SOCCER INJURY REHABILITATION PROCESS & PHASES
Dr. Juan Carlos Devia Ramos MD
Club Atlético Boca Juniors – Medical Department
Across elite level soccer, the increased demands of training, competitive match play and the ever growing congestive fixture periods in-season increases the players injury susceptibility. Recently, it has also been shown that losing soccer players to injury can be to the detriment of team success, so the importance placed on the rehabilitation process to recover and return the players back to training and games in a ready to play state is vitally important.
Furthermore, as a result of this, especially in soccer, it is essential to have well-processed, defined & professional protocols with the capability to carry out the rehabilitation.
It is proposed that soccer rehabilitation should begin as soon as possible post-injury, & should only be completed when the player or athlete can fully participate in competitive activities without limitations caused by the current physical state. In order to achieve this, it is of paramount importance to eliminate pain, achieve an adequate range of mobility, technique, coordination & to minimise the loss of strength, speed, power & endurance throughout the training and competitive cessation. Within this report, the author will describe rehabilitation across 3 phases: acute, rehabilitation, & training.
The acute phase of an injury may last days, but at times up to weeks. During this phase, the objective is to prevent the injury from getting worse. The player must reduce or stop the training routine & participation in competition or match-play. The duration away from training & competition will be determined according to the characteristics & severity of injury.
- For acute injuries, normally the principles of treatment PRICE (Protection, Rest, Ice, Elevation) are suggested (depending on physio or physician advice). Furthermore, an initial immobilization period for better control of inflammation along with the use of anti-inflammatories to control symptoms & pain are also common practice in this phase. During this phase – athletes or soccer players may be advised to train areas of the body that do not directly affect the injury area in an attempt to maintain physical condition to a certain extent.
Rehabilitation ranges from weeks to months. During this period, the athlete is prepared to resume training normally, thus ensuring normal range of motion, adequate strength, normal neuromuscular functions, aerobic capacity & all round general robustness. During this phase, it should be specified within a specific return to play strategy, how much training exposure the player should have & what type, as to not cause pain or re-injury. The occurrence or persistence of pain & inflammation are obvious give-away symptoms indicating the training load needs to be decreased.
Decreased range of motion will directly affect the ability to carry out regular normal training, whereas elongation of injured tissues & muscles should be cautiously performed according to the principles of light & frequent elongation early stage rehabilitation with increased intensity, volume & overall load from beginning to the end phase (return-to play) rehabilitation. Within the ISSPF online course in Injury, Prevention & Return to play in Soccer, Dr. Juan Devia Ramos MD (Club Atlético Boca Juniors – Medical Department) provides an overview and fantastic lectures in the exploration of injury prevention, rehabilitation & return to play structures.
With respect to strength development work in the rehabilitation processes, specific work should be carried out on the injured structures, of which the intensity & duration will depend upon the type of injury, location & evolution time. In addition, alternative routines are included that do not negatively influence the injury, but may allow it to maintain & strengthen the rest of the body.
All soccer players who are forced to stop training (completely or partially) lose resistance & strength gains at quite a fast rate due to the cessation, and as a result its vital to restore aerobic capacity to pre-injury levels. Generally, during the initial stages of rehabilitation process it is necessary to modify to ensure the player can do some type of graded, beneficial exercise without risking the recovery or re-injury of the injury.
Neuromuscular re-education exercises are vital in rehabilitation as painful disorders produce reflex inhibition, leading to changes in the muscle recruitment pattern of the compromised region. Exercises that require coordination, balance, weight transfer, & rapid reaction to changes in position are important in the restoration & re-education of the athlete’s neuro-muscle.
With soccer being an intermittent high intensity & high speed effort, contact sport, it is quite inevitable that traumatic injuries are common place. Additionally, injuries that occur within the game itself are well reported as being fatigue based non-contact due to the effort, speed or pace & longitudinal volume of the competitive season.
One of the primary aims of individuals involved within the development of soccer athletes or players (i.e. doctors, physiotherapists, sport science staff & coaches), is the prevention of injuries & performance development. In order to achieve this, it is of paramount importance that the specific developmental strategies, protocols & training programs are conducted within a way that is justifiable, scientifically led, to provide the players with the best possible tools & robustness for season duration.
When faced with individual injuries, or within fixture congestion periods that may spike injury rates irrespective of the preventative methods & strategies employed (i.e. squad rotation, training load management, injury reduction strategies, nutrition & recovery protocols), the injury mechanisms, compromised tissues & possible deeper research into injury analysis – individuals involved within the performance, coaching or medical aspects of player development must continue to offer the best possible treatment. Ensuring players or athletes return to the same level (or better) than pre-injury state is the focus. In order to achieve this, each of the phases described here in terms of acute, rehabilitation & training/or return to play is of huge importance.
Factors impacting the injury risk of soccer players:
- Warm ups. Adapted warm up is considering as a prevention strategies because it reduces the injury risk (Fields et al, 2010; Soligard et al, 2010). These studies showed that a specific intervention program used as a warm up & focusing on core stability, eccentric training of thigh muscles, proprioceptive training, dynamic stabilization & plyometrics can positively influence injury rates.
- Congested fixture periods. Dellal et al (2013) & Dupont et al (2010) have shown that a congested fixture period could affect & increase the injury risk. Consequently, when a team plays 6 or 7 matches in about 20 days for example, a global preventive plan has to be settled including the training load monitoring, the use of post-efforts recovery method (alternating cold & hot water immersion for example), and squad rotation of players.
