Physio for Common Football Injuries
A Physio's View: The End Of The UK Football Season
A Physio's View: The End Of The UK Football Season
Our knee and foot & ankle specialist physio Alex has worked as Head Physio at Crystal Palace Football Club for six seasons and experienced most of the highs and the lows of the UK football season from behind the scenes, so we’ve asked him to fill us in on the gory details of what happens at the end of the UK football season. It’s a really interesting read!
Staying Focused
This time of the year in the football world is mixed with an array of emotions and circumstances, depending on the team’s position. It may seem that there is a group of teams who 'have nothing to play for', i.e they are safe from relegation and are not involved in any fight for the title or promotion or European qualifying spots. Whilst this is true, all teams and players are competitive right until the end. Everyone wants to finish as high up the league as possible, not only for financial reasons to the club and its staff but also to achieve the best possible league position. So, wherever the club may be, the structure of training, the discipline, the organisation etc, all stay as they are right until the very final whistle. Any lack of focus will show up on the training pitch and then be carried into the matches.
Behind the Scenes
Personally I have been fortunate enough to have experienced all the emotions possible! I have been relegated with a club, promoted, fighting for survival, fighting to get into the top half, and been in FA cup finals. It can be a very hectic time: exciting, worrying, nerve racking, from sheer elation to deflation in the blink of an eye. As staff it's important to stay as grounded as possible. Even though the entire club goes through all these emotions, its the players who are out there and ultimately it comes down to how they perform on the day. You have to keep as level headed as possible, whilst not denying the highs and the lows of the weekends’ results, its crucial to not get carried away either way and allow either complacency or negativity to creep in.
Behind the scenes this is actually a very busy time for the club. It's a short off season nowadays, 5-6 weeks maximum so lots of planning goes on. Pre-season tours, matches, training schedules all need to be in place prior to leaving for the break. This is the only downtime staff and players get throughout the year so most people end up being away at the same time.
Rest and Rehab Through Off Season
As a medical department, unless you have been lucky and timings have worked out, it's rare not to have any injured players who will be carrying something into the off season. For these players, it's a difficult time to be doing rehab as the club is often very quiet: their team mates are all on holiday and so mentally it can be tough for them. So again this requires careful planning as they too have families who have been waiting for a break. It's important to strike a balance between time off and also rehab, it's always our aim to give the manager as full a squad as possible on day one of pre-season.
As well as the inured players, it's also important to monitor what the squad does during the off season. We used to give players individual rehab programs during the summer to work on things especially if they had picked up injuries in the season. Typically everyone is advised to have a couple of weeks off and just rest up, keep active but allow the body and mind to recover. Then it’s a combination of strength work and cardio vascular work but we aim to keep impact work down. Rest is really important but these athletes have to keep up a level of training so the body doesn't have too big a shock when training starts as that can lead to injuries.
It Never Really Stops!
The end of season is actually quite a strange time of year. Working for a professional football team is non stop, it's fuelled on adrenaline, days roll into one, you don't really feel that Monday to Friday rush then weekend break and then all of a sudden, mid May, it’s done! It's a long season, physically, mentally and emotionally draining for everyone involved, even more so if there is a crucial position to be played for so everyone deserves as much down time is possible, but behind the scenes in June there is lots still going on!
Words by Alex Manos.
Die Another Day PART 3: Total Hip Replacement - Ivan's Story
Forty-nine year old Physio Remedies total hip replacement (THR) patient Ivan describes how his knowledge of the modern day advances in hip replacement technology, famous sportsmen and women that had undergone THR surgery and the first class physiotherapy and referral advice he received from Sarah Lawson and Nick Smith of Physio Remedies enabled him to make the decision to have surgery early and start realising the benefits of doing so – PART 3, preparing for surgery, the operation, rehab and today’s update.
In Part 1 Ivan gave the background to his diagnosis, and in Part 2 Ivan talked through how he made his decision to have a total hip replacement (THR).
Preparing for surgery (Hint - Find a Buddy If You Can)
The date for my operation was set and I spent the preceding weeks preparing myself for what the immediate days after the operation would be like and also thinking through what my rehab plan would be like.
It is very personal choice as to how much information you want to know about any operation. For me though, I thought since I was going to have a new body part to keep me company hopefully for the rest of my life, I should find out at least what it was going to be. A visit to Professor Haddad’s clinic for my pre-assessment provided all the information I needed.
The femoral head (the round top of the hip bone) was to be cut off, shaving off the cartilage inside the socket. A titanium shell would then be placed into the socket and a titanium stem would be fitted inside my thigh bone. Finally, a plastic liner would be placed inside the socket, like a washer, and a ceramic head fitted on the femoral component. The stem in my femur would have special coating that would create a “biologic” fixation between my femur bone and the implant, which would prevent weakening of the bone in my femur around the stem. It all seemed very high tech and I was impressed by the apparent strength and robustness of the materials.
