Footballing injuries are a common problem. In many cases, injuries resolve and the player returns without a continuing problem. Unfortunately there are situations when an injury can persist or recur. There are a number of reasons why this can happen, including the effectiveness of the early management, the circumstance of the injury, the interpretation of the injury and early coping skills of the individual.
In this first blog dedicated to injuries in football, I am going to describe what happens when we damage soft tissues such as ligaments and muscles. For example, an ankle ligament sprain or a muscular strain. It is important to have an understanding of these natural and normal processes so that we can treat the injury appropriately and effectively.
When we injure our tissues playing football it is either with sudden force, for example when changing direction, or involving another player in a tackle or collision. Ultimately, the tissues are damaged and release chemicals into the local area. These chemicals are inflammatory and have a range of effects, including sensitisation of the local (peripheral) nerves, causing the blood vessels to widen (vasodilate) and become more leaky, and to attract other chemicals and cells to the area to begin the healing process. This is both normal and essential and usually hurts, although not necessarily straight away.
In most cases an injury like this will be painful. However, there are many stories of players sustaining injuries and not being aware of pain. The brain is quite capable of receiving dangers signals and concluding that there is no threat. This is because something else is more important at the time, i.e. winning the game.
Aaron Ramsey is challenged by Richard Dunne in a recent FA Cup match at the Emirates
The healing process runs through overlapping stages as the body deals with the damaged tissue and rebuilds the area. Sensibly, this process hurts as a way of ensuring that the area is protected. For example, an ankle ligament injury will be painful and provoke a limp so that limited force goes through the healing tissue. Some force and strain is needed for effective healing, so low load movement is very useful.
There are several key points to consider with pain. Firstly, pain is not an accurate indicator of tissue damage. I have already given the example of the undetected injury. How painful can a paper cut be? Secondly, pain is an experience produced by the brain and not the tissues. Here’s how.
When the nerves in the tissues are excited by inflammation, they send danger signals to the spinal cord. Various changes occur in the spinal cord as a result of this bombardment of signals meaning that subsequent signals are amplified. The spinal cord acts like a volume switch that can be turned up or down by the brain, as well as by signals from the tissues. Once the danger signal has reached the spinal cord, a second signal is sent from the cord to the brain. The brain scrutinises the messages on a background of past experience, beliefs, emotional state, gender, culture and a range of other considerations. On concluding that there is a danger, the brain will allocate pain to the area of the body that is perceived to be under threat.
Common injuries in football include ankle and knee ligament sprains; groin, hamstring and calf strains; and contact injuries. All of these are experienced via the aforementioned processes when the brain seeks to defend the body so that it may heal and restore normal function. The questions that the brain asks on receiving danger signals are: how dangerous is this really? And what do I need to do now? The answers to these questions are what we feel and do.
If you do suffer an injury, the body will immediately begin the process of protection and repair. The area will often swell, become reddened, hurt and be difficult to move. This is a normal response to damaged tissue. We must respect the incredibly powerful and effective healing process and optimise the outcome with practical management. Initially PRICE can be used: protection, rest, ice, compression and elevation. As soon as you can, a visit to your GP or physiotherapist for further specific advice and treatment that will help ensure that you start on the right road to recovery.
