growth plates have not yet matured.

As with any injury, one of the common side effects of trauma is the disruption of strength and proprioceptive or balance awareness. This lack of strength and proprioception in an ankle injury should be addressed with a progressive strengthening and balance program, and usually responds very quickly with proper rehabilitation and reconditioning. Supportive taping or bracing can also be helpful in providing a safe return to participation, but should never take the place of a quality rehabilitation program under the guidance of an ATC or physical therapist. It is imperative that even minor ankle sprains be completely rehabilitated to reduce the chance of a re-injury.

Sprains to the knee are also common and can be quite devastating. Knee sprains usually occur in the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL). Because the knee is not as stable a joint as the ankle, it does not respond as favorably to taping and/or bracing as the ankle does. Therefore, it is imperative to allow adequate time for healing and rehabilitation following knee sprains. MCL sprains are often caused when a force bends the knee inward. The MCL often heals well without surgical intervention.

The more infamous ACL sprains, however, can be caused by simple rotation of the knee as a player plants his foot and pivots to change direction. Often ACL sprains occur without any tackle or contact from another player. Grade 3 ACL sprains, which require surgical reconstruction, can cause little pain, which may allow players to think they can return to the field only to find out their knee is very unstable. This false sense of ability can cause a more devastating injury to the athlete who does not receive immediate evaluation by an ATC or MD on the field.

First Aid Tip: RICE, emphasizing REST with timely evaluation by ATC or MD
Average time loss: One day to several weeks
Best Prevention tip: Provide athletes a quality strength training program

SPRAINS

Ligaments that are torn are considered sprains. Ligaments are non-elastic, non-contractile tissue that connect bone to bone in a joint.

Another common injury to football players is a sprained ankle. Statistics have indicated the vast majority of ankle injuries occur to the lateral (outside) aspect of the ankle. The common mechanism for this injury is when the foot rolls inward, resulting in tearing of the ligaments located on the outside of the ankle.

Signs and symptoms include pain and swelling, and treatment is the RICE regimen. To rule out the possibility of a fracture, it is important that a doctor or ATC evaluate ankle injuries that result in swelling. This is especially important in young high school aged athletes, whose growth plates have not yet matured.

As with any injury, one of the common side effects of trauma is the disruption of strength and proprioceptive or balance awareness. This lack of strength and proprioception in an ankle injury should be addressed with a progressive strengthening and balance program, and usually responds very quickly with proper rehabilitation and reconditioning. Supportive taping or bracing can also be helpful in providing a safe return to participation, but should never take the place of a quality rehabilitation program under the guidance of an ATC or physical therapist. It is imperative that even minor ankle sprains be completely rehabilitated to reduce the chance of a re-injury.

Sprains to the knee are also common and can be quite devastating. Knee sprains usually occur in the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL). Because the knee is not as stable a joint as the ankle, it does not respond as favorably to taping and/or bracing as the ankle does. Therefore, it is imperative to allow adequate time for healing and rehabilitation following knee sprains. MCL sprains are often caused when a force bends the knee inward. The MCL often heals well without surgical intervention.

The more infamous ACL sprains, however, can be caused by simple rotation of the knee as a player plants his foot and pivots to change direction. Often ACL sprains occur without any tackle or contact from another player. Grade 3 ACL sprains, which require surgical reconstruction, can cause little pain, which may allow players to think they can return to the field only to find out their knee is very unstable. This false sense of ability can cause a more devastating injury to the athlete who does not receive immediate evaluation by an ATC or MD on the field.

First Aid Tip: RICE with timely evaluation by ATC or MD
Average time loss: A few days to several weeks
Best Prevention tip: Provide athletes a quality strength training program

BRACHIAL PLEXUS STRETCHES

This injury is often referred to as a stinger or a burner, due to the immediate symptoms that occur. The common mechanism for this injury is a lateral (sideways) movement of the head away from a depression of the shoulder. This causes a nerve root (brachial plexus) that runs relatively close to the surface of the neck and shoulder to be stretched.

This nerve root affects sensory and motor function to the arm; therefore, when it is disrupted, pain and/or strength loss can occur in any function of the arm. This may include movements of the shoulder, elbow, wrist, and/or fingers. The strength of each motion should be compared to the strength of the opposite side, and if there is a deficit of strength, the athlete should be rested and referred for more extensive evaluation.

After receiving a brachial plexus stretch, a player may appear with his arm hanging down low and be reluctant to move it. He may report a burning or stinging feeling in the arm, caused by the sensory nerve disruption of the brachial plexus.

If any loss of strength or sensory change does not completely resolve in five minutes, or if this injury reoccurs, the athlete should be evaluated by an ATC and MD before returning to participation. This injury often responds well to quality rest and an aggressive rehabilitation program, coupled with protective equipment.

If this injury is not treated properly, permanent nerve damage can result.

First Aid Tip: RICE with timely evaluation by ATC or MD
Average time loss: A day to several weeks
Best Prevention tip: Provide athletes a quality strength training program emphasizing neck musculature

CONCUSSION

Confusion, ringing in the ears, headache, nausea, dizziness, blurred vision that occurs after trauma to the head - any and all of these indicate the athlete has a concussion. What used to be referred to as "getting your bell rung" is now considered a substantial injury that requires further evaluation by an ATC and MD.

Loss of consciousness for any length of time should, without question, require an athlete to obtain immediate medical follow-up and a minimum of several days symptom-free prior to returning to football.

Concussion without loss of consciousness is one of the most difficult injuries for ATCís and sideline physicians to evaluate and treat. Because some of the symptoms can be slow to manifest and subjective in nature, players feeling great pressure to participate may downplay or even deny symptoms that may help determine proper management. It is of utmost importance that coaches understand the significance of concussion symptoms and instill that same appreciation to the players and parents.

There is mounting evidence that early return to activity and subsequent minor head injuries, even as minor as a tackling situation in football, can cause severe consequences if the brain has not healed from the first concussion. This phenomenon called second impact syndrome, can be lethal and often comes without warning. Treat all symptoms of concussion with concern, do not hesitate in seeking medical follow-up, and rely on other athletes,family and friends to help identify when an athlete is acting differently following even a minor head injury. There may be no second chance to do the right thing.

First Aid Tip: Immediate evaluation by ATC or MD
Average time loss: A few days to several weeks
Best Prevention tip: Properly fitted quality protective headgear and mouthguard worn at all times.






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