The ‘Rolled Ankle’ Injury In Soccer
A lateral ankle sprain/tear (or more commonly called a ‘rolled ankle’) is the most common ankle injury in soccer. It can occur due to playing on uneven grass surfaces, landing on other peoples shoes/feet during the game or a quick change in direction.
Pain will be felt on the outside of the ankle and will usually have swelling and bruising associated with it. The ligaments in that area are the ATFL, CFL and the PTFL (see picture) and the most common to sprain is the ATFL. Walking may be difficult, but you will be able to weight bear even if minimally. If you can’t weight at all for 4 steps you need to head to A&E for an x-ray to clear any fractures.
The most important thing to do immediately is RICE (Rest, Ice, Compression Bandages and Elevation) and then book in to see your Physiotherapist immediately. The Physiotherapist will be able to tell you the grade of tear and refer you for an x-ray/MRI if they suspect or want to clear a fracture or confirm the grade or severity. The grade of sprain will influence the treatment and your return to sport.
- Grade 1: minimal tear and will have minimal laxity compared to the other side.
- Grade 2: increased laxity exists but will have an end point (so its still attached)
- Grade 3: Full tear with no end point.
For your grade 2 and 3 sprains, a boot, brace or a period of non-weight bearing may be needed and can be advised by your Physiotherapist. Rehab will involve; range of motion exercises, hands-on Physiotherapy treatment, balance work and functional exercises to regain range of motion, motor control and strength. Taping will be needed for up at 6 months post an ankle sprain during all games to give feedback and help prevent another injury. It is super important rehab is done correctly, and continued till the ankle is equally as strong, flexible and stable as the non-injured side before full return to sport.
Post Game Recovery
It’s important to look after your body post game. On top of a good cool down and your static stretches, there are a few other things you can do to reduce the risk of injury and help improve recovery. The most important include:
- Re-hydration – Very important for your muscles, cells and fascial connective tissue. Try to avoid alcohol for 12 hours post game. You can vary drinks to include electrolyte drinks or coconut water, but the best is simply plain water. Approx. 250mls (1/4 L) is required. More is needed if its hot weather.
- Hot/cold showers – Eg. 1-2 mins warm, 30 secs cold. Repeat several times ending with cold. Cold baths of 20mins duration have been shown to reduce muscle soreness post intense exercise.
- Epson Salt baths – 1-2 cups per bath. Increases Magnesium in the body and aids recovery. These can now be purchased in most health food stores and supermarkets.
Strength and Cardio training Sessions
On top of scheduled soccer training and games, it’s important to alternate additional strength and cardio sessions throughout the week.
Strength training can include free weights, body weight exercises or machine weights in a gym or Pilates environment. Depending on what you want to achieve will determine the load and reps you do. It should target the major muscle groups, especially the legs and core for soccer and be functional to soccer.
- Endurance training: low loads and high reps
- Strength training: moderate load and moderate reps
- Hypertrophy (muscle bulking): high loads and low reps
It is always advised to start with endurance and strength style training if you are new to weight lifting for a good few weeks. Be prepared for DOMS (delayed onset muscle soreness). This is a normal process of resistance training, but increases in intensity with hypertrophy training. It usually starts about 24 hours post the session and can last several days. As you get more conditioned to resistance training the muscles adapt and DOMS is reduced.
Be careful when you schedule strength training sessions so that DOMS doesn’t affect you on game day.
One of the most important things to get right is your form. Incorrect form can cause an injury. Make sure someone is coaching you on good technique!
Cardio training sessions can vary depending on what is required during the game for you as an individual. For example if you are a keeper, you are not running around as much and it’s more bursts. Cardio training should represent roughly your game day with running as its most specific to soccer. Some examples include:
- Eg. 45 mins (60-70% Heart rate Max)
- Sprinting interval training. Eg. 2mins light jog or walk (50-60% Heart Rate Max) followed by a 30sec sprint (80-90% Heart Rate Max) for approx. 30mins in total
- Any combinations of the above.