- Playing surface. According to some reports in this area, the playing surface has an essential role in injury rates (Ekstrand et al, 2006), more so with the continued change of training or competitive surface (e.g. grass – synthetic – grass).
- Fatigue & training monitoring. The acute: chronic workload is well-reported within the literature & suggested as a key factor when discussing injury in individual and team sports. Periodization, & the capacity to plan & design a training schedule with the appropriate intensity & frequency around competitive fixtures is a key factor when trying to avoid injury. In this context, training load management should be considered as a preventative strategy. Every coach, technical staff & fitness training professionals have various personal & individual views of the microcycle loading design, but irrespective of the method used, the primary approach is to manage & manipulate the players fatigue & performance & to avoid injury.
- Injury history & re-injury. Previous injuries, which are poorly rehabilitated & managed, could well be the origin of a re-injury. Contextually, it is very important to take the time in order to totally recover, re-train & re-condition the injured area from a physiological & biomechanical perspective. The high risk of re-injury concerns the hamstring strain, & indirectly, after an ACL, there are a possibility of compensation & of re-injury on the same knee, & the contralateral knee, or muscle (i.e. hamstring, quadriceps, gastrocnemius).
- Nutrition & dehydration. Poor management from a food type & selection, combined with poorly planned hydration strategies or fluid intake could increase the risk of injury according to the period of the season & external conditions.
- The period of the season. The risk of injury differs according to the period of the season. For example, incidence of sprains was greatest during preseason & the beginning of the competition period, whereas muscular strains peaked in both the beginning & final weeks of the season phase (Mallo & Dellal, 2012). Concerning the in-season period, recent research has shown that performing an injury prevention program twice weekly for the entirety of the entire season (58 prevention sessions) can lead to significantly less muscle injuries. The findings from this study identified a multi component injury prevention training program may be appropriate for reducing the number of muscle injuries during a season but may not be adequate to reduce all other injuries.
The demand for sports science, physiotherapists, performance & coaching specialists in football & team sports is growing year upon year. Thousands of students are leaving university with a sport science degree, physio or therapy related qualification, however many of them asking the key question – What now? How do I get a job in football? What’s the next step? Which area of sport or football science & medicine do I want to specialise in? How can I take my learning to the next level?
These are certainly interesting questions as progressing from completing a sporting, medical or therapy related degree to then working in professional football & trying to understanding all the key components, and soft skills that come with jobs in football or careers within sport is complex.
As a result, the bespoke courses developed by ISSPF Medical & Football Science Faculty members are a way of further exposing learners, parents, professional coaches, students, or other individuals interested in football science with a thirst to develop & upskill further.
The link below will take you to the hugely popular & expertly designed ISSPF endorsed & accredited Soccer Injury, Prevention & Return to Play online sport science course, where you will be exposed to football medicine & coaching science led research, with practical examples used by the game’s leading practitioners.
Why is this course important?
- Provides up to date injury analysis, injury reduction processes & modern approaches & insights to individuals tasked with the injury, rehabilitation & return to play process of athletes or team sport players
- Discusses the most efficient training methods and detailed insights into developing player fitness alongside rehabilitation & training methodologies
- Gain a better understanding how to maximise the rehabilitation process within the game
- Learn from industry experts in the area of rehabilitation & return to play protocols
- Help maximise your decision making through a better understanding & appreciation of football or soccer rehabilitation
Who is this course for?
- Individuals tasked with the responsibility for management of players from a training, preparation, coaching & rehabilitation perspective
- Any individual who is working as part of a multi-disciplinary staffing structure within a team or individual sport.
Injury Prevention & Return to Play Course:
Module 1: Injury analysis in soccer
Lecturer: Dr. Hilary Obert (Major League Soccer [MLS Cup] Champion)
Module 2: How to implement injury prevention programs within soccer
Lecturer: Dr. Victor Salinas (Former Liverpool FC Physio)
Module 3: Understanding injury prevention and rehabilitation in soccer
Lecturer: Dr. Juan Carlos Ramos (Boca Juniors Medical Department)
Module 4: Injury reduction strategies in professional soccer
Lecturer: Dr. Patrick Orme (Bristol City FC, Head of Physical Performance)
Module 5: Screening processing in soccer & corrective implementation
Lecturer: Dr. Hilary Obert (Major League Soccer [MLS Cup] Champion)
Module 6: Nutrition for Injury Phases & Rehabilitation
Lecturer: Faisal Alshawa MSc
Module 7: Injury Prevention in Soccer: Key Strategies & Methods
Lecturer: Aleksa Boskovic MSc
Module 8: Psychology during soccer injury
Lecturer: Dr. Jorge David More Anzola (Millionares FC, Colombia)
Module 9: Soccer specific movement preparation: Improving efficiency
Lecturer: Aleksa Boskovic MSc
Module 10: Training Load Management: Performance Optimisation
Lecturer: Dr. Adam Owen
Module 11: ACL Injury Criteria Based Return to Play in Soccer
Lecturer: Dr. Felix Fischer
Module 12: Preparing the Injured player for return to play (RTP)
Lecturer: Matt Newton MSc (KitMan Labs, Former Cardiff City FC)
· How can you prevent injuries in soccer?
· What are some ways to practice injury prevention?
· What exercises help with soccer?
· What are the 3 most common soccer injuries?
· What are the main causes of soccer injuries?
· What are the common injuries in youth soccer?
All these frequently asked questions will be answered & further detailed information provided within our ISSPF online injury prevention & return to play course – we look forward to seeing you there!