Prevention Symposium Football
Updated: Apr 14
It was the second online symposium organized by the VBG (gesetzliche Unfallversicherung Germany ) which was held on 22th October. Physio Restart joined and made a summary about the most important information we took away from excellent speakers. VBG - Startseite
We take regularly part in online and live courses and congresses to use those information and ensure that we provide an evidence-based, and if not present in literature yet, qualitative good treatment to our patients.
Anneke is sportphysiotherapist for a local football team in Zurich as well as started in exchange for the national football teams from SFV.
What kind of injuries do we have in football?
The ischiocrural muscle group (hamstrings), which are on our back side of the thigh, are often injured in this sports. Especially the biceps femoris is with 79% (according to literature approved by BJSM) mostly affected. However, injury mechanism, prevalence and treatment is „a big, still unknown problem“.
Most of the time, an injury to this muscle groups happen during lunging movement (59%), next to kicking (30%) and landing (7%). If a player is in a stretching position with his / her back side of the leg (extended knee) and about to break or stop the movement, he / she has a 52% risk to injure that muscle group. In a sprint during the acceleration moment, he / she has a risk of 48%.
Which type of training need to be included in the training sessions?
For sure: sprints! Most of the training sessions of a football player should include sprints with variations: change of direction, breaking and stopping.
Also eccentric exercises should be included. Those exercises implement a „force production during active muscle lengthening“ (Harris-Love et al. 2021). An example is the Nordic Hamstring Curl for the back side of your thigh (see picture below). If we want to perform this exercise on the field, we should stabilize the legs with two persons (not one).
Nordic Hamstring Curl (NHE)
Important: only go as far forward that no hollow back occurs. Otherwise, drop forward on your hands. Feet must be well fixed.
© PHYSIO RESTART
Note: the Nordic Hamstrings Exercise (NHE) is a widely discussed but proven to be a good exercise in injury prevention of the hamstrings in football, but we need to consider its potential to produce an injury if applied mistakenly. As it requires a lot of muscle force and correct performance, experts recommend to vary the NHE by performing a guided push up. Put the knees on a towel and each hand on a football, get hold by another player on your calf muscles.
Train SMART!
Another factor is plyometrics, these type of training concentrates on „repeated rapid stretching and contracting of muscles (as by jumping and rebounding)“ (Merriam-Webster).
An important factor to consider is how and when we include those specific training components. Every implementation of exercise should consider the individual player, especially when he or she had an injury to the affected muscle group. Fatigue and pain should be considered. Otherwise we always need to have variations with change of type of exercise, repetition, duration, resistance, speed and range of motion. We need to do progressions in case the player is doing well and without any compensation or complaints. Or even regression if the exercise produces problems. And if the player has a match every Sunday, it makes sense to incorporate the specific, intensive and eccentric training within the middle of the week. To warm up before the match it is recommended to perform isometric exercises where there is no shortening or lengthening of the muscle included, for example: (see pictures below)
Supine bridge
Lift the pelvis only about 1 fist's width from the floor and keep it straight, try that the left side does not drop.
© PHYSIO RESTART
Prone Leg curl
To train the isometric type of this exercise, we want to hold the leg at a certain angle (test different ones). There is no movement of the leg.
© PHYSIO RESTART
What kind of exercises are further recommended for the back side of your leg?
Single leg romanian deadlift
At first, take little or even no weight to learn the right technique. The leg is almost completely stretched, head straight looking downwards, hips on one level, abdominals tensed to avoid a hollow back again.
© PHYSIO RESTART
Hip extension
In this exercise, people often make the mistake of going too far back with their leg and into a hollow back.
© PHYSIO RESTART
Romanian deadlift
In order to activate the back of the thigh better, we also stretch the legs in this exercise. Move the weight up and down close to the body along the legs.
© PHYSIO RESTART
What are common mistakes made in rehabilitation on side of the care givers?
Neglect or missing of:
correct diagnosis
time management (delayed diagnosis and treatment started)
tissue healing phases (too early or too late tissue loading)
mental readiness (no teamwork with patient)
individualistion (treating unspecific)
tests to check progress (wrong or even no progression)
Physio Restart ensures to avoid those mistakes by also working together with other specialised health care givers.
What’s the right time to return to sport after a muscle injury?
Everyone is different, it depends on type of human being, sports and occupation, age, previous injuries, treatment intervention (and others), but we can guess:
hypertonic muscle 1 - 3 days
soreness 2 - 5 days
mucle strain 3 - 5 days
muscle fiber tear 10 - 14 days
muscle spindle tear 6 weeks
muscle tear 12 - 16 weeks
muscle contusion 2 - 3 weeks
Last but not least:
We work WITH our patient, respect his / her thoughts and goals. We think OUTSIDE the box and are ready for unexpected changes, modifications and individualizations.
Authors:
Anneke and Oliver Penny
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