The other really helpful thing I did, again more through chance than real planned intention was that I found myself a ‘THR buddy’. I learnt at a work seminar that an old colleague of mine had only just been through a THR six months previously. Although ten years older than me he was a wonderful source of encouragement and advice in the weeks that led up to the operation on what to expect, what to take to hospital and what the immediate days afterwards would be like.
Finally, symptomatic with my nature and character I could not help myself writing down with the help of Sarah Lawson and Nick Smith a rehab plan (see the chart below). Maybe this sort of level of detail is not for everyone but having milestones and targets certainly helped me on the road to recovery post-op. They talked through the restrictions that I would need to adhere to to start with while my new joint settled down post-op, returning to a normal daily routine, taking up gentle sports and finally getting back to impact loading sports.
The Operation and Rehab Journey (Hint - prepare for small steps)
The details of the operation are beyond the scope of this article save for saying that I was unlucky to have some form of psycho-symptomatic shutdown of the muscles in my operative leg which slowed me to getting back on my feet in the hours and days following the surgery. It was also shocking to be on crutches and having to relearn to walk but the physios at Physio Remedies were absolutely brilliant. Nick Smith ‘absorbed’ my frustration at literally not being able to run before I could walk. Throughout the early part of 2017 he gradually guided me and supported me along my rehab journey from taking baby steps without the crutches, to isometric and proprioception exercises in their gym, to strengthening exercises using the multi-gym, to more advanced intensive work to rebuild the muscle bulk that I had lost as a result of the operation.
I will always remember that one day when my ‘Trendelenburg gait’ (an abnormal gait caused by post-operative weakness of the abductor muscles of the lower limb, gluteus medius and gluteus minimus) had disappeared and Nick saying to me in his broad Yorkshire accent “look at that Ivan, you have got your swagger back”. I certainly had.
Today’s Update (Hint - take the risk – millions have and will continue to do so)
As I conclude, the discomfort, pain and anxiety of those pre-op days are but a faint memory. So too are the nine months of rehabilitation. I can’t even imagine how I would be today if I had not taken the leap of faith to get on with it. I completed my first sprint triathlon on the 17th of September 2017, nine months after the surgery.
Since the operation I have kited in Mauritius, windsurfed in Maui, Hawaii, skied in Kitzbuhel, Austria and returned to a life of sport. The guys at Physio Remedies have recommended that I don’t ever run a marathon again – there are THR patients that unbelievably do as well as even ultra-marathons and IronMan triathlons – but I am ok with that.
Sprint Triathlon Nine Months After Total Hip Replacement Surgery, September 2017.
It is easy, having ‘come out of the other side’, to say this but the benefits far out weigh the risks of an operative nature.
My top five tips to aid a successful total hip replacement are:
Get the best advice.
Consult and work as early as possible with Phyisos who are deeply experienced with THR rehabilitation such as Physio Remedies.
Research as much or little as you need about the operation.
Find a THR buddy.
Set some goals to help you on the road to recovery.
Finally, with the recent arrival of my first child, Molly, it has become apparent that I made the right decision to have the THR early. As she grows up, although there is always a chance in ten to fifteen years’ time that I will need a revision to the THR, I can guarantee you that she will never know how the early onset of hip arthritis nearly killed me but I really have lived to die another day.
Ivan with Molly on the kite surfing beach at Hayling Island August 2018.
Words and images by Ivan. Ivan runs an IT professional services company, Snell Consultancy, and he can be contacted at www.ivansnell.com.
If you’re experiencing hip pain call us on 02030 12 12 22 to book an appointment with one of our hip specialists: Paul Martin or Alex Manos.
Injury Of The Month: Football Injuries
Injury Of The Month: Football Injuries
The football season is now well and truly under way both at professional and also amateur level so we've asked our physiotherapist Alex Manos, who specialises in the lower limb and hip & groin and used to be the First Team Physio for Crystal Palace FC, to give us the guided tour of common football injuries and how to avoid them:
Football Injuries
Having worked in professional football for most of my career, the injuries I see there are no different to the injuries seen at the local football pitch on a Sunday morning. So here is some information on common injures seen and advice on how to ensure the best possible recovery and reduce the risk of re injury.
Preparation
Even at amateur or weekend warrior level, it is still important to prepare as well as possible. A good level of prior conditioning, both strength and cardiovascular fitness wise, will reduce the risk of injury. Working on lower limb strength and stability and also increasing running endurance by using running drills or alternative forms of cardiovascular fitness such as the bike or circuit training will improve both performance and reduce the risk of injury.
Fitness for football
Football is a mixture of aerobic and anaerobic fitness as it can involve both short and long bursts of activity. If you are thinking of improving your fitness levels for football, training should replicate this. For example, you could do interval running session sessions on the treadmill or outside running.
For longer type runs, box to box runs are good where you run from the front edge 18 yd box to 18yd box and then very lightly jog to the goal line, turn and start the run again on the edge of the box. These would be at about 70-80%, 3-4 sets of 6-8 runs with a rest of 2-3 minutes in between sets is good.
