The emergency treatment of soccer injuries - part II

Part one available here.

Muscle cramp

Every soccer player has suffered a muscle cramp at some time or other. When muscle cramp occurs, the muscle tenses and contracts of its own accord, which results in a very unpleasant feeling. Muscle cramp is usually experienced at the end of a very tiring match or training session. Soccer players suffer most from cramp in the calf muscles. It is treated by active stretching(pointing the toes towards the nose as far as possible, and stretching the affected leg). Passive stretching by a teammate or a bystander must be carried out very carefully, to ensure that no tearing of the muscle fibers occurs. Another possibility is to grab hold of the muscle with one or both hands, and to stretch it diagonally while gently squeezing. Sporting activity must be resumed carefully, and must be stopped immediately if the cramp returns. Although this phenomenon is far from fully understood, there are a number of possible causes of muscle cramp:

• a slight muscle tear;
• excessive loss of fluid or salt;
• sudden cooling;
• disturbances of the blood circulation;
• lack of muscle fitness or general physical fitness.

Muscle cramp can best be treated by tensing the group of muscles whose action opposes that of the affected muscles. This causes a movement in the opposite direction(biceps/triceps, hamstring/quadriceps). Muscle cramp can be avoided by:

• maintaining a good level of physical fitness;
• wearing the correct(non-pinching) clothing;
• checking bandages, etc. during warming-up, to ensure that they do not pinch;
• drinking regularly if the weather is hot.

Torn muscles

There are all sorts of conceivable situations in which a player can tear a muscle. Usually an uncontrolled movement is the cause. A torn muscle often occurs immediately after the start of a match or a training session. This is usually attributable to insufficient warming-up. At the end of a match or an intensive training session, muscles are often tired and the players feel generally fatiqued. Common actions such as kicking, sprinting and jumping frequently cause a muscle to tear. Unlike muscle bruising, which is always the result of external violence, torn muscles have an internal cause. The symptoms of a torn muscle vary from:

• a relatively slight but often sharp, penetrating pain, especially when the affected muscle is stretched to the utmost;
• minor functional impairment and less strength, so that maximum performance is lower;
• slight swelling(in some cases);
• a certain degree of muscle contraction;
• the muscle feels hard(a sort of muscle cramp);
• the affected part of the muscle is tender to the touch;

to:

·         extreme pain, similar to a whiplash;

·         a snapping feeling, followed immediately by loss of function;

·         extravasation of blood;

·         swelling(fluid);

·         muscle contractions(spasms).

Torn muscles can vary in severity from a strain to a partial tear or a complete rupture. A torn muscle must first be given the RICE treatment. In more serious cases, a doctor must be consulted and physiotherapy is necessary. Torn muscles can be prevented by planning training sessions properly, by always carrying out warming-up routines, and by performing stretching exercises. Complete recovery is essential, because muscle tears can easily reappear at the same place. Local tenderness to the touch and stretching pains must disappear and the muscle must be restored to its initial strength  and size before sporting activities can be carried out again at maximal capacity.

Tendinitis

Tendinitis is an inflammation of the tendon and the surrounding tissue. Fluid associated with the inflammation penetrates between the tendon itself and sheath around it. Such inflammation usually occurs at a point where the tendon connects to a bone. Tendinitis can be regarded as a typical over-use injury. The major causes of tendonitis in sport are a too rapid increase in workload, repetitive one-sided movement, and repetitive one-sided work. In soccer, the tendons most frequently affected by this are the hamstring tendons, the patellar tendon and the Achilles tendon. The commonest cause of this latter injury is a hard or a very heavy pitch. Not only top sportsmen suffer from tendonitis – recreational players are also at risk. The term “over-use” is not very well understood. Players often do not know when the body’s limit has been reached, or what to do in such a case. A sportsman who finds it difficult to run on the morning after participating in his sport must take a breatk. Most people underestimate the problem, because the pain disappears after the first few strides. Many sportsmen continue to participate in their sport when they are in this condition. In doing so, they are risking a chronic over-use injury, which is often very difficult to overcome. Any sportsman who is in pain while participating in his sport, or feels pain when at rest, should consult a doctor. A painful tendon can be helped by placing a piece of foam rubber in the heel of the shoe. Thick socks and a soft insole can help, too. It is advisable to wear shoes with a thick insole or a shock-absorbent heel. Sports shoes should be thrown away when they start to wear or lose shape. In addition, training sessions should preferably be held on a soft surface such as grass. The healing process can be stimulated by an ice massage of the affected area. Massaging and stretching the affected muscles also helps. When the discomfort has disappeared, the muscles must be strengthened to prevent any recurrence of the injury. Good physical fitness is, of course, a necessity.