Please remember to seek advise from your coaches and your Physio for specific programs before starting any additional training, especially if you are working with an injury.
COMMON KNEEE INJURIES IN SOCCER
Knee ACL Sprain/Tear:
Caused by: A sudden stop when running or a change in direction. When the tibia (shin bone) moves forward on the femur (thigh bone). When the quads eccentrically pull in deceleration (slowing down). Women have a 7-10% higher incidence.
Sprains/Tears are assessed as Grades: 1,2 and 3 based on testing.
If it’s a Grade 3, to return to full sport, you would most often need an ACL repair.
Grade 1 and 2 can be managed conservatively with Physiotherapy.
Signs of a full tear: Considerable swelling quickly (1-2 hours). Often the person will hear a pop, be unable to weight bear on that leg and have instability of the knee.
Initial Treatment: RICE (rest, ice, compression, elevation) and Physiotherapy. Physiotherapists will test for ACL rupture and refer for an MRI if indicated. Surgery if ruptured (grade 3) will often be indicated to continue to play sports at a high level. Prehab (before surgery) and rehab (post-surgery) will be followed through with a Physiotherapist.
Meniscal Tear of the Knee:
Caused by: Usually a loaded twist of the knee.
Signs: Swelling is often delayed, 6-24 hours later. May have locking or clicking of the knee. Can experience a giving way feeling.
Initial Treatment: RICE and Physiotherapy. Physiotherapists can test for Meniscal tears and refer for an MRI if needed. Surgery may be indicated to return to sport at a high level – depends on many factors such as where in the meniscus the tear is and if it has a blood supply to heal. Often conservative treatment works well on the tears that have slow developing symptoms, ability to still weight bear, show minimal swelling or pain at only end of range knee bending. Surgery will most likely be indicated when the knee is locked, have a severe injury mechanism or there is minimal effect after conservative Physio treatment.
Caused by: Lateral (sideways) force to knee bending it inwards.
Signs: Initial tenderness and swelling of inside of knee. Often pain at both full bend and full straighten.
Treatment: RICE and Physiotherapy. Testing for grade of tear. Knee braces are sometimes used for initial support and stability. Taping and knee supports may be needed with return to play. Conservative management is very effective as treatment.
Physiotherapists have many tests to diagnose the above knee injuries and can direct you in the right place for your recovery and return to playing Soccer.
STRETCHING AND FLEXIBILITY
Why is stretching important?
Stretching mobilises the joints, muscles and most importantly, fascia (connective tissue that covers the entire body and weaves its way through all tissue). Moving the joints/muscles and fascia keeps them healthy and can improve overall flexibility. We need to have a certain amount of mobility of our tissue to reduce injury. There are “normal” ranges for all muscles/joints, and it’s important to know these. If you are restricted, you should aim to get to normal ranges especially as an athlete. If you are too mobile, it is important to know how well you control that mobility.
What types of stretching are there?
Static held stretches for 30secs and dynamic stretching. Dynamic stretching is where the muscle is taken through full range of motion using momentum and constant movement. For example: lunges with trunk rotation and high kicks.
When is best to do what?
Pre-game and pre-training it’s most important to do dynamic stretching as this warms the body up and helps promote the muscles to fire appropriately for entering the soccer game. Post-game and post-training is when static held stretches are best to help cool down the body, reduce muscle pain and improve any areas of inflexibility.
How do you know what to stretch?
All the global muscles should be stretched dynamically pre game or training – quads, hamys, calves, inside thighs and gluts of the lower limb, shoulders and back muscles of the truck and upper limb. Static stretches to the global muscles just mentioned can be performed post-game if needed.
Make sure your stretching is with good form and technique, appropriate for soccer, best for your body type (hypermobile players may need to avoid certain static stretches) and is used correctly to assist play, recovery and injury prevention. If you have an injury, it’s important to check with a Physiotherapist what stretching is best for you pre and post games.