For shorter drills then cone work which incorporates shuttle type runs or change of direction drills can be done. As the speed and intensity is higher, ensure a longer rest between runs and sets so you can work at maximum speed.
Circuits or what is commonly known as HIT (high intensity training) is a great way to work the entire body from a strength point of view and also gain cardiovascular benefits to give you a better engine during matches.
Focusing on lower limb stability exercises such lunges and squats will also help with fitness, power, speed and reducing injury risk.. A lot of force goes through the legs so having strong, balanced legs with good ability to safely change direction will help prevent injuries.
Common injuries
Muscular injuries are common as people often reach maximal sprint pace for prolonged distances and as there is kicking involved, it is an additional risk factor. Joint sprains in particular to the ankle and knee are also prevalent. Here are three common injuries:
- Hamstring tears – the hamstring is made up of three muscles at the back of the thigh. Hamstring injuries are very common in football. They typically occur when players are sprinting and when the hamstring is changing its function from shortening to lengthening. Players will report feeling a tearing or maybe even a popping sensation in the back of the thigh. This will lead to pain, reduced mobility and in moderate and severe cases there may be bruising and swelling.
These injuries need rehabilitation and won't just get better with rest. The muscle needs to be adequately strengthened for a safe return to sport. Mild strains can take as little as two weeks whereas severe tears could take up to three months if not more. Once you have had a hamstring tear the risk of re-injury is higher so it’s crucial to do the appropriate work to reduce the risk. A physio can help direct your rehab and ensure all the boxes are ticked. This would be a combination of flexibility and strength work and also then implementing some specific running drills. - Groin pain – groin pain is a very complex area but is very common in football. The complexity arises from the fact that there are many possible sources of groin pain in athletes and footballers. The hip joint, the pelvis, the lumbar spine, the muscles around the hip and groin and also the abdominal area can all be a source of injury and symptoms. Quite often there is also more than one pathology, or if not then the original injury can lead to other imbalances which then give rise to a secondary problem.
One of the most common misdiagnoses is one of repeated ‘groin strains’ as muscular injuries. Quite often these strains are not actually muscular and the pain originates from the hip joint. An accurate diagnosis is key to providing the right type of treatment to this area and with a thorough subjective history and detailed physical examination, a physiotherapist will be able to determine the problem areas. There may be times where physiotherapy alone is not enough and further intervention such as an injection or surgery may be required but the first thing to do is be properly assessed and referred on for further investigations or opinions if needed. Some groin injuries can become chronic and very difficult to get back from so the sooner they are dealt with the better. - Knee sprains – the knee is vulnerable to injury in football due to the nature of repetitive twisting and turning and contact. Two of the injuries which are seen are Anterior Cruciate Ligament and Medial Collateral Ligament injuries (ACL and MCL respectively). Both injuries can be a result of contact or non contact mechanism but will involve the knee being twisted beyond its normal range which causes ligament damage. ACL injuires usually require surgery whereas MCL injuries (unless very severe) are more often rehabilitated without surgery.
The recovery following ACL reconstruction is a minimum of six months but typically will be 9-12 months. Minor MCL injuries can recover in six weeks and more severe tears can take three to six months. These injuries require lots of rehabilitation to build the strength back around the knee and other joints. The ligaments provide stability to the knee so any disruption to this weakens the knee and it’s crucial to regain maximum strength and stability before returning to sport. A physiotherapist will guide you through the appropriate stages in rehab to try and return to your previous level of activity.
If you have picked up an injury related to football or want some advice on any of the above or anything else please feel free to call us on 02030 121222 to book in with one of our physiotherapists.
Words by Alex Manos.
Injury of the month: lower back pain
Lower Back Pain
Research studies show that over 80% of our population experiences lower back pain in their lifetime. In some people this can also be persistent or recurrent lower back pain.
What is lower back pain?
Lower back pain is pain is pain anywhere from the bottom of the rib cage to the buttock creases. Sometimes people with lower back pain may also feel pain in their legs and feet.
What causes the pain?
There can several structures contributing to lower back pain and these include the spinal joints, discs, nerves and the connective tissue such as the tendons/muscles and ligaments.
Why does it occur?
This depends on whether the lower back pain is a new episode, exacerbation, acute pain or persistent pain.
A diagnosis should always be established by your health professional, as causes can sometimes include infection, fracture, inflammatory conditions, malignancy or other systemic illnesses of the body.
However most commonly the cause will be related to sedentary lifestyles or incorrect training technique and posture.
How can physiotherapy help?
Your physiotherapist is specially trained to help diagnose your lower back and work with you to formulate the best treatment management plan for your recovery. Often this include hands on treatments such as mobilisations, massage, postural assessment, education on prevention and self-management at home and at work as well as prescribed exercises to assist you with pain reduction, increased mobility and strength.
If you'd like an appointment with either of our Spinal Specialists, Sarah and Paul, please call us on 02030 12 12 22.
Words by Shari Randall.