In a sport like football, whose determining actions take place intermittently and at a high intensity, player’s joints are subjected to a high level of demand, with sudden changes of direction at high speed, stopping and starting, jumping, sometimes in contact with opponents who unbalance and knock them down. In this post, I intend to look in detail at knee injuries in football, one of the greatest fears on a football pitch.
The most serious injury in football
The joints that suffer most from the aforementioned stress are those of the lower body, especially the knees, as they are located in the centre of the lever, between two other joints, the hip and the ankle.
Is the knee the joint that suffers the most in the world of football?
The knees are a type of joint called diarthrosis joints. Their main function is to allow flexion and extension of the leg, connecting the thigh (the femur) to the leg (the tibia). In addition, the patella will be the third bony component of this joint.
In addition, the leg muscles are responsible for providing mobility to the joint, as well as protecting it. Within these muscles, we find the quadriceps, adductors and hamstrings, mainly.
Finally, to prevent the impact between the distal head of the femur and the proximal head of the tibia from wearing down the bones, the menisci (internal and external) will act as pads to absorb these impacts.
How do footballers injure their knees?
As mentioned above, the knee joint allows flexion and extension movements.
Why do football players suffer knee injuries?
However, these movements, which occur in the majority of actions in football, do not always occur in a single plane (as happens with linear running), but are accompanied by changes of direction and turns that produce a rotation in the joint, or other movements the knee isn’t prepared for.
What are the most common knee injuries in football?
These affect the ligaments of the joint and can be classified into intracapsular and extracapsular, depending on whether they are inside or outside the joint capsule.
Furthermore, depending on the severity and level of ligament involvement, we can talk about sprains (when there is an over-stretching of the ligament without rupture) or tears (which can be partial or complete).
Within this type of injury, we’ll be looking at sprained ligaments and anterior cruciate ligament tears
- Ligament sprains: If the forces acting on the knee in a direction other than flexion and extension are light, our ligaments and muscles, through the mechanoreceptors they integrate, will be able to stabilise the knee. However, with football being a high-intensity sport, these actions rarely occur at low intensity, so the amount of force being withstood in a single instant can cause the ligaments to overstretch, resulting in a sprain. If the force is even higher, the ligament may even tear. Depending on the direction of the forces that our joint cannot withstand, we’ll injure one ligament or another. Sometimes more than one ligament can be damaged at the same time.
- Anterior Cruciate Ligament Tears: This is an intracapsular ligament that connects the head of the femur to the head of the tibia. The main cause of injury to this ligament occurs with knee valgus, when the knee is flexed and in internal rotation. Another fairly common injury cause for this ligament is during landing after a jump, when the joint is destabilised and the valgus occurs, over-stretching the ligament until it tears. As a general rule, this injury requires surgical intervention and its recovery (despite the fact that footballers insist on shortening deadlines), will not be complete until at least 9 months after the intervention.
This type of injury does not directly affect the knee joint, but rather the muscles that surround it, and, in particular, the tendons that are inserted around it.
These injuries are caused by an overuse of the muscles resulting in degeneration of the tendon, which causes pain and often prevents sports practice. The most common injury within this group is:
- Patellar Tendinopathy: The patellar tendon is responsible for connecting the patella to the tibia. This tendon is an extension of the quadriceps tendon below the kneecap and is essential for knee extension. This type of injury is usually chronic. It’s caused by overuse of the quadriceps musculature that pulls on the tendon, gradually leading to degeneration of the tendon’s collagen fibres. One of the main actions that degenerate this tendon is jumping, with landing being the moment in which it supports the greatest tension, as the quadriceps are responsible for cushioning, eccentrically, the inertia of the fall.
As mentioned above, the menisci (internal and external) are responsible for cushioning and absorbing the impacts between the femur and the tibia to prevent them from degenerating and giving rise to osteoarthritis.
The main injury is the meniscus tear, which can be caused by too strong an impact or too pronounced a rotation that causes both bones to pinch the tissue until it breaks.
— Newcastle United FC (@NUFC) March 23, 2021
As with anterior cruciate ligament tear, it requires surgery to replace the ligament with a tendon graft, as well as reconstruction of the meniscus.
Recovery times will be the same as for isolated anterior cruciate ligament reconstruction
How can a footballer prevent a knee injury?
The knee joint requires good stability to stay healthy. As a result, injury prevention aimed at reducing the chances of suffering a knee injury will, to a large extent, involve working on knee stability.
— Fútbol en Movistar+ (@MovistarFutbol) October 18, 2020
To achieve the desired stability, we have to take into account all the agents involved. Firstly, we have to work the muscles that protect the joint, in this case, mainly: the quadriceps, hamstrings and adductors.
A decompensation between these muscle groups can lead to instability in the knee, which will increase the chances of a future injury.
We often see athletes on unstable surfaces performing exercises more typical of the circus than their sport. Although it’s true that they’re activating their proprioceptor system, they’re doing so with movements and sensory information that are vastly different to what they’ll encounter in their sport.
As a result, proprioceptive work in football should be aimed at providing the joints with similar stimuli to those they’ll encounter in competition, such as one-legged actions (shots, passes), landings with opposition from an opponent, movements that endanger instability (loads or pushes), etc.
Knee injury prevention exercises
As we’ve seen in this article, there are a lot of knee injuries, so each type of injury, having a different injury mechanism, will require different exercises to minimise the risk of suffering them.
One of the muscles we need to be aware of in order to maintain a healthy knee is the gluteus medius.
Activation of this muscle while running is responsible for preventing knee valgus (when the knee turns inwards), which can endanger the ligaments.
Weakness in this muscle is a major risk factor for knee injuries.
The main recommendation for effective prevention of knee injuries is that preventive work should be another part of your weekly training routine. We should get into the habit of doing this type of work at least two days a week, always under the supervision of a professional.
Follow the recommendations of the professionals of physical preparation in football.
We also need to be clear that doing preventive work doesn’t mean we won’t get injured, but that we’re reducing, as much as possible, the chance of this happening, and, if it does, that our structures are in the best possible condition, which will favour a good recovery.
The recovery and adaptation of our tissues to training and competition will suffer, and this will increase our risk of injury.
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- Ferrer-Roca, V., Balius, X., Domínguez-Castrillo, O., Linde, F. J., & Turmo-Garuz, A. (2014). Evaluación de factores de riesgo de lesión del ligamento cruzado anterior en jugadores de fútbol de alto nivel. Apunts. Medicina de l’Esport, 49(181), 5-10.
- Gómez, P., & Ortega, J. M. (2013). PROPUESTA DE CONTROL Y SEGUIMIENTO DEL PROCESO DE READAPTACIÓN FUNCIONAL DE UNA LESIÓN DE RODILLA. Revista de Preparación Física en el Fútbol. ISSN, 1889(5050), 5050.
- Leiva, J. J. A. (2014). Propuesta de incorporación de tareas preventivas basadas en métodos propioceptivos en fútbol. Retos: nuevas tendencias en educación física, deporte y recreación, (26), 163-167.
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