Fractures

A bone may be fractured in one or more places, and may even be splintered at the site of the break. Fractures occur regularly in contact sports such as soccer. Fractures may be closed or open. If the skin at the fracture site is intact, then the fracture is said to be closed(or simple). An open fracture involves not only a broken bone, but also an open wound. This means that the site of the fracture is exposed to the air. Sometimes a piece of bone may project from the wound. The most common symptoms of a fracture are:

• extreme pain;
• in many cases the bone or part of the body assumes an abnormal position;
• absolute inability to move or take any strain on the bone;
• swelling due to bleeding(closed fracture), or visible loss of blood(open fracture);
• a feeling that something has been broken.

A fracture can resemble a bruise, strain or dislocation in all respects. It is sometimes very difficult to make the right diagnosis.

The symptoms may be so slight that a player carries on playing until the end of the game, even though he is later found to have a cracked bone. If there is the slightest suspicion of a fracture, therefore, it must be assumed that there is one. Playing on is out of the question. The injury must be immobilized, and the injured player must remain lying down if he is in great pain. The player must be transported to hospital under expert supervision. An open fracture must be covered with sterile gauze to prevent infection. X-rays must be taken at a hospital to determine whether the player has really suffered a fracture. Fractures can be avoided by general preventive measures such as maintaining a good level of physical fitness, wearing protective equipment such as shinguards, and fair play.

Cartilage injuries

Soccer players regularly have problems with damage to the cartilage in the joints, with zones of irritation or wear being formed on the cartilage. Such injuries usually occur behind the kneecap and the bottom of the femur. This pressure can be caused by unsuitable footwear, excessively strenuous conditioning, or insufficient muscle strength(through lack of fitness or during the growth phase). A cartilage injury is accompanied by symptoms such as pain around and/or long period with bent knees also gives rise to such complaints. Periods of more or less pain alternate. One way of preventing cartilage injuries is to cut down on the movements that cause the injury. Conditioning programs must be specially  adapted for soccer players that have cartilage problems, as should their footwear. Drills that increase the strength of the muscles of the upper leg are crucial to the treatment of these problems.

Meniscus injuries

If the body turns and the lower leg is blocked, the lateral of medial meniscus may be jammed. This often happens in soccer, and fortunately there are usually no ill effects. Sometimes, however, the applied forces are so great that the meniscus tears. Detectable symptoms are:

• acute pain on the medial or lateral side of the knee;
• bending and stretching are only possible to a limited extent(sometimes the whole knee is locked);
• the knee swells rapidly;
• the pain extends to the back of the knee and/or the front of the knee;
• within a few weeks the upper leg becomes thinner.

The meniscus can also suffer chronic damage by being continuously jammed during rapid turns and changes of direction, and again a tear may occur. Here, too, there are also a number of characteristic programs:

• slowly worsening complaints;
• pain in the knee;
• slight restriction of bending and stretching;
• pain extends to the back of the knee or to the front, when a full bend or stretch is made;
• slight swelling of the knee.

Such patterns of complaints are indicative of meniscus damage. The player should consult a doctor, to prevent any further damage to ligaments and/or cartilage. An exploratory operation of radiograph enables a diagnosis to be made and, in most cases, the necessary treatment can also be carried out.

Various injuries

A fresh bruise under the nail must be pricked with a drill or the hot end of a paper clip. The blood must then be drawn off, the wound treated with iodine, and a pressure bandage applied with tape or bandaid. Otherwise the nail will be lost due to the extravasation of blood. A blood blister under the skin or under a callous layer must be treated very carefully to avoid any infection. If necessary(for example, if an awkwardly situated blister is causing pain), a blister must be opened, emptied and disinfected. A broken collarbone is almost always clearly visisble on an X-ray. Naturally the player must go to hospital for examination and treatment. There is danger that the top of the lung may be pricked. Players who suffer eye injuries and/or a possible fracture of the orbit or cheekbone must always go to hospital for examination and treatment. It is possible to recover quickly from such injuries. During the preparations for the European Championship in 1988, Marco van Basten arrived from Italy with a fractured cheekbone on the Friday, underwent an operation, and took part in training session on the following Wednesday. He scored his first goal in a practice match on Friday, just two days later.

“Conditioning for soccer ”  Raymond Verheijen